Hysteroscopy and fertility: When a Closer Look Inside the Uterus Helps

Hysteroscopy lets a clinician look inside the uterus using a narrow camera passed through the cervix. It may help investigate a suspected polyp, fibroid affecting the cavity or another uterine finding. It is not a routine extra that everyone having fertility investigations needs, and the reason for offering it should be clear.

Ask which finding needs a closer look

A clinician may recommend hysteroscopy after an ultrasound finding or symptoms that suggest a problem in the uterine cavity. Ask what is suspected and whether the procedure is intended to diagnose it, take a tissue sample or provide treatment.

The pelvic ultrasound guide explains what may already have been assessed. If a polyp is suspected, the uterine polyp guide offers questions about its possible relevance. Seeing or removing a finding does not guarantee that pregnancy will follow.

Discuss pain relief before the appointment

Hysteroscopy can be painful, and for some people the pain is severe. Tell the team about earlier painful examinations, fainting with pain or anything that may make the procedure difficult. Ask which pain relief and anaesthetic options are available before deciding how to proceed.

Some procedures are performed while you are awake in an outpatient clinic. Others use sedation or anaesthesia in a different setting. A referral to another service may be needed for a preferred option. Do not assume you must tolerate an awake procedure simply because that is the first appointment offered.

Confirm preparation and the scope of consent

Hysteroscopy should not be performed if you could be pregnant. Follow the service’s contraception or abstinence advice before the appointment and tell the team if pregnancy is possible. Preparation differs when sedation or anaesthesia is planned, including instructions about eating, drinking and getting home.

Ask whether a biopsy or treatment could be offered during the procedure and what you are agreeing to. You can ask for the examination to stop at any point. Agreeing a clear way to signal this before it begins can help, especially if speaking feels difficult when you are uncomfortable.

Know what happens afterward

Cramping and some spotting can occur. Follow the discharge instructions about pain relief, pads, activity and sex. Arrange an escort if sedation or general anaesthesia is used, and follow the service’s restrictions on driving and other activities afterward.

Complications include infection and, rarely, injury to the uterine wall. Seek urgent advice for fever, offensive discharge or severe abdominal pain after the procedure. Before leaving, confirm how any biopsy results will reach you and when the fertility team will discuss whether the findings change your care.