Hysteroscopy – why it’s essential before IVF

Hysteroscopy – why it’s essential before IVF

 

A hysteroscopy before IVF treatment is a must. It won’t always be recommended, but have one anyway. A hysteroscopy is the best way to check your uterus is healthy and ready to carry a baby. It can spot things an ultrasound scan can’t.

So what happens during a hysteroscopy? First, you’ll be sedated or put under general anaesthesia. Then a narrow tube, with a telescope at the end, is passed through your vagina and cervix into your uterine cavity, which is sometimes filled with fluid or gas. The images are viewed on a screen and recorded.

The surgeon can then check for fibroids, polyps, scar tissue, septa and other malformations. These can usually be sorted out at the same time – i.e. your hysteroscopy changes from being diagnostic to operative.

A hysteroscopy is a straightforward, if invasive, procedure. For IVF patients, it’s really sensible to have one before treatment. Especially if you’ve had recurrent miscarriages or implantation issues. And don’t rely on an HSG. You’ve got to get up close and personal. For uterine analysis. hysteroscopy is the gold standard.

The importance of a hysteroscopy before IVF was identified in an early study of hysteroscopy and reproductive techniques. Out of 292 women who had failed IVF cycles, 25 per cent were found to have uterine problems. These were treated by operative hysteroscopy. Improved conception rates for this group ranged from 19 to 72 per cent.

But a larger study from 2015 into hysteroscopy and IVF found that a hysteroscopy before an IVF cycle didn’t improve live birth rates. And a 2019 study into recurrent implantation failure found that a pre-IVF hysteroscopy boosted implantation and pregnancy rates, but not live births.

So should IVF patients have a hysteroscopy or not? We can accept that a routine hysteroscopy before every IVF cycle is over-the-top. But no study is conclusive, and every patient is different. Your fertility clinic is best placed to advise because it provides personalised care.

For first-time IVF patients with clear, or suspected, past pregnancy problems, a hysteroscopy still seems sensible. We have seen problematic polyps and fibroids confirmed and successfully treated in hysteroscopies. Then, successful IVF cycles.

Side effects after a hysteroscopy are rare. Infections happen in less than 0.4 per cent of cases. And there’s a small chance of bleeding. More common side effects include a feeling of being bloated, and period-like cramping.

Your objective is to have a baby as soon as possible. Push for a hysteroscopy before you start your IVF treatment if you’ve had a past miscarriage or implantation issue. We did, a tiny polyp was removed, and we went on to have successful treatment.

15 Comments
  • Violet
    Posted at 22:50h, 26 July Reply

    Hi. We have unexplained infertility and 2 failed I’ve treatments. I have recently seen a doctor (abroad) for a second opinion and he told me I should have a hysteroscopy. The NHS and Nuffield have never mentioned this to me in the past. I am due another round of ivf but this doctor told me it’s crazy to do it without a doing a hysteroscopy first.

    My question; how long did you have to wait on the NHS for a hysteroscopy? I too want to demand this!

    • Laura
      Posted at 08:41h, 29 July Reply

      I have had 3 failed IVF’s (2 fresh and one FET) before I have my 4th and final FET my hospital suggested a hysteroscopy. They said it may take 3-4 months on the NHS however I think I must have got a cancellation as I was only on the waiting list for a week. I have my hysteroscopy on Friday. Good luck.

  • Violet
    Posted at 22:50h, 26 July Reply

    Hi. We have unexplained infertility and 2 failed I’ve treatments. I have recently seen a doctor (abroad) for a second opinion and he told me I should have a hysteroscopy. The NHS and Nuffield have never mentioned this to me in the past. I am due another round of ivf but this doctor told me it’s crazy to do it without a doing a hysteroscopy first.

    My question; how long did you have to wait on the NHS for a hysteroscopy? I too want to demand this!

    • Laura
      Posted at 08:41h, 29 July Reply

      I have had 3 failed IVF’s (2 fresh and one FET) before I have my 4th and final FET my hospital suggested a hysteroscopy. They said it may take 3-4 months on the NHS however I think I must have got a cancellation as I was only on the waiting list for a week. I have my hysteroscopy on Friday. Good luck.

