Operative Hysteroscopy — Polyps, Septa, Adhesions

Imagine a beautiful, cosy home. For a baby, that home is the uterus. If there are obstacles inside – perhaps a misplaced wall, some unwanted growths, or sticky traps – it can make it very difficult for a new life to settle in comfortably. This is precisely where operative hysteroscopy comes in, offering a gentle yet powerful solution to clear the path for fertility.

What Exactly is an Operative Hysteroscopy?

An operative hysteroscopy is a minimally invasive procedure that allows me to directly visualise the inside of your uterus – the uterine cavity – using a thin, lighted telescope called a hysteroscope. This scope is gently passed through your natural opening, the cervix, meaning there are no external incisions. Unlike a diagnostic hysteroscopy, where we only look, an operative hysteroscopy allows me to also treat and remove abnormalities found within the cavity during the same sitting. Think of it as keyhole surgery for your uterus, performed from the inside.

This procedure is typically performed in an operating theatre, often as a day-care procedure, meaning you usually go home the same day. It's done under either general anaesthesia or regional anaesthesia, like a spinal block, ensuring you are comfortable and pain-free throughout. The entire process often takes between 15 to 45 minutes, depending on the complexity of what needs to be addressed.

When Do I Recommend an Operative Hysteroscopy?

I frequently recommend an operative hysteroscopy to my patients who are struggling to conceive, have experienced recurrent miscarriages, or have abnormal uterine bleeding. The goal is always to optimise the uterine environment for a successful pregnancy and a healthy outcome. It's a crucial step before begin fertility treatments like IVF, as even a perfectly formed embryo needs a perfect bed to implant into.

Specific conditions that often necessitate an operative hysteroscopy include:

• Uterine Polyps: These are benign growths of the uterine lining (endometrium) that can act like an intrauterine device, preventing implantation or causing abnormal bleeding. They are very common and easily removed.

• Uterine Septum: This is a band of fibrous tissue that divides the uterine cavity, making it heart-shaped. It's a congenital abnormality and can significantly increase the risk of miscarriage or premature birth. Removing it restores a normal, spacious cavity.

• Intrauterine Adhesions (Asherman's Syndrome): These are scar tissues that form inside the uterus, often after uterine surgery, infection, or D&C procedures. They can partially or completely obliterate the cavity, leading to infertility or light periods. Separating these adhesions carefully is vital.

• Submucosal Fibroids: These are benign muscular tumours that protrude into the uterine cavity. Even small ones can interfere with implantation or cause heavy bleeding. Hysteroscopy can remove these if they are mostly within the cavity.

• Retained Products of Conception: Sometimes, after a miscarriage or delivery, small pieces of placental tissue remain. Hysteroscopy can safely remove these without blind scraping, preserving the endometrial lining.

The Procedure: What to Expect

Before the procedure, we will have a detailed discussion about your medical history and the specific findings that led to the recommendation for hysteroscopy. I will explain the procedure in detail, including the type of anaesthesia, potential risks, and benefits. You will need to fast for a few hours before surgery, as is standard practice for anaesthesia.

On the day, once anaesthetised, a sterile solution (like saline) is gently infused into your uterus to distend it slightly, allowing for clear visualisation. The hysteroscope is then introduced. Special micro-instruments, passed through channels in the hysteroscope, are used to precisely remove polyps, shave off septa, or meticulously cut away adhesions. The entire process is displayed on a monitor, allowing for precision and minimal impact on the surrounding healthy tissue. Once the work is done, the instruments are withdrawn, and you are moved to the recovery area.

Recovery and Post-Procedure Care

Most patients experience minimal discomfort after an operative hysteroscopy. You might have some mild cramping, similar to menstrual cramps, and light vaginal bleeding or spotting for a few days. We will provide pain relief medication as needed. It's advisable to rest for a day or two, avoiding strenuous activities. I usually recommend abstaining from intercourse and avoiding tampons for about two weeks to minimise the risk of infection.

I often advise my patients to resume normal activities gradually. For fertility treatments, we typically wait one to two menstrual cycles to allow the uterine lining to completely heal and regenerate before attempting embryo transfer or natural conception. Depending on the extent of the procedure, I might prescribe hormonal therapy, like oestrogen, to aid endometrial healing, especially after extensive adhesion removal.

Risks and Considerations

While generally very safe, like any surgical procedure, there are minimal risks associated with operative hysteroscopy. These are rare but important to be aware of:

• Uterine Perforation: A tiny hole in the uterine wall, usually minor and self-resolving, but can sometimes require further intervention.

• Infection: Although uncommon due to sterile techniques and prophylactic antibiotics in some cases.

• Bleeding: Usually minimal, but rarely requires intervention.

• Fluid Overload: If excessive distension fluid is absorbed into the bloodstream, this is monitored closely during the procedure.

• Anaesthesia Risks: As with any anaesthesia.

I take every precaution to minimise these risks, and our experienced anaesthesia team at Apollo Fertility Hyderabad ensures your safety throughout.

Cost and Accessibility in India

The cost of an operative hysteroscopy in India, specifically in cities like Hyderabad, can vary based on the complexity of the procedure, the hospital's facilities, and the surgeon's fees. Generally, you can expect the cost to range from INR 40,000 to INR 90,000. This usually includes surgeon's fees, anaesthesia charges, facility charges, and basic consumables. It's always best to get a clear, itemised estimate from your clinic.

It's important to remember that under the ART Act 2021, procedures like hysteroscopy, when medically indicated for fertility purposes, are part of comprehensive reproductive healthcare. Many health insurance policies now cover diagnostic and operative hysteroscopy if deemed medically necessary, so it's worth checking with your provider.

My Philosophy: Precision and Patience

My approach to operative hysteroscopy is rooted in precision and patience. I believe in meticulous dissection and careful tissue handling to preserve the delicate endometrial lining, which is crucial for future implantation. It’s not just about removing the problem; it’s about restoring the uterus to its optimal, natural state. I always ensure a thorough post-operative review to discuss the findings, show you images or videos from the procedure if you wish, and outline the next steps in your fertility journey. This 30-minute procedure often unlocks an otherwise resistant cavity, transforming a challenging fertility landscape into one filled with hope.

If you're facing fertility challenges or have been diagnosed with an intrauterine abnormality, and are considering an operative hysteroscopy, please feel free to message me on WhatsApp. I am here to help you understand your options and guide you towards the best possible outcome for your family.