A leader in fertility treatment for over 15 years

Combining heart and science, Bahman Hospital Fertility Clinic has helped thousands of couples start and grow their families.

Our clinic in Tehran has become a trusted destination for fertility services. With the success rate of 58%, we proudly maintain some of the highest verified success rates in Iran thanks to years of specialized experience, education and the latest technology.

Whether you’re seeking professional advice on getting pregnant or planning ahead for a future baby, our team of experts offers compassionate care and affordable individualized treatment plans designed for your specific needs.

Give your family the best possible chance with us.

After your First visit and consultation session, depending on the evaluation result of our expert specialists, the best plan will be designed for you, including:

The special services of this department include:

  • Outside the body fertilization through IVF and ICSI
  • Intrauterine insemination (IUI)
  • Laser assisted hatching to help fertilized eggs attach to the uterus
  • Freezing sperms for men with impaired spermatogenesis or varied cancers
  • Freezing of testicular tissue for infertile men and men with cancer
  • Freezing the eggs for single women and couples for various reasons
  • Freezing extra embryo for couples undergoing infertility treatment
  • Embryo biopsy and preimplantation genetic (gene and chromosome) diagnosis in order to understand the genetic disorders before attachment (PGS, PGD)
  • Semen analysis and sperm evaluation
  • Performing diagnostic hysteroscopy and laparoscopy
  • Performing operative hysteroscopy and laparoscopy
  • Examining all the factors causing recurrent miscarriage and treating them
  • Examining the factors causing recurrent IVF failure and treating them
  • Egg and embryo donation

Cost

The price varies considerably from clinic to clinic. The price you pay will depend on your insurance coverage, whether the price is for one procedure only or it also includes fertility drugs, blood work and ultrasound monitoring. It also depends on the type of procedure and number of cycles, so make sure you ask for the price before you start treatment.

Now, we briefly explain some terms & procedures, their indications & contraindications, how to get prepared for them and so on.

Andrology

Andrology is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are specific to men. It is the counterpart to gynecology, which deals with medical issues which are unique to female health, especially reproductive and urologic health.

IUI (Intrauterine Insemination)

IUI, or intrauterine insemination, is a simple fertility treatment. It may be done with or without fertility drugs. This procedure involves transferring specially washed semen directly into the uterus via a thin catheter.

You may know of IUI by another commonly used term artificial insemination (AI). IUI and AI are the same.

Indications

IUI treatment may be recommended for any of the following situations:

  • Male infertility
  • Hostile cervical mucus
  • Unexplained infertility
  • If treatment with fertility drugs alone is not successful
  • If a sperm donor is being used
  • If sexual pain makes intercourse not possible

IUI is not recommended for ladies with:

  • Blocked fallopian tubes
  • Severe endometriosis
  • Previous pelvic infection 

The Procedure

The procedure is pretty simple, though it’s normal to feel nervous about it.

If you’re using a sperm donor, the donor sperm will be thawed and prepared.

If not, your partner will come into the clinic that day with you and give a semen sample. The semen sample is achieved via masturbation. (Similar to how a semen analysis is done).

If your partner will be out of town—or, if he had difficulty providing a sample in the past—your partner may provide the semen sample before IUI day. In this case, if the sample is frozen, it will be thawed and prepared.

Semen contains more than just sperm. Your doctor will put the semen through a special “washing” procedure. This takes out the impurities and leaves only what’s needed for conception.

For the procedure itself, you will lie down on a gynecological table, similar to the ones used for your yearly exam.

A catheter—a small, thin tube—will be placed in your cervix. You may have some mild cramping, similar to what you might feel during a pap smear.

The specially washed semen will then be transferred into your uterus via the catheter.

The catheter is removed, and you’re done!

Your doctor may suggest you remain lying horizontally for a short while after the procedure, or you may be able to get up right away.

In either case, you don't need to worry about the sperm falling out when you stand up. The sperm are transferred directly into your uterus. They aren't going anywhere but up, to a (hopefully) waiting egg!

What to Expect Post-Procedure

After the IUI procedure, you may be prescribed progesterone. This is usually taken via a vaginal suppository.

About a week after the IUI, your doctor may order blood work. He will check your progesterone levels, estrogen, and (maybe) hCG levels.

Ten to 14 days post IUI, your doctor may order a pregnancy blood test. Or, he may tell you to take an at-home test.

Waiting to find out if the treatment was successful can be very stressful. Take good care of yourself!

How to Cope During the Two-Week Wait

Risks

IUI is a relatively low risk procedure. There is a very small risk of infection. Some of the biggest risks come from the fertility drugs used. If you’re using gonadotropins, you may be at risk for developing ovarian hyper stimulation syndrome (OHSS).

Ovarian Hyper stimulation Syndrome (OHSS) Symptoms, Treatment, and Prevention

Your risk of conceiving multiples (twins, triplets, or even more) is higher when taking gonadotropins. This is why monitoring is important.

If there are too many potential follicles, the cycle may be canceled and tried again another time.

If your doctor cancels your cycle because there are too many follicles, he will also likely tell you to abstain from sexual intercourse. It is important you take this instruction seriously. 

Some couples are hesitant to "throw away" the cycle. However, if you have sex and conceive, you put yourself and your future babies at risk. Don't do it.

Success Rate

In cycles where fertility drugs and IUI were combined, the pregnancy rate was 8 percent to 17 percent. These are per cycle rates, meaning that the success odds are higher when looking at multiple cycles together.

Your personal success rate will vary depending on the cause of your infertility and your age.

In a study of about 1,000 IUI cycles, researchers found that the success rate per couple (over one or more cycles) depended on their age and cause of infertility.

Success rates per couple (over more than one cycle) in this study were...

  • 6 percent for cervical factor infertility
  • 4 percent for anovulation (problems with ovulation(
  • 7 percent for male factor infertility
  • 6 percent for oligospermia (less than 20 million sperm per ml(
  • 1 percent for unexplained infertility
  • 4 percent for asthenospermia (poor sperm motility(
  • 7 percent for endometriosis
  • In a review of studies on IUI and unexplained infertility, just 4 percent of women got pregnant per cycle without fertility drugs.

IVF (In Vitro Fertilization)

Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as "test-tube babies."

Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus.

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

  • Endometriosis
  • Low sperm counts
  • Problems with the uterus or fallopian tubes
  • Problems with ovulation
  • Antibody problems that harm sperm or eggs
  • The inability of sperm to penetrate or survive in the cervical mucus
  • An unexplained fertility problem

IVF is never the first step in the treatment of infertility except in cases of complete tubal blockage. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.

What Can I Expect From IVF?

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one. You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner's sperm, which he will have donated on the same day.

While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

What Are the Success Rates for IVF?

Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age.

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.

Assisted Hatching

During in vitro fertilization (IVF), a technique called assisted hatching may be performed to help an embryo implant in a woman’s womb.

Let’s start at the beginning. The first step of pregnancy occurs when sperm fertilize an egg. In cases of natural conception, fertilization takes place in the fallopian tube when you have intercourse around the time of ovulation. The fertilized egg, now called the embryo, then travels from the fallopian tube into your uterus for implantation. Implantation takes place about a week after fertilization. If you use IVF to conceive, fertilization takes place outside of your body. After several days, your doctor transfers the embryo into your uterus, where it will hopefully implant and grow. With both natural conception and IVF, the embryo must hatch before it can implant in the womb. To successfully hatch, the embryo must spontaneously rupture through its outer layer, called the zona pellucida.

The Assisted Hatching Procedure

In 1990, the medical procedure called assisted hatching was used to assist the implantation process during IVF. The technique is performed three days post-fertilization, after the embryo has had a few days to develop. During assisted hatching, the zona pellucida, which coats the embryo, is thinned or ruptured. Sometimes, the outer layer of the zona pellucida is dissolved with an acidic mixture. Alternately, a laser or fine needle may be used to break open the outer layer of the zona pellucida.Assisted hatching is done with a micromanipulation technique requiring the use of microscopic tools, robotic assistance, and a microscope to view the minuscule embryo. If you use IVF with assisted hatching, the embryo will be transferred into your uterus a day after hatching. To reduce the risk of complications, steroids and antibiotics may be administered, which can sometimes cause side effects.

Who needs assisted hatching?

As we mentioned, hatching is a requirement for all successful pregnancies and births. However, some embryos do not hatch on their own. This is when assisted hatching can be useful. According to the American Society for Reproductive Medicine (ASRM), assisted hatching is most beneficial for women who have had at least two unsuccessful IVF treatments, as well as women over the age of 38. If a couple’s embryos are determined to be of questionable condition, like having a thick outer wall, assisted hatching may also be recommended to boost pregnancy success.

