Dr. Grace Couchman

Couchman - NEWDiagnostic hysteroscopy is considered the “gold standard” for evaluation of the inside of the uterus, also called the uterine cavity. The uterine cavity is the triangular-shaped inside of the uterus where an embryo will hopefully implant. Diagnostic hysteroscopy means that we are observing the shape of the uterus but operative hysteroscopy means that an abnormality is being corrected.

There are 3 main ways that infertility doctors look at the inside of the uterus. These are: HSG (Hysterogalpingogram), saline ultrasonography and hysteroscopy. HSG uses radiographic dye and X-ray technology, saline ultrasonography uses saline (salt water) and ultrasound but hysteroscopy is the only procedure in which your doctor can look up close and personal with a camera at your uterine lining when you are sedated and your uterus is relaxed.

We primarily use hysteroscopy for evaluation of infertility, recurrent miscarriage or abnormal uterine bleeding. The doctors at Carolina Conceptions perform hysteroscopies under IV sedation at Blue Ridge Surgical Center across from Rex hospital. The procedure is performed through the vagina and begins with the insertion of a speculum. The opening of the cervix is dilated (stretched) to allow entry of a very thin camera/telescope called the hysteroscope. The hysteroscope is gently guided along the cervical canal into the uterine cavity. Saline (salt water) flows through the hysteroscopy and expands the uterine cavity so that we can see anything that may be abnormal such as endometrial polyps (small benign growths), adhesions (scar tissue), fibroids (growths from the muscle of the uterus) or septum (division of the uterine cavity that you were born with).

Small operative instruments can be inserted through an operative channel of the hysteroscopy so that polyps and fibroids can be removed, adhesions lysed and septums resected with very small scissors. All of this is done through the vagina and cervix and does not require any abdominal incisions. You will quickly awaken from IV sedation and after a short stay in the recovery area, will go home that afternoon with over-the-counter pain medication or prescription narcotics.

When women have not been successful after 1-2 embryo transfers, a diagnostic hysteroscopy is often performed to see if there is anything about the uterine cavity that can be improved upon to increase the odds for a successful embryo implantation. Studies have shown that an initial HSG or saline sonogram can sometimes miss small findings that can be seen at hysteroscopy only. Due to the cost of hysteroscopy and small operative risks, such as possible perforation of the uterine cavity, it is not considered a first step in an infertility investigation.

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