Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
What are endometrial polyps, and how do they affect fertility?
Endometrial polyps are benign overgrowths of the inner uterine lining. They are single or multiple, range from a few millimetres to several centimetres, and are among the most common findings when the uterine cavity is investigated for infertility. Many polyps cause no symptoms at all and are found incidentally; when symptoms occur they include irregular spotting between periods, unusually heavy periods, or post-coital bleeding.
Polyps can mechanically occupy and distort the cavity, impair sperm transport, or create a localised inflammatory environment that reduces endometrial receptivity. Even small polyps have been associated in some studies with reduced implantation rates in IVF, which is why removal before embryo transfer is generally recommended by fertility specialists regardless of size. Polyps are removed hysteroscopically — a procedure called polypectomy — performed under direct vision during hysteroscopy as a day-case procedure. See the hysteroscopy page for how the procedure is carried out and what recovery involves.
Symptoms to note: abnormal uterine bleeding; spotting between cycles; post-coital spotting; difficulty conceiving without another identified cause.
What is a uterine septum, and why is it associated with miscarriage?
A uterine septum is a congenital anomaly in which a band of fibrous or muscular tissue extends downward from the fundus (top) of the uterus, partially — or, rarely, completely — dividing the uterine cavity. It forms during embryonic development when the two Müllerian ducts, which normally fuse to create a single uterine cavity, fail to resorb the midline tissue fully. A uterine septum is the most common Müllerian anomaly and the one most strongly linked to adverse pregnancy outcomes, particularly first-trimester and second-trimester miscarriage.
The mechanism is not entirely understood, but the fibrous septal tissue is poorly vascularised (has limited blood supply) and does not respond normally to hormonal changes during the cycle. An embryo that implants on or near a septum may not receive adequate blood supply to sustain early placentation. Additionally, a large septum physically reduces the available cavity volume. The uterine septum is also associated with preterm delivery and malpresentation.
Importantly, a uterine septum can be present without any symptoms whatsoever — many women are diagnosed only when investigating recurrent pregnancy loss or repeated failed IVF transfers. Three-dimensional ultrasound, HSG, or MRI may raise the suspicion, but hysteroscopy combined with laparoscopy (to assess the external uterine contour and distinguish a septum from a bicornuate uterus) is considered the reference standard for definitive characterisation.
The treatment is hysteroscopic septum resection — also called metroplasty — in which the septum is divided under direct vision using fine scissors or an electrosurgical resectoscope, restoring a single unified cavity. This is performed via hysteroscopy; the procedure itself, recovery, and timing before conception or embryo transfer are described there. Because uterine septum is a leading structural cause of recurrent miscarriage, it is evaluated as part of the workup described on the recurrent pregnancy loss page.
In Marathi, conditions affecting the inside of the uterus are commonly referred to as गर्भाशयातील अडथळे — obstacles within the uterus — a term patients in the Vidarbha region may encounter in consultation.
What is Asherman's syndrome (intrauterine adhesions), and how does it cause infertility?
Intrauterine adhesions — known as Asherman's syndrome when the condition causes symptoms or fertility problems — are bands of scar tissue that form inside the uterine cavity. The adhesions replace normal endometrium with non-functional fibrous tissue, reducing the surface available for implantation. In severe cases, the cavity is partially or fully obliterated.
Causes: Asherman's syndrome is almost always acquired rather than congenital. The most common trigger is instrumentation of the uterus, particularly:
- Dilation and curettage (D&C) after miscarriage, termination, or for retained products of conception — the risk is highest when performed in the context of infection or immediately postpartum.
- Myomectomy or caesarean section if the endometrial cavity is inadvertently entered.
- Endometrial ablation (intentional destruction of the lining for heavy bleeding).
- Uterine tuberculosis — in regions of India where TB remains prevalent, including parts of Vidarbha, uterine TB is an important cause of intrauterine adhesions and must be actively excluded in any woman with a relevant history or unexplained infertility.
Symptoms: The classic presentation is a progressive reduction in menstrual flow (hypomenorrhoea) or complete absence of periods (amenorrhoea) after a uterine procedure — the cycle disappears because the functional endometrium has been replaced by scar tissue. Cyclic pelvic pain without bleeding may occur when complete cavity obliteration traps menstrual blood (haematometra). Recurrent pregnancy loss and implantation failure in IVF are also presentations of Asherman's syndrome — making it relevant both to the recurrent pregnancy loss workup and to the recurrent implantation failure workup.
Diagnosis: Diagnostic hysteroscopy is the definitive investigation — it directly visualises adhesion extent, density, and location, and permits simultaneous treatment. 3D ultrasound or MRI can suggest the diagnosis but are less sensitive for mild disease.
Treatment: Hysteroscopic adhesiolysis — division of the adhesions under direct vision — is performed via hysteroscopy. Post-operative management to prevent re-formation typically includes oestrogen therapy, intrauterine balloon or spacer placement, and serial follow-up hysteroscopy. Severe Asherman's syndrome may require multiple procedures; outcomes depend on the extent of original endometrial damage. In cases of underlying uterine TB, anti-tubercular therapy is administered before and alongside surgical treatment. Earlier diagnosis and treatment, before extensive scarring consolidates, is generally associated with better cavity restoration.
How do submucosal fibroids affect the uterine cavity?
