Diagnosis and Treatments

Fertility Testing For Women

At Fertility C.A.R.E. our first goal during your initial visit is to place you at ease. Before we begin testing, we explain our approach to your care and answer any questions you may have. We take time to explain your reproductive anatomy and any factors that may be contributing to a fertility problem. We believe knowledge is power!

Following a thorough medical interview, we offer you a comprehensive physical examination and pelvic ultrasound. At the conclusion of your visit we outline a thorough infertility work-up to determine the cause of your fertility problem. The evaluation may include:

Endometrial Biopsy

An endometrial biopsy is a minor office procedure and involves placing a small catheter through your vagina into your uterus to remove a small sample of the lining (endometrium) for microscopic examination. Common reasons for performing this test are to evaluate abnormal uterine bleeding to determine if your lining is over-developed (endometrial hyperplasia), to detect the presence of an important protein needed for embryo implantation (integrin), and to calculate if the lining is being prepared correctly by your hormones to receive the embryo or deficient (luteal phase defect). Test results are usually available within ten days.

Hormonal Studies

A hormone is a steroid in your blood produced from one organ and having its function on other parts of the body. Female hormones (estradiol and progesterone) fluctuate based on your menstrual cycle and are involved in the development of eggs, ovulation, and implantation of the embryo in the uterus. For this process to occur effectively, hormones must be produced in a specific amount and time. . Other reasons for testing include evaluation of ovarian age, thyroid and adrenal gland function. Levels are measured by a blood sample in the office.

Hysterosalpingogram (HSG)

A hysterosalpingogram (HSG) is a specialized office x-ray procedure that determines if the fallopian tubes are open and if the uterus is of normal shape.

The HSG is performed following completion of your menstrual flow and before ovulation -- usually between cycle days 6-12. An antibiotic is prescribed to reduce the risk of infection. Ibuprofen (Motrin, Advil) is usually taken 30 minutes prior to the test to minimize cramping. The procedure involves placing a small catheter through your vagina and into the cervix to inject a small amount of contrast dye and observe the liquid filling the uterus and flowing through the tubes. Please inform your doctor if you are allergic to contrast dye, iodine, seafood/shellfish to avoid an allergic reaction to the HSG dye.

Please view these photos of a normal hysterosalpingogram and a blocked fallopian tube.

Laparoscopy

Laparoscopy is an outpatient surgical procedure to view the pelvic organs by using a small, lighted telescope (laparoscope) inserted through the abdomen at the belly button. This procedure is used to diagnose and treat problems such as blocked fallopian tubes, endometriosis, ovarian cysts, or adhesions (scar tissue) all of which may impact fertility.

A laparoscopy is performed under general anesthesia. After you are asleep, a needle is inserted through your belly button and the abdomen is filled with carbon dioxide gas. The gas pushes the internal organs away from the abdominal wall so the telescope and any necessary instruments can be used in the cavity to treat your condition.

When surgery is complete, the gas is removed from your abdomen, the incisions are closed, and you are taken to the recovery room. When the effects of anesthesia have worn off you may return home and continue your recovery for a few days prior to resuming activity and work. A two-week post-operative follow-up appointment will be scheduled prior to surgery.

Take a look at these photos (caution: contains graphic images) of a normal laparoscopy and a blocked fallopian tube.

Hysteroscopy

Hysteroscopy is a method of examining the inside of the uterus using a small, lighted telescope (hysteroscope). Conditions that can be treated by hysteroscopy include fibroids, uterine scarring, polyps, and congenital malformations.

A diagnostic hysteroscopy can be done in our office during menstrual cycle days 6-12. A tiny, flexible, lighted telescope is passed into your vagina and through your cervix into the uterus. A small amount of saline is injected through the scope to allow for better visualization of the uterine cavity. Images of the uterine cavity will be projected on a monitor so you can watch. If abnormalities are discovered, an operative hysteroscopy will be scheduled. The procedure normally takes less than 5 minutes and involves minimal to no cramping.

An operative hysteroscopy is performed under sedation or general anesthesia. Anesthesia is required because your cervix must be dilated to allow instruments into your uterus to correct conditions such as removal of scar tissue, polyps, or congenital abnormalities such as a uterine septum.

Ultrasound

Ultrasound is a method to view your reproductive organs using high frequency sound waves that bounce off of body structures to create pictures on a monitor. The method most commonly used in fertility practices is transvaginal ultrasound. This refers to a probe that has been covered with a condom and placed into the vagina for close proximity to the pelvic organs.

Transvaginal ultrasound (TVUS) is used to diagnose conditions such as ovarian aging, uterine fibroids, ovarian cysts, or early pregnancy. During your fertility treatment cycles, TVUS is used to monitor development of follicles (cysts containing microscopic eggs) and during the egg retrieval of an In-vitro Fertilization (IVF) cycle to help the physician guide a needle into the follicles and retrieve eggs.