By Dr. Preston Parry | Positive Steps Fertility
If you’ve been trying to get pregnant and your doctor has mentioned a procedure called operative hysteroscopy, you probably have questions. What exactly is it? What does it feel like? And most importantly, could it actually help?
You’re not alone in wondering. This is one of the most common procedures we perform at Positive Steps Fertility, and understanding what to expect can make the entire experience feel a lot less overwhelming. Here’s everything you need to know, in plain language.
Many women we see are ovulating normally and still not getting pregnant, and the reason often comes down to something structural inside the uterus that hasn’t been identified yet.
What Is Operative Hysteroscopy and How Does It Work?
The word “hysteroscopy” comes from the Greek word for uterus (hystero) and the Latin word for seeing (scope). Put them together, and you get exactly what it is: looking inside the uterus with a small camera.
A standard diagnostic hysteroscopy uses a very small camera — about the size of a coffee straw — to get a view of the inside of your uterus. Operative hysteroscopy goes one step further. It uses a slightly larger camera that also allows instruments to be passed through, so your doctor can not only see what’s inside, but actually treat it.
Why Is Operative Hysteroscopy Used for Fertility?
There are a number of uterine conditions that can silently interfere with your ability to get pregnant or carry a pregnancy. Operative hysteroscopy is used to diagnose and correct many of them, including:
- Uterine polyps — small growths on the lining of the uterus that can block implantation
- Fibroids — benign muscle tumors that can distort the uterine cavity
- Scar tissue (adhesions) — sometimes called intrauterine adhesions or Asherman’s syndrome, these can develop after a D&C, miscarriage, or infection
- A uterine septum — a condition present from birth where tissue divides the uterine cavity, which is associated with miscarriage and preterm labor
- tissue — tissue remaining after a miscarriage or delivery that can affect future pregnancies
- Cesarean niche defect — a small pocket that forms at a prior C-section scar where blood can collect and affect fertility
- Blocked fallopian tubes — catheters can sometimes be passed through the hysteroscope to attempt to open blocked tubes
- Adenomyosis — in certain cases, adenomyotic cysts can be addressed hysteroscopically
In short, if something inside your uterus doesn’t look the way it should, operative hysteroscopy gives us the tools to try to make it better.
How Do You Know If You Need Operative Hysteroscopy?
One of the most important questions I want patients to ask is this: Do we actually know that there’s something inside the uterus that needs to be treated?
Because operative hysteroscopy is not something you do just to look around. It’s something you do when you already have a reason.
At our clinic, we often start with a diagnostic approach that allows us to evaluate the uterus, tubes, and ovarian function simultaneously. That tool is called the Parryscope — an in-office procedure I developed to get a clear picture before making any surgical decision.
If everything looks normal, there’s no reason to proceed with a surgical procedure. But if we do see something — like a polyp, fibroid, or scar tissue — then operative hysteroscopy becomes a very targeted way to fix a specific problem.
The goal is always the same: Don’t guess. Understand what’s there first — then treat it.
What Is Operative Hysteroscopy Like? (Step-by-Step Experience)
One of the most common things we hear from patients after operative hysteroscopy is, “Wait — we’re already done?” For many conditions, particularly polyp removal, it really can be that efficient.
Here’s what the experience typically looks like at Positive Steps:
Before the procedure: You’ll arrive about 40 minutes ahead of time. The team will review your medical history, allergies, and confirm what you’re having done. You’ll change into a gown and get an IV placed. It’s a more personal, streamlined process than a hospital setting — we tend to know our patients well.
The procedure itself: Because operative hysteroscopy uses a larger camera than a standard office scope, most patients are given sedation (typically propofol) so they can rest comfortably throughout. You’ll drift off, the procedure will be completed, and you’ll come back around shortly after. Before anything begins, we do a formal “time out” — a team review of your name, date of birth, allergies, and the procedure being performed. This is a safety standard we take seriously.
After the procedure: Most patients are ready to go home within 20 to 30 minutes. You’ll walk out, see your support person, and we’ll review how everything went. Because propofol clears quickly, recovery is usually fast — though you’ll want someone with you for the rest of the day.