Submucosal fibroids are uterine fibroids (smooth-muscle benign tumours) that grow beneath the endometrial lining and project into the uterine cavity, either partly (types 1 and 2) or entirely (type 0). Unlike intramural or subserosal fibroids, which sit within the muscle wall or on the outer surface of the uterus, submucosal fibroids directly disrupt the cavity environment. They can distort the cavity shape, impair sperm transport, compress the tubal ostia, and create a local inflammatory or vascular environment that reduces implantation.
For a full discussion of uterine fibroids — their classification, medical management, and the spectrum of surgical options — see the uterine fibroids condition page. This page focuses on their cavity-level impact. The specific treatment for submucosal fibroids projecting into the cavity is hysteroscopic myomectomy — resection under direct vision via hysteroscopy.
How is the uterine cavity assessed before IVF or fertility treatment?
A normal uterine cavity is a prerequisite for successful embryo implantation. Before IVF or frozen embryo transfer, confirming that the cavity is free of structural pathology is a routine and important step. The investigations available are:
Transvaginal ultrasound (TVUS): The standard first-line investigation. It can detect larger polyps (as echogenic intracavitary lesions), submucous fibroids, and gross cavity distortion, and is used routinely to assess the endometrial lining thickness and trilaminar pattern in the follicular phase. Small polyps and thin adhesions may be missed.
Saline infusion sonography (SIS / sonohysterogram): Sterile saline is instilled into the cavity through a fine catheter and a transvaginal scan is performed simultaneously. The fluid outlines the cavity walls, making small polyps, synechiae (adhesions), and minor distortions visible that a standard TVUS would miss. It is more sensitive than TVUS alone for intracavitary lesions and is a useful step before proceeding to hysteroscopy.
Hysterosalpingography (HSG): A fluoroscopic X-ray investigation in which contrast dye is instilled through the cervix. HSG provides a cavity outline and also assesses fallopian tube patency in a single procedure — see HSG. It has lower sensitivity than hysteroscopy for intracavitary lesions, and filling defects require correlation with hysteroscopy.
Diagnostic hysteroscopy — the reference standard for the cavity: Direct telescopic visualisation of the uterine cavity is the reference standard investigation. It provides an unambiguous view of the cavity lining, any polyps, septum, adhesions, or fibroid projections, and allows biopsy where indicated. When a lesion is found, hysteroscopy combines diagnosis and treatment in a single procedure — this is its major clinical advantage. For how the hysteroscopy procedure itself is performed, see hysteroscopy.
3D ultrasound and MRI: 3D ultrasound adds an axial (coronal) plane that standard 2D TVUS cannot provide, helping characterise cavity shape and identify a uterine septum or bicornuate uterus. MRI is reserved for complex cases where cavity anatomy needs detailed mapping before surgery.
When should uterine cavity conditions be investigated?
The uterine cavity should be assessed when there is a clinical reason to suspect a structural problem is affecting fertility, pregnancy, or bleeding. Common indications include:
- Recurrent pregnancy loss — two or more miscarriages prompt investigation for a uterine septum, adhesions, or other cavity pathology. See the recurrent pregnancy loss page for the full workup.
- Recurrent implantation failure in IVF — repeated failure of good-quality embryos to implant warrants hysteroscopic assessment of the cavity. See the recurrent implantation failure page.
- Abnormal uterine bleeding — irregular spotting, heavy periods, or post-coital bleeding in a woman trying to conceive should prompt cavity assessment to exclude polyps.
- Before IVF or frozen embryo transfer — confirming the cavity is clear, particularly in women with a history of prior uterine surgery, D&C, or previous failed transfers.
- History of uterine surgery or infection — any history of D&C, myomectomy, or known pelvic TB raises the likelihood of intracavitary pathology.
- Subfertility with no other obvious cause — when semen analysis, ovarian reserve, and tubal patency are normal, the uterine cavity is the next structure to assess formally.
A fertility assessment with Dr. Shweta Agarwal will determine which investigations are appropriate based on your history.
Why does a normal uterine cavity matter specifically before IVF?
Even a single missed intracavitary lesion can be the difference between a successful and a failed IVF cycle. When embryos are transferred into the uterus during IVF, the cavity must be smooth and receptive — the embryo has no mechanism to navigate around a polyp, implant on scar tissue, or attach to the avascular fibrous tissue of a septum. Pre-transfer cavity assessment, and treatment of any abnormality found, is part of optimising the uterine environment before transfer. For couples who have had repeated failed transfers, cavity pathology is one of the structured investigations in the recurrent implantation failure workup.
Treatment costs for uterine cavity procedures depend on the investigation and treatment required. Hysteroscopy typically ranges from ₹20,000 – ₹25,000, and 0% EMI options (3–24 months) are available. Final cost depends on individual clinical evaluation — see Costs & EMI for current pricing.
When should I consult a specialist about a uterine cavity problem?
Consult Dr. Shweta Agarwal if:
- You have had two or more miscarriages and have not had a uterine cavity assessment.
- You have experienced two or more failed IVF transfers with good-quality embryos.
- Your periods have become significantly lighter, shorter, or have stopped after a uterine procedure (D&C, myomectomy, or similar).
- You have irregular spotting, heavy periods, or bleeding between cycles without explanation.
- You are planning IVF and have not had a cavity assessment, particularly if you have a history of prior uterine surgery.
- An ultrasound has suggested a possible polyp, fibroid, or septum but no further evaluation has been done.
- You have a history of pelvic tuberculosis or live in a TB-prevalent area with unexplained infertility.
At Aansh Hospital & IVF Center, cavity assessments including saline infusion sonography, diagnostic hysteroscopy, and operative hysteroscopy are performed in-house. You can verify our ART registration and find location information at our Chandrapur center page.