TESE (Testicular Sperm Extraction)

TESE is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate.

Who is TESE suitable for?

TESE is used for men with both obstructive and non-obstructive azoospermia. These men have no sperm in their ejaculate because either there is a blockage in the route between the site of sperm production (the testes) and ejaculation or because there is a partial or complete failure in sperm production in the testes.

What does TESE involve?

TESE is a minor procedure carried out on an outpatient basis under local anesthesia.

Sperm are retrieved from the testes and can be used to achieve fertilization of eggs in the laboratory. However, because the numbers of sperm that retrieved is often very low, it is necessary to combine TESE with ICSI.

When is TESE carried out?

The consultant may advise that TESE is carried out in advance of any fertility treatment to confirm that sperm production is occurring. If suitable numbers of sperm are identified on this occasion, it is sometimes possible to freeze the testicular extract and to thaw and use this sample for subsequent treatment. More commonly however, once it has been confirmed that sperm production is occurring, the TESE procedure is repeated on the day of the egg retrieval and the fresh sample used for ICSI. Again, providing that there are suitable numbers of sperm present, the sample can sometimes be frozen for use in future treatment cycles.

PESA (percutaneous epididymal sperm aspiration)

How PESA can help your male infertility problem?

To understand how PESA (percutaneous epididymal sperm aspiration) works, you have to first understand the anatomy of the male testicle. The testicle is connected to a tube called the epididymis. The epididymis is then connected to the vas deferens, a duct which transports sperm to the ejaculatory ducts and the urethra. In the event of a blockage in the vas deferens, sperm is unable to be transported into the urethra, making normal conception impossible. PESA is a special minimally invasive technique that extracts the sperm from the epididymis for use in assisted reproductive technology.

Who is PESA used for?

PESA is used as part of assisted reproductive treatments for infertility. It can be used for IVF, where the extracted sperm is mixed with the wife’s egg for fertilization to occur, or it can be used for ICSI, where a single extracted sperm is injected directly into an egg to fertilize it. This procedure is commonly used for patients who have undergone a vasectomy. If they do not wish to undergo a vasectomy reversal, or if they have had a failed reversal, PESA is a good way to help them reproduce. A vasectomy is often completed through either the cutting of the vas deferens or creating a blockage in the vas deferens. This does not affect the epididymis, and it is possible to extract healthy sperm for artificial insemination. It is also possible to develop blockages in the vas deferens due to genetic conditions or infections to the vas deferens. In these situations, PESA can also be used to treat male infertility caused by the blockages.

How does PESA work?

During PESA, a very thin needle is inserted into the epididymis in order to extract the sperm. This procedure can be conducted in the clinic and does not require hospitalization. The extracted sperm is then used as part of IVF treatment or in an ICSI procedure.   To find out more about PESA, make an appointment with one of the fertility specialists and urologists at ACRM.

PGD (Preimplantation Genetic Diagnosis)

Preimplantation genetic diagnosis (PGD) is a reproductive technology used along with an IVF cycle to increase the potential for a successful pregnancy and delivery. PGD is a genetic test on cells removed from embryos, to help select the best embryo(s) to achieve pregnancy or to avoid a genetic disease for which a couple is at risk.

Who should consider PGD?

PGD may be considered in all IVF cycles; however, those who might benefit most from this test are couples at increased risk for chromosome abnormalities or specific genetic disorders. This includes women who have had several miscarriages, or who have had a prior pregnancy with a chromosome abnormality. Women over 38 years of age and men with some types of sperm abnormalities may produce embryos with higher rates of chromosome abnormalities. This test is also known as PGT-A (aneuploidy). In addition, if a person carries a structural rearrangement of the chromosomes, PGD can identify which embryos have a normal amount of chromosomal material. This technology is also known as PGT-SR (structural rearrangement). When there is a 25% or 50% chance to have a child affected with a specific genetic disease, PGD can be designed to identify which embryos are affected, unaffected, or a carrier (if applicable) for that disease. Then, only embryos without the disease are transferred to the uterus to attempt pregnancy. This is also known as PGT-M (monogenic disorders).

What are the PGD steps during an IVF cycle?