At home: You’ll receive clear guidance on next steps — medications, follow-up appointments, and what to watch for. Don’t hesitate to call if something is on your mind. Our number one rule: you can’t fix what you don’t know about.
What Are the Risks of Operative Hysteroscopy?
Every surgical procedure carries risks, and we believe in being honest and thorough about what those are. The good news: for the vast majority of patients, operative hysteroscopy is a safe, well-tolerated procedure.
Here are the risks we discuss with every patient:
Infection — Any time instruments are introduced past the cervix, there is a small risk of infection. In practice, true post-operative infections after hysteroscopy are rare. Signs to watch for include abnormal discharge or progressive pelvic pain — always reach out if something doesn’t feel right.
Bleeding — Some spotting or light bleeding after the procedure is normal. If you were on birth control pills to prepare for surgery, expect a period-like bleed once you stop them. Heavier bleeding can occasionally occur with fibroid removal.
Uterine perforation — In rare cases (roughly 1 in 100 to 1 in 1,000), a small hole can occur in the uterine wall during the procedure. This sounds alarming, but in most cases it heals on its own without additional surgery. The risk can be reduced by keeping a moderately full bladder before the procedure, which helps position the uterus more favorably.
Anesthesia reactions — Truly serious allergic reactions to anesthesia are very rare. Some patients with sensitive airways may experience mild coughing or discomfort, but this is uncommon.
Conditions can recur — Polyps, fibroids, and scar tissue can return after removal. This doesn’t mean the procedure wasn’t worthwhile — it means ongoing monitoring is part of the plan. A uterine septum, once corrected, rarely recurs, though some patients benefit from a follow-up (“second look”) hysteroscopy to confirm healing.
We also discuss the possibility, however remote, of more serious complications — because we believe informed patients make better decisions and have better outcomes. If you have specific health conditions or risk factors, your care plan will be tailored accordingly.
What to Know About Common Uterine Conditions That Affect Fertility
Polyps: Polyp removal is usually one of the most straightforward hysteroscopic procedures — efficient, well-tolerated, and highly effective. One nuance: if the base of the polyp isn’t fully addressed, it can regrow. Think of it like cutting a tree — you need to get below the roots.
Fallopian tubes: If blocked tubes are found during your hysteroscopy, we may attempt to open them using a small catheter. It’s important to set realistic expectations here. The fallopian tube isn’t simply a pipe — it’s lined with tiny hair-like structures called cilia that help move the egg. Even if a tube can be opened mechanically, that doesn’t necessarily restore full function. And in cases of significant tubal disease, a catheter may not be able to pass through at all. Your doctor will discuss whether IVF may be a better path forward in those situations.
Uterine septum: Correcting a septum is generally effective and the condition rarely recurs. The key is precision — removing just enough tissue to create a normal cavity, without going too far and thinning the uterine walls. After septum correction, estrogen therapy is often prescribed to support healing of the lining.
Scar tissue (adhesions): Removing scar tissue carries a risk of new scar tissue forming — which is why follow-up hysteroscopy is sometimes recommended to confirm the uterus has healed well. For more extensive adhesions, estrogen support and sometimes a uterine balloon are used post-operatively to reduce the chance of recurrence.
Cesarean niche defect: If you’ve had a prior C-section and have been experiencing unusual bleeding or difficulty conceiving, a niche defect may be a factor worth discussing. This is an area where the research is still evolving, and treatment decisions are very individualized.
Is Operative Hysteroscopy Right for You?
That’s a conversation worth having. For many women on a fertility journey, operative hysteroscopy is a straightforward, minimally invasive step that removes a real obstacle to pregnancy. For others, it may be one part of a broader treatment plan.
If you’ve been told you may need a hysteroscopy — or if you’re still searching for answers — the first step is simply understanding what’s going on.
At Positive Steps Fertility, we focus on providing you with the clarity you need so you can move forward with confidence.
Every step forward matters. Yours is worth taking.
This blog is based on general medical information shared by Dr. Preston Parry during First Friday Fertility Live. It is not a substitute for personalized medical advice. Please speak with your clinician about your specific situation and goals.
Ready to take the next step? Schedule a consultation with Positive Steps Fertility today.
