What is hysteroscopy?
Hysteroscopy is a procedure that lets us see directly inside the uterine cavity using a thin lighted instrument called a hysteroscope. It's the most direct way to evaluate the uterus — better than ultrasound, better than HSG, and the only way to actually treat many intracavitary problems without abdominal surgery.
For couples with recurrent implantation failure, recurrent miscarriage, or unexplained infertility, hysteroscopy is often the diagnostic step that finally explains what's been going wrong — and the same procedure that fixes it.
Diagnostic vs operative
Diagnostic hysteroscopy
An outpatient procedure to look only. The scope enters through the cervix; saline expands the cavity for visualisation. Takes 10–15 minutes. Usually no anaesthesia. We see polyps, fibroids, septum, adhesions, or scarring — in real time.
Operative hysteroscopy
Performed in an operating theatre under sedation or short general anaesthesia, with same-day discharge. Allows removal of polyps, fibroids (submucous type), uterine septum, and adhesions through small instruments passed alongside the scope. No abdominal incision; recovery is fast.
When is it indicated?
- Recurrent implantation failure after IVF.
- Recurrent miscarriage — two or more pregnancy losses.
- Suspected endometrial polyps or submucous fibroids on ultrasound.
- Uterine septum — a congenital partial division of the uterus, treatable in one session.
- Asherman syndrome — intrauterine adhesions from prior surgery, infection, or D&C.
- Abnormal uterine bleeding — postmenopausal bleeding, intermenstrual bleeding, heavy periods.
- Retained products of conception after miscarriage or delivery.
- Pre-IVF cavity assessment when imaging is ambiguous, especially after a failed cycle.
How the procedure works
- Scheduling — usually in the early follicular phase of the cycle (days 6–10) for the clearest view of the cavity.
- Pre-procedure — routine pre-anaesthetic checks for operative cases; light meal restriction.
- Insertion — the hysteroscope (3–5 mm diameter for diagnostic, slightly larger for operative) is passed through the cervix into the uterus.
- Distension — saline fills the cavity to allow visualisation.
- Inspection — the cavity, both tubal openings, and the endometrium are evaluated systematically.
- Treatment if needed — polyps cut and removed, submucous fibroids resected, septum divided, adhesions released.
- Recovery — usually 1–2 hours in the day-care unit, then discharge.
What we can find and treat
Some of the most common findings:
- Endometrial polyps — soft growths in the lining; common cause of bleeding and implantation failure.
- Submucous fibroids — fibroids growing into the cavity; reduce implantation rates significantly.
- Uterine septum — a fibrous partition that often causes miscarriage; corrected in a single procedure.
- Asherman syndrome — adhesions that distort or close the cavity; treatable hysteroscopically.
- Chronic endometritis — suspected on biopsy taken during the procedure.
Recovery
Same-day discharge for almost all cases. Mild cramping for 24–48 hours, like a heavy menstrual day. Light spotting is normal for up to a week. Most patients return to desk-based work the next day. Sexual activity and exercise can resume after about a week.
Risks
Hysteroscopy is one of the safest procedures in gynaecology. Risks are low and include:
- Cervical or uterine perforation (rare, ~1%, usually self-limiting).
- Bleeding or infection (low risk with sterile technique and prophylactic antibiotics where indicated).
- Fluid overload from distension media in long operative cases (avoided with saline-based systems and timely procedure).
What it costs in Hyderabad
Diagnostic hysteroscopy: ₹10,000–₹20,000. Operative hysteroscopy: ₹30,000–₹60,000 depending on the specific procedure (polypectomy, myomectomy, septoplasty, adhesiolysis).
How I work
I have a low threshold for hysteroscopy when a patient has had a failed IVF cycle or a recurrent pregnancy loss without clear cause. Imaging often misses small polyps, mild adhesions, or chronic endometritis. Direct visualisation is the most reliable evaluation — and in many cases the treatment happens in the same session.
Wondering if hysteroscopy is the missing step?
For recurrent implantation failure or unexplained losses, it often is. Let's evaluate.
Book at KIMS Fertility (opens in a new tab)Frequently asked questions
The questions patients ask most often about hysteroscopy.
Is hysteroscopy painful?
Diagnostic hysteroscopy outpatient causes mild–moderate cramping for a few minutes, well-tolerated without anaesthesia. Operative is done under sedation or short general anaesthesia — no pain at the time. Mild cramping for 1–2 days afterwards.
Do I need anaesthesia?
Diagnostic (just looking) is typically done without anaesthesia in the outpatient clinic. Operative (removing polyps, fibroids, septum, adhesions) is under sedation or short general anaesthesia.
When is it indicated for fertility?
Recurrent implantation failure, recurrent miscarriage, suspicion of polyps/fibroids on ultrasound, septum or Asherman, pre-IVF assessment when imaging is ambiguous.
Can it improve IVF outcomes?
Yes when there's a treatable finding. Polyps, submucous fibroids, septum, adhesions all reduce IVF success; removing them through operative hysteroscopy substantially improves implantation.
What can be treated through hysteroscopy?
Most intracavitary uterine pathology: polyps, submucous fibroids, septum, Asherman adhesions, retained products of conception, lost IUDs. No abdominal incision needed.
How long is recovery?
Same-day discharge. Mild cramping and light spotting for 24–48 hours. Back to work next day for diagnostic, 2–3 days for operative. Sex after about a week.
Will it leave a scar?
No external scar — the scope goes through the cervix, no abdominal incision. Internal: modern operative techniques minimise endometrial trauma.
What does it cost in Hyderabad?
Diagnostic: ₹10,000–₹20,000. Operative: ₹30,000–₹60,000 depending on the specific procedure.