After embryos are created in the laboratory, they are grown for five to six days. On day five or on day six, the biopsy for PGD is done on all appropriately developing embryos. Biopsy involves removing a few cells from the trophectoderm, or the layer of cells that is ‘hatching out’ of the embryo at this stage of development. The embryos are stored while genetic material inside the removed cells is tested for abnormalities. One of Genetic & IVF’s genetic counselors discusses PGD test results with the woman/couple, and a frozen embryo transfer (FET) cycle is planned for use of the embryo(s). Decisions regarding selection of embryos to transfer into the uterus are made with the advice of both the medical and genetics team.

Blastocyst-embryo-cycle

Is embryo biopsy and PGD safe?

Yes. Data from many years of PGD in animals and several hundred thousand live births in humans indicate that PGD does not lead to an increase in birth defects over that of the general population. Follow-up evaluation of children born after PGD does not show any evidence for a detrimental effect of the process on growth or neurological development over the first several years of life. In embryos where chromosomal PGD testing is performed, one can expect fewer pregnancies ending in miscarriages due to chromosomal disorders since most abnormalities are identified prior to transfer of the embryos to the uterus. Removal of a few of the trophectoderm cells of the early embryo does not alter the ability of that embryo to develop into a complete, normal pregnancy.

PGS (Pre-implantation genetic screening)

PGS (also known as aneuploidy screening) involves checking the chromosomes of embryos created by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) for abnormalities.

Embryos with abnormal chromosomes often end in miscarriage, a failed treatment cycle or the child may have a condition like Down’s Syndrome.

During PGS, a single cell or a small number of cells is removed from the embryo. The DNA of these cells is then tested to see whether they have any chromosomal abnormalities. Only embryos without chromosomal abnormalities are placed back in the womb.

Who might be recommended to have PGS?

Older women are more likely to have eggs with the wrong number of chromosomes, so traditionally it’s been offered to women over 37. Abnormal chromosomes are thought to be the main reason why older women have difficulties conceiving and are more likely to have a miscarriage or a baby with Down’s Syndrome.

Your doctor may also recommend PGS if you have a family history of chromosome problems, if your sperm is at risk of carrying abnormal chromosomes or if you’ve had several miscarriages or failed IVF attempts without explanation.

However, there is limited evidence to show that PGS benefits these groups (see more below.)

What causes abnormal chromosomes?

Abnormal chromosomes happen very frequently during the normal production of eggs, sperm and during embryo development. When the cells of eggs, sperm and embryos divide this can lead to too many or too few chromosomes, or with missing or added pieces of DNA.

How safe is it for the embryos?

Because PGS involves removing a cell or number of cells from an embryo this can cause damage to the embryo and prevent it from developing once it has been transferred into the womb.

Also research has shown that often the cells in an embryo are not chromosomally identical (called mosaicism). PGS relies on test results from one or a small number of cells being representative of the embryo as a whole. As this is not always the case, it may be possible for an embryo to give an abnormal test result when it is in fact capable of producing a healthy pregnancy.

Are there any other risks?

PGS carries the same risks as IVF, which you can read about here.

However, PGS also has some treatment specific risks. This includes the possibility of a misdiagnosis, although modern PGS techniques are very accurate. There’s also the risk that if all the embryos are found to have abnormal chromosomes there won’t be any embryos to put back in the womb. This is especially likely for older women.

Egg and embryo donation

Egg donation is when eggs from another woman are fertilized with your partner’s sperm in a laboratory. The resulting embryos are then transferred to your womb (uterus).

Embryo donation is when another couple’s embryo is implanted in your womb during IVF. This is an option if you and your partner need both egg and sperm donation, or if you’re a single woman who cannot use your own eggs.

Your doctor may recommend egg donation if:

  • If you have no ovaries, produce low-quality eggs, or no eggs at all. This may be due to premature menopause, an inherited condition such as Turner syndrome, surgery to remove your ovaries, or treatment for cancer using chemotherapy or radiotherapy.
  • If you and your partner have been unsuccessful with other treatments, such as IVF.
  • If you’re at risk of passing on an inherited disorder or chromosomal abnormality.

Your doctor may recommend embryo donation if:

  • You and your partner are unlikely to conceive using your own eggs and/or sperm for fertility treatment.
  • You or your partner is at risk of passing on a genetic disorder to a child.
  • You’re single and have gone through the menopause.

How does egg and embryo donation work?

The process starts with finding a donor. This is usually carried out by your fertility clinic.

