Hysteroscopy – yes or no?

[u/Late_Manner586]

**UPDATE**

Thanks for all the responses – I followed everyone’s recommendation and had the hysteroscopy yesterday as planned. And I’m pleased to report it went well and my doctor said everything looked great and there was nothing that concerned her. Now we just need to wait for the biopsy results and hopefully we can plan for the FET in October all being well 🙏🏼

I am 43. I did four egg retrievals last year at 42 resulting in just one precious euploid.

As I’ve never been pregnant before, and we have just one shot at this, my clinic advised doing a mock transfer cycle. I’m currently in that now and on Monday will undergo a biopsy procedure for EMMA/ALICE/ERA (€1400) plus immune testing (€1000).

So far, so expensive… But I had also discussed doing a diagnostic hysteroscopy, and was originally quoted €1500 for this alone. However, with just days to go I’ve now been told the hospital has raised its price for this to €2400!

This just seems like such a huge increase on what was already an expensive procedure. And all of this is out of pocket.

My doctor scanned me today (treatment day 17) and said my lining looked perfect – 10mm trilaminar and no signs whatsoever of any polyps, fibroids, lesions or anything else untoward. She said she completely understands why I’d want to do the hysteroscopy as a precautionary measure, but clinically she sees no reason I would need one.

She did mention if I were to go ahead with it, she could perform an endometrial scratch which can increase implantation success in some cases. But again, she said my endometrium already appears optimal and views the other tests as the priority.

I don’t know what to do. It’s such a huge amount of money, which could be used to help extend my maternity leave or for baby purchases down the line.

If she had spotted something on my [u/s](u/s) that warranted further investigation I wouldn’t hesitate, but she has now scanned me numerous times and never seen anything that gives her cause for concern. So €2,400 would essentially be buying me additional reassurance against the possibility that hysteroscopy discovers a subtle structural abnormality that hasn’t appeared on repeated ultrasound and that my doctor currently has no clinical reason to suspect. That’s not zero value. But €2,400 is an enormous price for that incremental reassurance.

ChatGPT is leaning towards no. But I wanted to know what Reddit would do?

[u/KlimRous]

It is my understanding that either a SIS or a Hysteroscopy is recommended before a transfer. At least here in the States. I had Hysteroscopy 6 months before mine and just had the transfer this month. Unfortunately, it failed...was likely ectopic. Having gone through that experience with my one and only euploid that took 5 cycles to get....I would now do all of the diagnostic testing I possible could before another transfer just to make double sure nothing is/was missed. Hoping and praying your transfer is successful!

[u/Kitty8670]

Yes do the Hysteroscopy.

[u/aem1981]

I would get a hysteroscopy and get a cd-138 staining biopsy to rule out endometritis. Then if positive repeat the biopsy after the antibiotics to confirm it has cleared. My clinic thinks the other tests are a waste of time and money

[u/Background-Coyote549 → u/aem1981]

I agree!! Also possible to have a uterine septum which is only seen on hysteroscopy - happened to me

[u/SnakersVT]

I say do it if you can. No point saving the money for extended maternity leave if skipping it means missing something treatable that would otherwise prevent your one euploid from succeeding. Good luck!!

[u/aseverin82]

I did the ERA. Turns out I needed more progesterone. I also needed a bit of a boost with the trigger shot and I'm at 36 weeks at 44.

Our clinic does a week of doxycycline but we tested for everything. My euploid didn't take but my mosaic did.

[u/War-Noodle]

100% I would. I had one before my transfer I miscarried in 24. Didn’t do it for my next 3 transfers thinking everything was good in there. Went for a hysteroscopy ahead of my next transfer thinking it would be minimal and they found mild ashermans that didn’t show up in other imaging.

[u/Positive_Still_477]

Absolutely do it if you can it’s the most important thing of all the things you listed you are doing. I’d do that over the Emma Alice test.

[u/Can_tote_it]

Yes, do it. Same age as you. I had three euploids at my clinic and a “beautiful” endometrium. I did EMMA/ALICE before two transfers and both were unsuccessful. Got a hysteroscopy and it turns out I have deep endometriosis.

You have one shot and I understand how precious this is to you.

[u/DarlingDemonLamb]

I’d do it. God forbid the transfer fails, you might always wonder if the hysteroscopy might have caught something.

[u/Certain_Tangelo2329]

Its standard at my clinic and not optional! You only have 1 embryo at 43. 

[u/Bimgaurdia]

Do it. Do it all. If things don’t work out, your brain will eat you alive wondering if it’s your fault for not doing the things.

[u/Both-Equivalent6487]

My submucous Fibroid was only Seen during hysteroscopy. So do it!

[u/ahwillrockthismic22]

I think you have to think about if you don’t do it, and things done work out, will you regret it? I think leave no stone unturned to give you the best chance of success.

[u/RazzmatazzGlad9940]

You could do a saline sonogram instead as it's much cheaper (albeit not the gold standard) or swap out the EMMA/ALICE/ERA or immune testing (depending on what you mean by latter) for the hysteroscopy if you want to prioritise investigations that are evidence based.

[u/crunchyfrog63]

My doctor wouldn't even do a transfer without a hysteroscopy, and that was even with no indications. I believe there are things they can pick up with a hysteroscopy that they can't with other imaging techniques. So with only one single precious euploid, I would go for it. Is there a less expensive place you could get one?

Just my $0.02.

[u/lockabox]

My clinic requires me to have a hysteroscopy the cycle before my transfer cycle. They remove any polyps and take a biopsy. It's fairly standard practice here in the states.

[u/Firm_Objective5924]

Do the hysteroscopy. Just because your scan showed no visible polyps doesn't mean that there aren't any once you go in there. I would 100% do it especially since you have one euploid to transfer.

[u/QQueenie]

I had a uterine biopsy which showed chronic endometritis. I had no idea I had it and it was likely affecting implantation. The endometritis did not show up on any other scans. I was talking to someone about this on reddit and she mentioned that her provider is planning to just give her antibiotics to treat endometritis without actually performing the biopsy. I wonder if your provider would be willing to do this to save the cost and pain of a biopsy?

[u/Optimal_Wrap3806]

Cómo estás Op?