This video demonstrates the use of diagnostic hysteroscopy in a 43-year-old woman with primary infertility, thickened endometrium, and a suspected endometrial polyp. During hysteroscopy, the surgeon identifies abnormal hypervascular and polypoidal endometrium with irregular vascular patterns suggestive of possible malignancy. The procedure then proceeds with Manual Vacuum Aspiration (MVA) to remove the abnormal tissue while preserving the basal endometrium. The surgeon explains why MVA is often preferable to curettage or immediate resectoscopic surgery in selected patients. The video provides valuable insights into hysteroscopic diagnosis, fertility-preserving tissue removal, and evidence-based intraoperative decision-making.