What is a hysteroscopy?
Hysteroscopy is a minimally invasive procedure for diagnosing and correcting the condition of the uterus. During the procedure, the doctor inserts a hysteroscope (a lighted telescopic instrument with a camera at one end) into the vagina to examine the cervix and uterine cavity. A small instrument may be passed through the cervix to perform a biopsy or to remove detected uterine abnormalities. Hysteroscopy does not require an incision. Diagnostic hysteroscopy can take up to 30 minutes, but the hysteroscopy may take longer if your doctor needs to perform a procedure, such as removing a fibroid. Diagnostic hysteroscopy can often be performed comfortably and conveniently in a doctor's office, but more complex procedures are best performed in a hospital setting.

Who needs a hysteroscopy?

 An important part of the IVF process is an accurate assessment of the uterus. If there is a problem with the uterus, the best embryos from the best eggs and sperm will not implant into the pregnancy. This procedure allows a woman to fully understand the health and fertility of her reproductive system. Studies have shown that hysteroscopy revealed disease in the uterus in 38% of patients. Hysteroscopy effectively detects abnormalities in the uterus and increases the chances of IVF success.

 Use of hysteroscopy to determine female infertility
Hysteroscopy is often used by doctors to determine the cause of heavy or irregular bleeding, which may indicate problems with ovulation. Hysteroscopy diagnoses and treats several conditions that affect a woman's ability to conceive and become pregnant. Some possible uses of hysteroscopy are:

Assess and remove fibroids, polyps, or scar tissue.
The structure of the uterus is assessed and the uterine septum (the tissue that separates the uterine cavity) or other abnormalities are identified. Do a biopsy.
Common problems evaluated include detecting birth defects in women (such as fibroids), tumors or scar tissue inside the uterus, and chronic infections. Other problems that are more and less discovered during uterine evaluation include the presence of chronic infection, precancerous tissue, or inflammation due to endometriosis.

Diagnosis of uterine malformations
Polyps and fibromas are common causes of infertility. Polyps are abnormal growths of tissue that develop on the lining of the uterus (endometrium) and can be detected by hysteroscopy. Fibroids are benign muscular growths in the uterine wall and can also be diagnosed with a cervical biopsy. After detecting any condition, the doctor removes the tissue through hysteroscopy. Fertility treatments, including IVF, are often more successful because they make the uterus more susceptible to implantation. Hysteroscopy can also determine if a woman has an abnormally shaped uterus or diaphragm. Both conditions can prevent a woman from getting pregnant or going to term. It can be corrected surgically.

Diagnosis of chronic infection
A guided biopsy of the cervix is ​​an effective method of diagnosing chronic infections that affect a woman's fertility. Chronic infections occur in about 15% of FIV patients. And in patients with repeated implantation failures after IVF, about 42% of patients have chronic infections. Studies have shown that after chronic infection is treated, pregnancy after IVF treatment doubles.

Diagnosis of endometriosis
It is estimated that 1 in 10 women have endometriosis and almost half of the patients with unexplained infertility have endometriosis. Endometriosis can cause inflammation of the lining of the uterus and cause the implant to fail.

Doctors can diagnose endometriosis by examining endometrial tissue taken via a hysteroscopy-guided biopsy for certain markers. In one study, 88% of patients with unexplained infertility tested positive for the endometriosis marker BCL-6. Women with this marker had an IVF pregnancy rate of only 17.3%, compared to 64.7% of women without the same marker. The same study found that treating endometriosis before embryo transfer may increase implantation and pregnancy rates.

Endometrial sampling for the endometriosis marker BCL-6 to improve IVF success is a less invasive and more accurate method for diagnosing endometriosis than other invasive surgical procedures such as laparoscopy. 

How does hysteroscopy compare to other procedures?
Hysteroscopy is the gold standard for assessing uterine health. It is more accurate for identifying and diagnosing many conditions affecting infertility than other methods. Ultrasound hysterography, often considered an alternative to hysterosalpingography (HSG) and hysteroscopy, often referred to as saline infusion ultrasound (SIS), is less accurate in diagnosing some conditions. HSG testing is limited in the amount of information it can provide about a woman's reproductive health. The HSG test uses an injected dye and x-ray technology to examine the uterine cavity and the connection between the fallopian tubes and the uterus. However, the HSG test cannot assess the entire length of the fallopian tube (the tube that connects the ovaries to the uterus), thus limiting the diagnosis of fallopian tube disorders to certain conditions and blockages.

Although HSG tests can effectively diagnose major birth defects and tumors, they cannot often be used to diagnose small tumors or uterine scars. In ARMS, an HSG test and hysteroscopy are often performed before treatment begins.

During an SIS exam, your provider injects a saline solution into your uterus during the ultrasound to check for endometrial scarring, polyps, or changes in thickness. Although SIS can effectively diagnose birth defects and uterine tumors, it is less effective than hysteroscopy for other findings.