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The physician will document that your tubes and uterus are free of obstruction with a hysterosalpingogram. This procedure is conducted at the hospital radiology department as an outpatient procedure.
A small catheter is used to inject die into the uterus. The movement of the dye is monitored by X-ray from the uterus through the fallopian tubes. If there is a tubal blockage, it is seen as a “collection of dye” which appears as a “white mass” before the blockage and very little dye is seen past the blockage. The shape, length, and condition of the fallopian tubes can be assessed.
The HSG also allows visualization of the inside of the uterus making polyps, fibroids, adhesions, or congenital abnormalities visible.
The hysteroscopy involves filling the uterus with carbon dioxide gas (or other special media) causing it to expand. The hysteroscope is inserted through the vagina into the uterus allowing close examination. Congenital abnormalities such as a uterine septum, fibroids, polyps, and adhesions may be seen, and can be repaired by a reproductive endocrinologist. (See section on reproductive surgery. )
The sonohysterogram is another means to evaluate the uterus (but not the Fallopian tubes). In this procedure, the uterus is filled with saline solution causing it to expand. The vaginal probe ultrasound (ultrasound probe inserted into the vagina) is used to visualize the uterus. The contrast media (saline solution) makes conditions such as fibroids and polyps visible.
The ultrasound is a valuable tool used during the infertility evaluation and for monitoring the growth of ovarian follicles. The vaginal probe ultrasound allows the physician to visualize the ovaries, follicles, endometrium and other internal structures. The size and number of follicles is measured, and medications are adjusted accordingly (also depending upon other factors such as estrogen levels).
The endometrium must become more vascular and thicken during the ovulatory cycle. The vaginal probe ultrasound is used to measure endometrial thickness, which is a function of its development. Other conditions such as congenital uterine malformations are also visible via ultrasound. Ultrasound is also used to document pregnancy by visualizing the developing fetus.
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