Three Key Considerations for Hysteroscopy: Cost, Procedure, and Aftereffects

Hysteroscopy (HSC) is a minimally invasive procedure using a small endoscope to inspect the uterus. It is often recommended for women struggling with infertility. Many women may fear discomfort, but the pain is usually mild.


Today, doctors at Taichung Lee Women’s Hospital will explain the two types of hysteroscopy: diagnostic and therapeutic. They will also detail the costs, procedures, and potential aftereffects of the exam, providing key points to help you feel more at ease when undergoing hysteroscopy. By understanding the procedure's purposes, fees, and risks, you’ll be more prepared and reassured during your examination.

Hysteroscopy serves two purposes:  

  Many patients worry about pain and discomfort during a hysteroscopy. However, clinical observations indicate that the discomfort is much less than that experienced during a hysterosalpingography. Patients may feel a slight foreign body sensation when the endoscope is inserted, followed by possible cramping as saline is injected into the uterine cavity.

Here’s a brief outline of the hysteroscopy procedure:

1. Check in and head to the second-floor operating room.
2. Use a pain-relieving suppository.
3. Change into sterile surgical attire.
4. Lie on the examination table.
5. The doctor disinfects the instruments.
6. Insert a vaginal speculum and disinfect the cervix.
7. Insert the hysteroscope into the uterine cavity and inject saline.
8. The doctor observes and captures images via a screen.
9. Remove all instruments.

The entire procedure takes about five minutes from start to finish.

Best Timing for Hysteroscopy

The optimal time for a hysteroscopy is between the end of menstruation and before ovulation, roughly days 7 to 11 of the menstrual cycle. In gynecology, if there is abnormal bleeding, a hysteroscopy is generally recommended. For infertility treatments, doctors also suggest scheduling a hysteroscopy.

If you wish to have a hysteroscopy at Lee Women’s Hospital, please contact our International Affairs to make an appointment during days 1-3 of your menstrual cycle.

Does Hysteroscopy Require Anesthesia?

A soft hysteroscope is used for the procedure, and anesthesia is not required. However, for a therapeutic hysteroscopy with a rigid scope, intravenous anesthesia will be administered before the procedure. Typically, hospitalization is not necessary after the surgery.

What is the Cost of Hysteroscopy?

Hysteroscopy is covered by health insurance for eligible patients, provided they haven't had the same procedure in the last three months. If self-paying, the cost at Lee Women’s Hospital is NT$3,000. 

What Should Be Noted Before the Hysteroscopy?

Lee Women’s Hospital provides sanitary pads to avoid staining clothes.

Situations Not Suitable for Hysteroscopy

• Heavy Bleeding: Performing hysteroscopy during heavy bleeding can obscure images, making the examination impossible.
• Pelvic Inflammatory Disease: Hysteroscopy is not appropriate during pelvic inflammatory disease to prevent worsening the infection.
• Pregnancy:Hysteroscopy should not be conducted during pregnancy to avoid affecting the fetus.

Are There Any Side Effects?

Complications from the procedure are rare (0.05% to 1%) and may include uterine perforation, allergic reactions, infection, or hyponatremia.

Post-Hysteroscopy Bleeding and Complications

It's normal to experience slight vaginal bleeding after hysteroscopy before the next menstrual period, typically within 30 to 40 days post-procedure. Patients with larger fibroids may require multiple sessions to minimize risks like water intoxication.
Compared to abdominal surgery, hysteroscopy has a much lower complication rate. Potential complications include allergic reactions, bleeding, infection, uterine perforation, gas embolism, electrolyte imbalances, and water intoxication. A thorough assessment of personal health and medical history is crucial before the procedure.

Post-Hysteroscopy Instructions

After a hysteroscopy, expect mild bleeding and abdominal discomfort that usually resolves on its own. Avoid strenuous activities for 1 to 2 days to facilitate recovery.

Key Considerations:

• Maintain cleanliness with showers.
• Avoid heavy lifting and intense exercise for one month.
• Refrain from embryo implantation in the same month as polyp removal; wait until the next cycle.
• Take prescribed medications as directed.

Case Sharing from Taichung: How Hysteroscopy Aided Conception？

A 36-year-old woman, after two years of unsuccessful attempts to conceive, consulted an infertility specialist. Hysteroscopy revealed multiple polyps in her uterus. After discussing options, the physician performed a polyp removal using a cold knife hysteroscopy. A month later, following a tailored fertility program, she successfully became pregnant.
At Taichung Lee Women’s Hospital, a unique case involved a patient with unexplained infertility. A hysteroscopy revealed she had a double uterus and double vagina. The doctor examined her unique uterine structure through the hysteroscope and performed surgery to remove the vaginal septum. Following a personalized fertility plan, the patient ultimately achieved a successful pregnancy.

Expert in Hysteroscopy Explains Infertility

Dr. Chen Chung-yi, an expert in hysteroscopy, has performed nearly 40,000 procedures over 30 years, gaining significant insights into endoscopic techniques. He discusses how hysteroscopy is applied in infertility treatment and how it can help couples increase their chances of conception.
For more details, please watch: "Future Reproductive Academy: Demystifying Hysteroscopy."

Reference:
Attilio Di Spiezio Sardo, Ivan Mazzon, Silvia Bramante, Stefano Bettocchi, Giuseppe Bifulco, Maurizio Guida, Carmine Nappi, Hysteroscopic myomectomy: a comprehensive review of surgical techniques, Human Reproduction Update, Volume 14, Issue 2, March/April 2008, Pages 101–119, https://doi.org/10.1093/humupd/dmm041