Evaluation of our Female Patient
Our basic female infertility evaluation consists of several tests.
Pelvic Ultrasound
The evaluation of the female starts with a pelvic ultrasound. This is a noninvasive method for evaluating the uterus and ovaries by using high frequency sound waves rather than x-rays to show what is inside your body. Because the body contains over 90% water, sound can be used just as sonar is used in the ocean. Each time the sound hits a tissue interface, like a blood vessel, an echo is sent back. Sophisticated, high-speed computers can use these echoes to create a picture of your internal organs. Ultrasound carries little risk or discomfort while producing clear images that enable the physician to count any mature follicles present and examine the endometrium. Fibroid tumors and ovarian cysts can be diagnosed as well.
Sonohysterography
Sonohysterography, or saline contrast hysterography, is a diagnostic test involving the use of saline as a contrast agent inside the uterine cavity. This contrast is visualized by vaginal ultrasound. The contour of the endometrial cavity can be assessed using this technique. Many uterine abnormalities can be identified by this method. There is usually no discomfort with this procedure.
This is a procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized. This procedure allows us to determine whether there are any defects such as Fibroid tumors, polyps, scar tissue, a uterine septum, or other uterine problems inside the cavity.
Laparoscopy
About 40% of infertile women whose initial Fertility work-up is unrevealing will demonstrate abnormal tubal or uterine findings on a laparoscopic examination. Laparoscopy requires two small incisions (one at the navel and one above the pubic bone). Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away. The laparoscope, a hollow tube equipped with a tiny camera, lenses, and a fiberoptic light source, is inserted through the umbilical incision. A probe is then inserted through the second incision allowing the physician to directly view the outside surface of the uterus, fallopian tubes, and ovaries. Endometriosis, pelvic scar tissue, and blockage at the ends of the fallopian tubes can all be identified using laparoscopy. Some of these conditions can be corrected during the procedure by cutting away any scar tissue that may be binding organs together or by destroying endometrial implants. The procedure is usually done under general anesthetic and the wound itself is minimally painful.