Hysteroscopy
A hysteroscopy is a look inside the uterus with a camera about as thick as a drinking straw. It goes in through the vagina and cervix, so there is no cut on the skin. Saline gently opens the cavity, and the image on the screen shows the endometrium, the lining where an embryo implants.
Many hysteroscopies do more than look. Fine instruments pass down the same scope to remove polyps, shave away fibroids that bulge into the cavity, divide a septum or cut scar tissue. Often the whole thing is done as an outpatient, and people are home the same afternoon.
Its real strength is treatment. When a polyp, fibroid, septum or scar tissue is sitting in the cavity, removing it gives an embryo a smooth, healthy surface to implant on, and that can make a real difference. Large trials show that a routine look adds nothing when the cavity is already normal, so a good scan comes first and tells you whether you are someone who will benefit.
At a glance
- Also known as
- Diagnostic hysteroscopy, operative hysteroscopy, outpatient hysteroscopy, polypectomy, hysteroscopic myomectomy, septum resection, adhesiolysis
- Appointment time
- 5–15 minutes to look; 20–60 minutes to treat
- Anaesthesia
- None or local for a look; sedation or general for most treatment
- Time in clinic
- Outpatient or day case
- Back to normal
- Same day to 2 days
- Whole process
- About a week; 1–3 months before an embryo transfer after larger work
- Scar
- None on the skin; the camera goes in through the cervix
- Typical cost
- $1,000–$3,000 diagnostic in clinic; $3,000–$8,000 operative in theatre (United States, self-pay)
- Usually preceded by
- Fertility Testing
Figures reviewed .
On this page
Who it’s for
The clearest candidates have something already seen or suspected on a scan. That might be a polyp, a fibroid that pushes into the cavity, a suspected septum, or a lining that looks thin and patchy after a previous operation or infection. Irregular bleeding between periods is another reason, because polyps are a common cause.
The other group is people whose embryo transfers have not implanted. After two or three good-quality embryos have gone back without a pregnancy, you want answers rather than another blind attempt, and a hysteroscopy is the sensible next step to find anything the scans missed. Scarring after a miscarriage procedure, known as Asherman's syndrome, is one of the things it finds.
If your scans and tubal patency test show a normal cavity and you are about to start a first IVF cycle, you can usually go straight ahead without one. Larger fibroids in the wall of the uterus belong to a myomectomy rather than a hysteroscopy.
Before you book
Ask your doctor what they expect to find and what they will do about it if they do. Going in with a clear purpose means you walk out knowing exactly what was done and why.
How it’s done
Most hysteroscopies are booked just after a period, when the lining is thin and the view is clearest. For a diagnostic look you lie as you would for a smear. The surgeon passes the scope through the cervix, saline fills the cavity, and they look at the walls, the top of the uterus and the openings of both tubes.
Operative work is done through the same scope. Polyps are snipped or shaved off. Fibroids that sit mostly inside the cavity are shaved away layer by layer, which is called a hysteroscopic myomectomy. A septum, a band of tissue dividing the cavity, is cut until the two halves become one. Adhesions are divided carefully to reopen the space.
Small jobs are often done in the outpatient clinic with no anaesthetic or a local block. Larger fibroids, a septum and severe scarring usually go to theatre under sedation or a short general anaesthetic. Anything removed is sent to the laboratory.
After septum or adhesion surgery, some surgeons place a small balloon or prescribe oestrogen for a few weeks to help the lining regrow. A second look a month or two later checks that the cavity has stayed open.
At the consultation
Ask whether anything found on the day will be treated in the same sitting, and what anaesthetic that would need. Agreeing it in advance means one procedure instead of two.
After hysteroscopy
For most people a hysteroscopy feels like a strong period cramp that settles within a few hours. Spotting or a watery pink discharge is normal for several days. Painkillers you would take for a period are usually enough, and most people are back at a desk the next day.
After theatre work under sedation or a general anaesthetic, plan a quiet day at home. Avoid sex, swimming and tampons until the bleeding stops, which keeps infection out of a healing cavity.
The wait before your next transfer is the part people often do not expect, and it is easier to bear once you know it is the lining doing its healing. After a simple polyp, the next IVF transfer can often go ahead after one period. After a septum, a fibroid or adhesions, the lining needs one to three months to heal properly.
| Before | Scan or HyCoSy shows something in the cavity. The hysteroscopy is booked just after a period. |
|---|---|
| Day 0 | Outpatient look or day-case procedure. Cramping for a few hours, home the same day. |
| Days 1–3 | Spotting and mild cramps. Back to desk work for most people. |
| Weeks 1–2 | Bleeding stops. Sex, swimming and exercise back on. Laboratory results on anything removed. |
| Weeks 4–8 | Second-look hysteroscopy after septum or adhesion surgery, where the surgeon advises it. |
| 1–3 months | Green light for an embryo transfer or trying again, once the lining has healed. |
In the first week
Keep a period-style pad and painkillers ready at home before you go. Having both ready makes the first evening feel routine rather than a worry.
Hysteroscopy scars
There is no scar on the skin. The scope goes in through the cervix, so nothing is cut on the outside and there is nothing to see afterwards.
What matters is the inside of the uterus, and that is where a careful surgeon makes the difference. Taking only what needs to come out, and protecting the healthy lining around it, helps the cavity heal smoothly.
