Infertility is a common gynecological concern and can be caused by a variety of factors. One of the key issues often identified is abnormalities within the uterine cavity, which can directly affect embryo implantation and successful pregnancy. Hysteroscopy is a medical procedure that allows physicians to accurately diagnose and treat such abnormalities, particularly in patients with a history of infertility.
Hysteroscopy is a minimally invasive technique that enables doctors to closely examine the interior of the uterine cavity using a small camera inserted through the vagina and cervix. This procedure allows for the detection and treatment of uterine conditions without the need for open abdominal surgery, making it especially valuable in reproductive medicine.
What is Hysteroscopy?
Hysteroscopy is a procedure that uses a small device called a hysteroscope—a thin tube equipped with a light and a video camera. The hysteroscope is inserted through the vagina into the uterine cavity without the need for open surgery. This allows the doctor to view the uterine cavity in real-time and diagnose or treat certain abnormalities during the same procedure.
Who is Hysteroscopy Suitable For?
Your doctor may recommend a hysteroscopy if you experience any of the following conditions:
1.Abnormal uterine bleeding, such as unusually heavy periods, spotting between cycles, or postmenopausal bleeding—even after hormone treatment.
2.Infertility or recurrent miscarriages, especially in those with a history of light or absent menstruation after a dilation and curettage (D&C), which may indicate intrauterine adhesions (Asherman’s syndrome).
3.Uterine abnormalities found during ultrasound, such as fibroids, polyps, adhesions, or a uterine septum (a wall dividing the uterine cavity).
4.Repeated IVF failures, where hysteroscopy can help identify hidden uterine issues.
5.Foreign body removal, such as a retained or embedded intrauterine device (IUD), broken IUD strings, or parts of an IUD that have penetrated the uterine wall.
Uterine Abnormalities Detectable by Hysteroscopy
Hysteroscopy can help detect several intrauterine abnormalities, including:
1.Intrauterine adhesions (Asherman’s syndrome) – often caused by previous uterine curettage (D&C) or infections.
2.Endometrial polyps – overgrowths of the endometrial lining that may interfere with embryo implantation.
3.Submucosal fibroids – uterine fibroids that protrude into the uterine cavity.
4.Congenital uterine anomalies, such as a septate uterus (a partition dividing the uterine cavity) or an arcuate uterus (a heart-shaped uterus).
These conditions can negatively impact embryo implantation or cause recurrent early miscarriages.
What Conditions Can Be Diagnosed with Hysteroscopy?
Hysteroscopy is a valuable diagnostic tool that allows doctors to directly visualize the uterine cavity, enabling accurate identification of various uterine abnormalities or conditions, such as:
1.Abnormal uterine bleeding – to determine the cause of heavy menstrual bleeding, intermenstrual spotting, or postmenopausal bleeding.
2.Unexplained infertility – to assess the uterine cavity for abnormalities that might interfere with embryo implantation.
3.Endometrial polyps – small growths inside the uterus that may lead to abnormal bleeding or infertility.
4.Submucosal fibroids (myomas) – hysteroscopy helps evaluate the size, location, and extent of fibroids that protrude into the uterine cavity.
5.Intrauterine adhesions (Asherman’s syndrome) – scar tissue that may develop after uterine surgery or infection and can negatively affect fertility.
6.Septate uterus – a congenital uterine anomaly where a fibrous wall divides the uterine cavity, often associated with recurrent miscarriages.
7.Abnormal endometrial thickening or suspected endometrial cancer – hysteroscopy allows for targeted biopsy of suspicious tissue for pathological analysis.
Contraindications for Hysteroscopy
Hysteroscopy is generally safe but should be avoided or used with caution in the following situations:
- Pregnancy – Hysteroscopy is strictly contraindicated as it may disrupt the pregnancy or lead to miscarriage.
- Pelvic or vaginal infections – Active infections, such as acute pelvic inflammatory disease (PID), can worsen or spread during the procedure.