  • Joan
    Posted at 20:39h, 20 October Reply

    Hi I have had 2 failed Ivf and my doctor couldn’t explain why because My uterine lining looked so fine in size, position and whatever. My FET was first grade. Long story short…It was a BFN twice. My Obs suggested I do a hysteroscopy to increase my chances. I was mad at not having done that operation first before I spent all my dime on 2 failed cycles. Do I have to cough another $2000 for the hysteroscopy. However I want to be optimistic that results will be worth the two times miss….xoxoxo

  • Joan
    Posted at 20:39h, 20 October Reply

    Hi I have had 2 failed Ivf and my doctor couldn’t explain why because My uterine lining looked so fine in size, position and whatever. My FET was first grade. Long story short…It was a BFN twice. My Obs suggested I do a hysteroscopy to increase my chances. I was mad at not having done that operation first before I spent all my dime on 2 failed cycles. Do I have to cough another $2000 for the hysteroscopy. However I want to be optimistic that results will be worth the two times miss….xoxoxo

  • Zoe
    Posted at 08:51h, 06 January Reply

    Hi I have had 3 failed Ivf’s I keep having miscarriages. I have only now just been told about hysteroscopy. I’m hoping to get booked in for this to get some results. Has anybody had this operation and had a successful Ivf after also how long after the opp can u have any round of Ivf xx

  • Zoe
    Posted at 08:51h, 06 January Reply

    Hi I have had 3 failed Ivf’s I keep having miscarriages. I have only now just been told about hysteroscopy. I’m hoping to get booked in for this to get some results. Has anybody had this operation and had a successful Ivf after also how long after the opp can u have any round of Ivf xx

  • Djr4399
    Posted at 05:54h, 23 February Reply

    Hi guys.
    Been ttc for 5yrs. Finally i decided to join a fertility clinic. Did an HSG to make sure my tubes are cleared, however my uterus was unclear so I was scheduled an Saline Sonogram right after. That’s when they found several polyps & a thick lining of my uterus. 2 weeks later (yesterday) I did my Hysterocopy/D&C… & clean out everything. It went pretty well. I was asleep the whole time. Bad cramps after I woke up but pain med fixed that right away.
    Waiting on my follow up at my clinic for the next step.
    My question is… Do i try on my own for my BFP or I go straight for the IVF?
    & How long is the wait time for the 2nd IVF if the 1st failed?
    Thank you.

    Ps. I’ve never been pregnant b4.
    Hubby also went for semen analysis.

  • Djr4399
    Posted at 05:54h, 23 February Reply

    Hi guys.
    Been ttc for 5yrs. Finally i decided to join a fertility clinic. Did an HSG to make sure my tubes are cleared, however my uterus was unclear so I was scheduled an Saline Sonogram right after. That’s when they found several polyps & a thick lining of my uterus. 2 weeks later (yesterday) I did my Hysterocopy/D&C… & clean out everything. It went pretty well. I was asleep the whole time. Bad cramps after I woke up but pain med fixed that right away.
    Waiting on my follow up at my clinic for the next step.
    My question is… Do i try on my own for my BFP or I go straight for the IVF?
    & How long is the wait time for the 2nd IVF if the 1st failed?
    Thank you.

    Ps. I’ve never been pregnant b4.
    Hubby also went for semen analysis.

    • CALIFONIA
      Posted at 02:36h, 02 April Reply

      Whichever way you’re choosing, give at least 6 months gap before trying for baby.
      After failed IVF, one could wait for 6 months or one year so that the body would recover from those hormonal injection and the womb will be calm enough from the stress of thickening.
      Even the ovaries will be calm from the stimulation it went through. Trying natural isn’t bad, but wait at least 6 months. Baby dust to you!!!!!

  • TTC sunshine
    Posted at 12:42h, 10 April Reply

    Hi,
    We had similar case. Failed attempts of IVF and an FET. Now the Dr suggests hysteroscopy. I have heard, hysteroscopy does improve the chances of getting positive results. Any idea on which day of cycle it has to be done or one has a liberty to do it at any day once the M.cycle stops.

  • TTC sunshine
    Posted at 12:42h, 10 April Reply

    Hi,
    We had similar case. Failed attempts of IVF and an FET. Now the Dr suggests hysteroscopy. I have heard, hysteroscopy does improve the chances of getting positive results. Any idea on which day of cycle it has to be done or one has a liberty to do it at any day once the M.cycle stops.

    • CALIFONIA
      Posted at 02:29h, 02 April Reply

      It’s normally done after menstruation. After period the lining of the uterus won’t be thicken and it will be easy for free Access to the uterus.
      Some doctors does hysteroscopy before ovulation, that’s a week after period.

  • Cristina Williams
    Posted at 11:54h, 01 May Reply

    Hi, I’ve had four babies in my twenties and now I’m 41 and remarried to an amazing man so we’d like to have our own. We had one IVF cycle that didn’t produce viable embryos after PGS testing, and so we are about to try again.

    It was suggested that I have a Hysteroscopy after a possible fibroid was observed on my HSG. My question is, how long after the hysteriscopy will I have to wait before being able to do the next IVF cycle? There is so much mixed info out there… I don’t want to wait 6 months before starting. At my age I can’t afford to!

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