The uterus is where an embryo has to implant and grow. And yet, for a long time in fertility medicine, we were essentially guessing about what was going on in there — relying on ultrasound images that sometimes miss things entirely.
Hysteroscopy changed that. It lets us look directly inside the uterine cavity with a tiny camera, in real time, with far more detail than any scan.
I use it regularly at Punit Fertility — and it changes the management plan for a significant number of patients.
A thin, flexible telescope (hysteroscope) is passed gently through the cervix into the uterine cavity. No cuts. No stitches. The uterus is distended slightly with saline to get a clear view, and we can see the entire inner surface of the uterus — the lining, the corners where the tubes enter, any abnormalities.
Diagnostic hysteroscopy (just looking) can be done without general anaesthesia in most cases — it takes about 10–15 minutes. Operative hysteroscopy (treating what we find) is done under light sedation or anaesthesia.
Small, finger-like outgrowths of the uterine lining. They’re extremely common and often symptomless — yet they significantly impair implantation. Removal via hysteroscopy is simple, quick, and has been shown to improve IVF success rates.
Fibroids that protrude into the cavity distort the uterine shape and make implantation difficult. Hysteroscopic removal restores the normal cavity.
Scar tissue inside the uterus — usually following a D&C or infection — that can partially or completely obliterate the cavity. Hysteroscopic adhesiolysis (cutting the adhesions) can restore a functional cavity. This is delicate surgery requiring experience.
A partition dividing the uterine cavity — a developmental abnormality. Associated with recurrent miscarriage. Easily removed hysteroscopically with excellent outcomes.
Diagnostic hysteroscopy: most women return to normal activity the same day or next. Some mild cramping and spotting for 1–2 days.
Operative hysteroscopy: typically 1–3 days rest, minimal discomfort. Fertility treatment can usually resume the following cycle.
At Punit Fertility, Kandivali Mumbai, we believe in checking the uterine cavity before any fertility treatment — because even the best embryo won’t implant in a hostile environment.
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