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Diagnostic ProceduresWhile the cause of a couple's infertility may be diagnosed solely on the basis of laboratory tests, and may be treated successfully with drug therapy, there are many other potential causes that may also warrant investigation.When structural abnormalities in the woman such as tubal disease, myomas or endometriosis are suspected, several additional tests and procedures may be required to identify the infertility factors. Some of these procedures may involve outpatient surgery. Such diagnostic procedures provide the physician with the comprehensive information necessary to accurately assess the structure, condition and function of the reproductive organs. Several of the diagnostic procedures we perform include: Hysterosalpingography (HSG)The HSG is one of the primary tests used to reveal tubal or uterine problems contributing to infertility. Conveniently performed at our clinic, the procedure has two steps.. First, a dye is injected into the uterine cavity. Then a series of x-ray pictures are taken. As the dye moves through the organs, the physician can assess the condition of the cervical canal, uterus and fallopian tubes. LaparoscopyThis is an outpatient surgical technique used for diagnostic purposes and for the treatment of certain diseases or conditions. Performed under general anesthesia, laparoscopy involves making a small incision, usually through the navel, to minimize scarring. The abdominal cavity is then observed through the laparoscope, a long tube with a light and lens system for viewing the intra-abdominal organs. Conditions such as tubal disease, adhesions (scar tissue), endometriosis, or the location of cysts or tumors can be accurately diagnosed. If an abnormality or disease is found, specialized instruments or lasers may be employed to correct the problem at the time of diagnosis. Additional small incisions in the lower abdomen may make it possible to remove adhesions, cysts or endometriosis, or even open obstructed fallopian tubes. A diagnostic laparoscopy examination typically takes less than one hour and causes only mild discomfort for a day or two. Operative laparoscopy can take two or more hours, but still only causes mild discomfort for a day or two. HysteroscopyHysteroscopy is also an outpatient procedure. But unlike laparoscopy, it does not require an abdominal incision. The cervix is dilated and the uterine cavity is distended with fluid. The hysteroscope is passed through the cervix and permits the examination of the inside of the cervix and uterus. It is particularly useful in the diagnosis of adhesions (scar tissue) within the uterus as well as fibroid tumors or polyps. These conditions can usually be treated at the time of the initial hysteroscopy. Transvaginal UltrasoundTransvaginal Ultrasound is a technique which enables the physician to visualize your ovaries and uterus during ovulation and pregnancy by using sound waves. The ultrasound probe is placed in the vagina. It gives off an intermittent, high-pitched sound out of the normal hearing range, which is reflected off the pelvic organs. These echoes are recorded and a picture is created on a TV screen/monitor. The transvaginal ultrasound is used to monitor the growth of follicles in the ovary throughout the cycle, and to confirm ovulation. It is also used to check for an intrauterine pregnancy, and is very helpful in ruling out ectopic pregnancies and in diagnosing other pelvic disorders. The procedure is usually painless. Post-Coital TestA sample of mucus is removed from the cervix at the time of ovulation. The couple is asked to have intercourse on the preceding evening or that morning. The gross characteristics of the mucus are noted. It is then examined microscopically observing the quality of the mucus and the number of sperm and their motility in the mucus. The test determines whether adequate mucus is being produced at the time of ovulation and whether sperm are entering and surviving in the mucus. Endometrial BiopsyA small sample of the lining of the uterus is removed a day or two before menses is expected. The specimen is obtained by passing a plastic tube through the cervix into the uterine cavity. Suction is applied and the tube is removed. The resulting small piece of tissue is then examined microscopically. The procedure may cause cramping. This procedure is used to diagnose abnormal cellular changes of the uterine lining which may be associated with abnormal bleeding. It is also sometimes used to look at the development or maturation of the lining in patients with infertility or recurrent pregnancy loss. SonohysterographyThis is an office procedure which evaluates the uterine cavity for polyps, fibroids or scar tissue. A catheter is placed into the uterus and fluid is injected while transvaginal ultrasound visualizes the cavity. Antisperm Antibody TestingDetects the presence or absence of antibodies on the sperm surface,
particularly useful in case of a vasectomy reversal or with a history of
testicular injury or infection.
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