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Infertility/Fertility/Hysteroscopy - Lidocaine Injection


I'm 38 from Vancouver, suffering from unexplained infertility. I've had a cancelled IUI (failure to respond to drugs), and two back-to-back chemical pregnancies in the last six months from IVF #1 and #2. We have eight frozen embryos and have started our first FET.

Our RE has recommended that I undergo a hysteroscopy, which I will have on the same day as my baseline ultrasound for FET #1.

Reluctantly, I will have local anaesthesia instead of general anaesthesia. I'm quite stressed, because my last egg retrieval under twilight sedation was painfully memorable--the two "pinches" the doctor suggested I would experience felt long and horrible.

I can't opt for the general anaesthesia because of time: the procedure would be completed at a hospital rather than my doctor's office and not available for some time. I feel I'm too old to wait, and need to keep moving with FET #1. Therfore, I'm sticking to local anaesthesia.

Question: I need an honest answer about what to expect from four lidocaine injections to my cervix. I will be given an Atavin and Oxycodone before the procedure (but I have no idea about dosages). Will the Oxycodone make it easier to cope with the injections?

I'm honestly not focused on the camera or the saline; I suppose because of the egg retrieval I'm feeling very stressed and anxious about the lidocaine injections. And I can't really get an answer from my clinic.

Please help me--even if it's not what I want to hear. I haven't been able to sleep properly in two weeks. Your feedback would be greatly appreciated.

Hello Tracy from Canada,

My answer will probably be inadequate for you because my technique is different.

First, I do hysteroscopy as a prerequisite to doing IVF.  I want to know before I do the IVF that there are no abnormalities in the most important part of the IVF process, the endometrial cavity.

Second, I use a very small flexible scope and therefore the pain is minimal.  For that reason, I only give my patients a little Toradol (a strong Motrin like drug), but no other sedation or anesthesia. In general, the procedure takes 5 minutes or less.

I do know that patients have told me of extreme pain with hysteroscopies in doctor's offices that use a straight 5 mm scope with a paracervical block (local anesthesia# and some mild sedation.  The pain is usually a cramping pain that is caused from cervical stretching due to the requirement to dilate the cervix (with my scope, I don't have to dilate the cervix).  The paracervical block helps a little but not completely.  The narcotic, Oxycodone will help with the pain, so hopefully, the combination will be adequate.  In the old days, I used to do D&C's (dilation and curettage) for miscarriages in the emergency room using mild sedation such as valium (sedative) with fetanyl (narcotic) without the paracervical block and patients tolerated it just fine.  Hopefully, yours will be tolerable as well, but you need to expect that there will be some pain and discomfort.  If they find something and have to remove it, that moves you into an operative hysteroscopy and you will need anesthesia for that.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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