Egg donations can be from egg donors or egg sharers:

Egg donors are women who are not receiving fertility treatment themselves, but who choose to donate their eggs to help other women, or a particular woman they know.

Egg sharers are women undergoing fertility treatment, who donate some of their eggs as part of their IVF cycle.

Embryos are usually donated by couples or women who have successfully had their baby or babies from IVF and who want to help other parents-to-be.

It’s recommended that egg donors are under 36 years of age, because fertility treatment is more successful with younger eggs. But there can be exceptions to this, such as when a woman is donating eggs to friends or family.

All egg donors are screened for infectious diseases such as HIV, hepatitis B, hepatitis C, and some genetic conditions such as cystic fibrosis, before their eggs are used.

Where possible, egg donors may be matched as closely as possible with the recipient couple for characteristics such as hair color, eye color, occupation, and even interests.

In cases of both egg and embryo donation, the woman giving birth to the child is the legal mother. Your partner will be the other legal parent if you’re married. If not, you’ll need to sign legal parenthood consent forms before the treatment takes place.

What are the success rates of egg and embryo donation?

Each IVF treatment cycle using donated eggs has a success rate of between 28 per cent and 35 per cent, according to figures from 2013. It can depend on your age and whether the sperm used is your partner’s or donated. Bear in mind that it may take several attempts before it’s successful.

Freezing embryos and freezing eggs

Freezing embryos and freezing eggs are two separate processes each of which has their own advantages and disadvantages.

Reasons for freezing embryos and eggs

Egg freezing, also known as mature oocyte cryopreservation is a new technique for preserving fertility. The reasons why you may consider freezing your embryos and eggs are as follows:

  • You are over 30 years old but you haven’t met your right partner: Your fertility may start declining after the age of 28 years. This decline becomes very significant around 35 to 40 years of age. The decline in fertility may occur due to the aging of the eggs. As your eggs age, their quantity and quality may become lower and this may reduce the chances of your getting pregnant. Freezing your eggs may help preserve your fertility till the time you have met your right partner with whom you want to parent your child or until you want to become a single parent with the help of a sperm donor.
  • You don’t want to have a child now but you want to have a child (biological) in future: There may be many professional and personal reasons due to which you may not want to have a child while you are at the peak of your fertility. These may include military deployment, financial uncertainty, a recent divorce, job issues or other such challenges. These reasons may imply that you don’t want to conceive now but you want to have a child in the future. Frozen embryos and eggs are a good option in such scenarios.
  • You’re about to have treatment for cancer or any other illness, which may affect your fertility potential in the future: Preservation of fertility is a concern if you’re about to have chemotherapy, radiation therapy or surgery for cancer or any other illness as these treatments may harm your fertility. In such cases, frozen embryos (if you have a partner) or frozen eggs may enable you to have biological children after your treatment.
  • You suffer from other illnesses: Certain medical issues such as recurring or large ovarian cysts or severe endometriosis may limit your fertility. Chronic and progressive diseases such as kidney disease, sickle cell disease or systemic lupus erythematosus may also affect your fertility. In these cases, frozen eggs and frozen embryos may make it possible to have biological children through gestational surrogacy in case you are unable to carry your child due to health concerns.

Freezing Sperm

Freezing sperm refers to the freezing and storage (called cryopreservation) of a man’s sperm. Sperm freezing is the process of collecting, analyzing, freezing and storing a man’s sperm. The samples are later used for fertility treatments or donated to other couples or individuals, including same sex female partners. This overall process is known as cryopreservation and is sometimes referred to as sperm banking.

Stored sperm (i.e., “banked” as in a sperm bank) can be frozen indefinitely until needed for assisted reproductive procedures, such as in vitro fertilization (IVF), intrauterine insemination (IUI) or sperm donation.

Typically, a man freezes his sperm if undergoing a medical treatment that may interfere with his fertility, including a vasectomy and chemotherapy or radiation for cancer.

A man may also choose to freeze his sperm if he is in a line of work that puts him in life-threatening danger or otherwise puts his fertility at risk.

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The cryopreservation process involves:

  • Routine screening for infection (HIV, hepatitis and rapid plasma regain  test for syphilis).
  • Providing a semen sample or undergoing a sperm extraction.
  • Lab analysis of sperm quantity and quality.
  • Freezing of viable sperm.
  • Storage of the sperm indefinitely.