- Unexplained abnormal uterine bleeding – The cause of bleeding should be thoroughly investigated before performing hysteroscopy.
- Advanced cervical cancer – The procedure may increase the risk of cancer cell dissemination.
- Severe endometritis – Active inflammation of the endometrial lining is a contraindication due to the risk of exacerbating the condition.
Hysteroscopy Procedure: Step-by-Step Diagnostic and Operative Approaches
Hysteroscopy can be performed in two main forms: diagnostic hysteroscopy and operative hysteroscopy. In some cases, both diagnosis and treatment can be performed in a single session—especially when the physician is confident there is an intrauterine abnormality that needs treatment.

1.Diagnostic Hysteroscopy this is a minimally invasive outpatient procedure that typically does not require hospitalization or general anesthesia. It causes little to no discomfort and is often compared to a routine pelvic exam or cervical cancer screening.
The procedure begins with thorough cleansing of the area using a sterile technique. A small hysteroscope, about 3–4 millimeters in diameter, is gently inserted through the cervix into the uterine cavity. The physician can then inspect the cavity for abnormalities such as polyps, fibroids, or adhesions.
The procedure usually takes 5–10 minutes. Afterward, the patient may experience mild cramping or a sensation similar to menstrual discomfort. A short observation period of 30 minutes to 1 hour is typically sufficient before being discharged home.
2.Operative Hysteroscopy (Hysteroscopic Surgery) operative hysteroscopy is performed when surgical removal of abnormalities is required, such as large polyps, submucosal fibroids, or intrauterine adhesions.
Most cases do not require hospital admission, except when
- The fibroid or lesion is large
- Surgery is prolonged
- There's a risk of heavy bleeding or fluid overload
Typically, patients are observed overnight. This procedure is done under general anesthesia in an operating room under strict sterile conditions. A slightly larger hysteroscope is used to accommodate surgical instruments for removing the abnormal tissue.
The surgery generally lasts no more than 1 hour, followed by 1–2 hours of recovery monitoring. If there are no complications, the patient can go home the same day and return for a follow-up in one week.
Benefits of Hysteroscopy
1.High diagnostic accuracy: Hysteroscopy allows direct visualization of the uterine cavity, enabling doctors to precisely identify the causes of abnormalities such as abnormal uterine bleeding or infertility.
2.Improves pregnancy success rates: Particularly beneficial for women undergoing assisted reproductive technologies like IVF or ICSI.
3.Diagnosis and treatment in one session: Polyps, fibroids, or adhesions can be removed during the same procedure, without the need for open abdominal surgery.
4.Short recovery time: Most patients can return home on the same day and resume normal activities shortly afterward.
5.Reduces the need for major surgery: In many cases, hysteroscopy can help avoid more invasive procedures like hysterectomy or open abdominal surgery.
6.Advanced technology: The use of high-definition 4K hysteroscopes allows for clearer, more detailed visualization of abnormalities, enhancing both diagnosis and treatment effectiveness.
 "See Clearly into the Uterine Cavity — Safe, Precise, and Scar-Free"
Hysteroscopy is a safe and effective procedure that provides detailed insights into the health of the uterine cavity. It is especially recommended for women experiencing abnormal uterine bleeding—such as heavy menstrual periods, bleeding between cycles, or postmenopausal bleeding—as well as those facing unexplained infertility or recurrent miscarriages.
If your doctor recommends this procedure, there’s no need to worry. Hysteroscopy is minimally painful, takes only a short time to perform, and allows for accurate diagnosis and treatment of uterine abnormalities—without the need for major surgery.
For those seeking more information or evaluation regarding uterine conditions, we recommend consulting with our expert gynecologists at Phyathai 2 Hospital. Our team of specialists is equipped with advanced medical technology and is committed to providing attentive, personalized care at every step—ensuring your safety and the best possible treatment outcomes.