Risks and complications
Hysteroscopy is one of the safest procedures in fertility surgery. Cramping and spotting are expected rather than risks. Infection is uncommon and treated with antibiotics. Feeling faint during an outpatient procedure happens occasionally and passes with a few minutes lying flat.
Perforation, where the scope or an instrument passes through the wall of the uterus, is uncommon on a diagnostic look and somewhat more likely during operative work. Most small perforations heal on their own. A few need a laparoscopy to check nothing else was touched.
The risk specific to fertility is new scar tissue inside the cavity. It is most likely after treating adhesions or large fibroids, and less likely after polyps. That is the reason for oestrogen, a balloon or a second look after the bigger operations. Fluid overload during long operative procedures is rare, and theatre teams measure fluid closely to prevent it.
Hysteroscopy results
A good result is a normal-shaped cavity with a healthy lining, confirmed on a follow-up scan. Polyp removal is simple and nearly always complete. Fibroids that sit mostly inside the cavity can usually be cleared in one sitting, while larger ones sometimes need a second.
For fertility, the gain depends on what was found. Removing a polyp or a fibroid distorting the cavity, or dividing a septum, gives an embryo a proper surface to implant on. Mild adhesions respond very well. Severe Asherman's syndrome can need more than one operation, and the lining may never fully regain its thickness.
Where nothing was found, you still come away with something real: certainty that the cavity is normal, and a clinic that can put its attention where it will count.
Alternatives to hysteroscopy
A HyCoSy or a saline scan answers many of the questions a diagnostic hysteroscopy would, without a camera. That is why I would usually want one of those first. A hysteroscopy then becomes the treatment step rather than the search.
For fibroids, size and position decide the route. If most of the fibroid sits inside the cavity, a hysteroscopy is the gentler way. Larger fibroids, or ones deep in the muscle wall, go to an open or laparoscopic myomectomy. Polyps are sometimes watched rather than removed, though before IVF most clinics prefer them gone.
Myomectomy
A myomectomy removes fibroids while leaving the uterus in place, either from inside through the cervix, by keyhole surgery or through an open incision. For fertility, the fibroids that matter are those inside or pressing on the cavity.
Best for: women with fibroids distorting the uterine cavity who want to conceive, or whose fibroids cause heavy bleeding or pressure
Combining hysteroscopy with other treatment
Hysteroscopy is often combined with a laparoscopy under the same anaesthetic, so the inside and outside of the uterus and the tubes are checked in one sitting. It also sits naturally before an IVF cycle or a frozen embryo transfer. Many clinics time the procedure to allow embryos already in storage to go back once the lining is ready.
Hysteroscopy cost
The quote varies most with where it is done. An outpatient diagnostic look in a clinic room costs a fraction of an operative procedure in theatre with an anaesthetist and a day-case bed. Ask which setting the price assumes, and what changes if they find something to treat on the day.
Laboratory analysis of removed tissue, a second-look procedure and any balloon or hormone treatment are sometimes billed separately. I would ask for those to be listed before you agree.
In Bangkok, many of the larger hospitals and fertility centres offer hysteroscopy as a straightforward day case at well below US prices. It also fits well into a visit for a frozen embryo transfer.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Facility and anaesthesia fees can double a surgeon-only quote | $1,000–$3,000 diagnostic in clinic; $3,000–$8,000 operative in theatre | Often covered for abnormal bleeding or a lesion seen on a scan, even where fertility treatment is not |
| United Kingdom Outpatient services are common and quick to book privately | £800–£1,500 diagnostic; £1,800–£4,000 operative | Available on the NHS for abnormal bleeding and suspected lesions; routine pre-IVF use varies |
| Europe Outpatient diagnostic look at the lower end | €600–€2,500 | Commonly covered by state systems where clinically indicated |
| Thailand Day-case packages are common; ask whether anaesthesia and pathology are included | $800–$3,000 | Self-pay for international patients |
Read more: Fertility Surgery
Choosing a clinic for hysteroscopy
Hysteroscopy is routine for any gynaecologist. What you are choosing is someone who does operative hysteroscopy often, and who thinks about fertility. Ask how many septum or adhesion procedures they do a year, and how they protect the healthy lining during treatment.
Ask whether they can treat what they find in the same sitting, and whether outpatient treatment is available for smaller jobs. For anything more involved, ask whether a follow-up look is part of their plan.
The question that reveals the most is how they decide what to remove. A surgeon who can explain why they would leave something alone, as well as what they would take out, is thinking about the lining rather than the procedure.
After the procedure
Ask for the report and the photos from the camera to be sent to your fertility clinic. They give your clinic a clear picture of the cavity when planning the next transfer.
Frequently asked questions
Does a hysteroscopy hurt?
A diagnostic look feels like a strong period cramp for a few minutes. Treatment in theatre is done under sedation or general anaesthetic. See recovery.
Should everyone have a hysteroscopy before IVF?
Not routinely. When a scan shows a normal cavity, large trials found no added benefit. It earns its place when there is something to treat. See who it's for.
How soon can I have an embryo transfer afterwards?
Often after one period for a polyp, one to three months for a septum, fibroid or adhesions. See recovery.
Can it remove fibroids?
Ones that sit mostly inside the cavity, yes. Larger fibroids or those deep in the wall need a myomectomy. See alternatives.
Will I need a second hysteroscopy?
Sometimes after septum or adhesion surgery, to check the cavity has stayed open. See how it's done.