Diagnostic Hysteroscopy for Infertility

A great option as a first choice test

Many physicians will use as their first choice for uterine cavity evaluation, a diagnostic hysteroscopy for infertility. As long as the patient’s evaluation does not require evaluation of the fallopian tubes, than diagnostic hysteroscopy is an excellent choice. In addition, diagnostic hysteroscopy can be used as a backup when other tests are inadequate or uncertain.

Hysterosonogram – How it works

A hysterosonogram is a minimally invasive ultrasound procedure that can determine if there are abnormalities inside the uterus that might interfere with pregnancy. It is important to have an evaluation of the uterine cavity with a hysterosonogram or other method before proceeding with an IVF or FET cycle. This test involves no radiation, and there are very few risks from the procedure. Compared to a regular ultrasound, a hysterosonogram is better at detecting abnormalities on the inside walls of the uterus because it involves infusing saline inside of the uterus. This way, the walls of uterus separate from each other and any abnormalities that might have been hiding right along the sides of the walls will be easily identified.

Think of your uterus like a collapsed balloon. If there was a small growth or bump on the inside wall of the collapsed balloon, it might be hard to see since the top and bottom walls are touching each other. However, if we inflated the balloon, the small growth will be easier to see since it will likely be able to hang away from the wall.

In some cases, however, the images obtained with a hysterosonogram may not be optimal. Here are a few circumstances in which a hysterosonogram may be difficult to view:

  • The patient is overweight or obese
  • The position of the uterus does not give an adequate view
  • Inadequate separation of the walls of the uterus due to inadequate filling of saline
  • Uterine lining is too thick
Normal hysterosonogram
A high quality hysterosonogram image
Diagnostic hysteroscopy for questionable HSN
Diagnostic hysteroscopy for questionable HSN
Diagnostic hysteroscopy for poor quality HSN
Diagnostic hysteroscopy for poor quality HSN

Diagnostic hysteroscopy as a backup for saline ultrasound (hysterosonogram)

Occasionally, a hysterosonogram may identify small abnormalities that are not clinically important such as blood or clots in the uterine cavity, loose fragments of uterine lining or air bubbles. Using the hysterosonogram alone, the physician may not be able to say with certainty whether an abnormality is a significant problem or not.

In the event that visualization is poor or small abnormalities are seen which the physician suspects may not be important, he or she may elect to also perform a diagnostic hysteroscopy.

A hysteroscope is a small fiber optic telescope connected to a viewing monitor. The tip of the hysteroscope can be advanced into the uterine cavity to view the cavity directly. By using hysteroscopy as a backup for an inadequate hysterosonogram, we can make sure the uterine cavity is adequately assessed.