Who should consider freezing sperm and why?

The primary benefits of freezing sperm are to allow a man to preserve his fertility by using his sperm at a later date or to give an infertile couple, an infertile individual or a lesbian couple a chance to conceive.

Common reasons to choose to freeze sperm:

  • Advancing age.
  • Deteriorating sperm quality or low quantity.
  • Cancer or other medical reasons.
  • Pre-vasectomy patients.
  • Transgender patients.
  • Career and lifestyle choices, such as those with high-risk occupations or who spend a lot of time away from their significant other.

Hysteroscopy

Hysteroscopy is a minimally invasive surgical procedure for viewing the inside of the uterus. Hysteroscopy is performed by inserting a visualizing scope through the vagina and into the cervical opening. Hysteroscopy allows visualization of the inside of the uterus, including the openings to the Fallopian tubes, as well as direct examination of the cervix, cervical canal, and vagina.

Why is a hysteroscopy done?

Hysteroscopy can be performed for both diagnosis or also for treatment (therapeutic). Hysteroscopy is one of several procedures that your doctor may recommend to evaluate or treat abnormalities of the uterus or cervix. Since hysteroscopy examines the lining and interior of the uterus, it is not suitable for evaluating problems within the muscular wall or on the outer surface of the uterus.

Hysteroscopy may be recommended as one step in the evaluation of a number of gynecological problems, including:

  • Abnormal vaginal bleeding
  • Retained placenta or products of conception after a birth or miscarriage
  • Congenital (inborn) anatomical abnormalities of the female genital tract
  • Scarring, or adhesions, from previous uterine surgery or instrumentation such as dilation and curettage (D&C)
  • Polyps or fibroid tumors inside the cervical canal or inside the uterine cavity
  • Hysteroscopy can be used to help pinpoint the location of abnormalities in the uterine lining for sampling and biopsy, and it can be used to perform surgical sterilization.

How is the hysteroscopy performed? What are the types?

There are a number of different sizes and types of hysteroscopes available, depending upon the type of procedure that is required. Some hysteroscopes are combined with instruments that allow surgical manipulation and removal of tissues if necessary.

Hysteroscopy may be performed in an outpatient surgery center or a hospital operating room, or a physician's office. A number of different methods for anesthesia and pain control may be used, depending upon the individual situation. Sometimes, hysteroscopy using narrow-diameter hysteroscopes that do not require dilation of the cervical opening can be performed without anesthesia. In other cases, a local anesthetic can be applied topically or given by injection. In certain cases, a regional or general anesthetic may be recommended.

A vaginal speculum is often inserted prior to the procedure to facilitate insertion of the hysteroscope through the uterine cavity. Depending upon the exact type of hysteroscope that is used, dilation of the cervical opening with surgical instruments may be necessary. After insertion of the hysteroscope, fluid or gas is injected to distend the uterine cavity and allow for better visualization.

Acetaminophen (Tylenol and others) and nonsteroidal antiinflammatory medications are generally recommended after the procedure to control any pain or cramping that may occur.

Hysteroscopy should not be performed if a woman is pregnant or has an active pelvic infection. It is also not recommended if a woman has known uterine or cervical cancer. Certain conditions (abnormal position of the uterus, obstruction of the cervical canal or uterine cavity, scarring or narrowing of the cervical opening) may make hysteroscopy more difficult or impossible to perform in certain cases.

What are the side effects, risks, and complications of hysteroscopy?

Women should expect to experience light vaginal bleeding and some cramping after the hysteroscopy procedure. Some cramping may be felt during the procedure, depending upon the type of anesthesia.

Complications of hysteroscopy are rare and include perforation of the uterus, bleeding, infection, damage to the urinary or digestive tract, and medical complications resulting from reactions to drugs or anesthetic agents. Accidental perforation of the uterus is the most common complication and occurs in 0.1% of diagnostic hysteroscopy procedures and 1% of therapeutic (surgical) hysteroscopies. Other rare complications are fluid overload or gas embolism (when gas bubbles enter the bloodstream) from the distending medium used in the procedure.

What is the outlook after hysteroscopy?

The outlook depends upon the individual case and the reason for hysteroscopy. Many minor surgical procedures can be successfully performed using hysteroscopy. Complications are rare, and most women recover with only minor post-procedure cramping and bleeding.