After a hysteroscopy: recovery, periods, sexual intercourse, and the waiting period before embryo transfer

Hysteroscopy is one of the procedures I see most frequently in patient records prior to IVF: to examine the uterine cavity, remove a polyp, or treat a septum or adhesions. What happens next depends entirely on the procedure carried out. A diagnostic hysteroscopy lasting a few minutes and the removal of a fibroid require very different timeframes.

Two very different situations

• Diagnostic hysteroscopy: a thin camera is passed through the cervix to view the inside of the uterus. It is often carried out during a consultation, without general anaesthesia, and takes just a few minutes. It may be combined with an endometrial biopsy.
• Operative hysteroscopy: the same access route is used to remove a polyp, a fibroid protruding into the cavity, a uterine septum or adhesions. It is more often carried out under anaesthesia, and the healing time depends on the extent of the procedure.

To find out which of these procedures are recommended prior to IVF, see fibroids and polyps and hysteroscopy and chronic endometritis.

The days following the procedure

After a hysteroscopy, most women resume their usual activities on the same day or the following day. Information provided to patients by the UK’s National Health Service and the Royal College of Obstetricians and Gynaecologists describes the same post-procedure effects:

• pain similar to period cramps for a few hours, sometimes a few days;
• bleeding or pink-tinged discharge for up to a week; use pads rather than tampons during this time;
• sexual intercourse and exercise can resume once the pain and bleeding have stopped.

Seek medical advice promptly if you experience a fever, foul-smelling discharge, pain that is getting worse rather than better, or heavy bleeding: these are signs of an infection or a complication, which are rare but should not be ignored.

Periods after a hysteroscopy

A diagnostic hysteroscopy does not usually affect the menstrual cycle: your next period will arrive on the usual date. Following a surgical procedure, your period may be slightly heavier or delayed, particularly if hormone treatment has been prescribed to aid healing. It is often this first cycle after the procedure that serves as a guide for planning the next steps.

How long before embryo transfer?

This is the most important question before IVF, and the answer depends on the procedure performed.

A systematic follow-up study one month after the procedure illustrates these differences: the cavity had fully healed in 86 per cent of patients following the removal of a polyp and in 67 per cent following the treatment of adhesions, but only in around one in five following the removal of a fibroid or the resection of a septum. The same study observed new adhesions following some of the more extensive procedures, which explains the value of a follow-up hysteroscopy before embryo transfer in these situations.

Following a purely diagnostic hysteroscopy, no scarring is to be expected: the clinic generally schedules the next step for the following cycle. Ask your doctor for precise instructions, as these also depend on the type of embryo transfer planned.

When the endometrium takes time to rebuild

Following treatment for adhesions, or after an extensive procedure, the endometrium may remain thin for a few cycles. The doctor checks this via ultrasound before scheduling an embryo transfer, and may sometimes adjust the hormonal preparation. This does not mean the procedure has failed, but it is yet another reason not to set a transfer date before the uterine cavity has been re-examined. What can be done in this case is detailed in the article on a thin endometrium.

For a patient coming from abroad

The question of location arises: should the hysteroscopy be carried out at home or in Greece? If done at home, the examination takes place without the need for additional travel, and the report and photographs can be sent to the Greek clinic. In Greece, some clinics offer to carry out the procedure during a stay prior to the transfer, which means the dates need to be carefully coordinated. The transfer itself then requires a short stay, organised as described in the article on frozen embryo transfer in Greece. In both cases, ask for a written report detailing what was observed and removed, along with the results of any analysis if a sample was sent to the laboratory: it is this document that enables the doctor to set the timeframe.

If you are unsure how to coordinate the hysteroscopy with your transfer schedule, please write to me: this is typically the sort of schedule I organise with the clinic.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/after-hysteroscopy-recovery-transfer/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook