Hysteroscopy is a small sometimes OPD or maximally a day care procedure done to thoroughly evaluate the inside of the uterus, cervix and vagina. Hysteroscopy is performed from the 12th to the 21st day of your cycle. When performed in the OPD it is called office hysteroscopy. Usually done as a day care procedure it is performed in the operation theatre. Short general anesthesia is given to the patient. A small camera lens fitted instrument is introduced starting from the introitus, which then evaluates the vagina, the cervix, all the uterine walls – anterior, posterior, left lateral and right lateral, the uterine fundus and both the ostial opening in the uterus and its position.

Normally, the uterine cavity should have good smooth contour and a late proliferative to secretory endometrium on the 12th to 21st day depending on the day of the cycle. If there is any focal lesion interfering with the cavity such as a fibroid or an adenomyotic area, it can be removed in the setting and definitely boosts fertility. Small uterine cavities can be iatrogenically increased in size, well enough to accommodate a baby. Since hysteroscopy is direct visualization of the inside of uterus by an expert, it is the gold standard diagnostic test for uterine wellbeing.

Post hysteroscopy, the endometrial sample can be curetted and be sent in for histopathological evaluation – that is a microscopic analysis of the tissue obtained to ensure everything is going good in the endometrium and in synchrony with the hormones that should be acting on it. Not only this some special tests such as DICE culture or uterine NK cells and plasma cell analysis can be done along with it to maximize productivity of the test. DICE culture tells us what is the good bacteria-bad bacteria status of our uterus. Uterine NK cells and plasma cells reflect the immunological status of the uterus and help predict the success of our IVF cycle.

In other words hysteroscopy is no more restricted to just visualization of the inside of the uterus. Endometrial cells obtained can tell us about the chronic endometritis inside, the kind of uterine receptivity present and the microbio-flora envoirment inside. It is one of the best available modalities for helping improve positive fertility outcomes.