Diagnostic Procedures – Finding Out What’s Wrong

Testing for Fallopian Tube and Uterine Abnormalities

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.

POST-COITAL TEST (PCT)

The post-coital test (also known as a Huhner) is an excellent means of assessing the interaction of the sperm and the cervical mucus.

In order to reach the fallopian tube and fertilize an egg therein, the sperm must first migrate through the cervical mucus.

There are many factors which can impair the ability of the sperm to survive and traverse the cervical mucus, including infection, prior surgery on the cervix, and production of antibodies (substances that can kill or immobilize the sperm).

During a normal menstrual cycle, there are only a couple of days during which the sperm can survive in the cervical mucus. At other times of the cycle the mucus is a very effective barrier. Around the time of ovulation, the cervical mucus becomes very thin and watery and probably even somehow assists the sperm as they migrate through to the uterus and on to the fallopian tube.

The quality of the cervical mucus as well as the number of sperm present and their motility will be assessed. The timing of this test is, therefore, crucial and must be done within 12 hours after Intercourse.

The post-coital test is an important part of the evaluation of difficulty conceiving. If it is not normal, other evaluation or therapy may be suggested.

SPERM ANTIBODY TESTING (INDIRECT IBT)

Is used to rule out the presence of sperm antibodies in female partner’s serum. May be drawn at anytime during the woman’s cycle.

ENDOMETRIAL BIOPSY

A procedure by which a sample is taken of the endometrial lining of the uterus, shows evidence of ovulation and degree of maturation of the uterine lining, and can reveal uterine cancer, uterine fibroids, uterine polyps, and adenomyosis.

This test also reveals if the woman has a luteal phase defect – a hormonal imbalance which prevents a woman from sustaining a pregnancy because not enough progesterone is produced.

The test is typically performed 1-3 days before onset of woman’s menstrual flow.

HYSTEROSCOPY

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.

MICROLAPAROSCOPY

A new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal.

If this procedure is appropriate for your condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.