The uterus should ideally be free of tumors (fibroids) that are large and/or near the endometrium, which is the site of embryo attachment. Additionally, the tubes should be free of obstruction and freely mobile in order to capture an egg efficiently. A combination of tests may be necessary to fully evaluate all of these factors.
Pelvic (transvaginal) ultrasound is commonly performed at the first visit. The purpose of the ultrasound is to exclude the presence of uterine tumors, ovarian cysts, and estimate the number of eggs contained within the ovaries (preantral follicle count).
Hysterosalpingogram (HSG) is a radiological study that allows for contrast dye to be injected through a small catheter into uterus and fallopian tubes. This exam evaluates the uterine cavity for shape/structure of the uterine cavity (rules out congenital anomalies), assesses for the presence or absence of tumors and endometrial polyps, and demonstrates patency of the fallopian tubes.
Sonohystogram (SIS) is performed by way of pelvic ultrasound combined with some saline instilled into the uterine cavity through a small catheter. This allows for evaluation of the uterine cavity from several angles and views to observe for potential filling defects consistent uterine polyps or fibroids .
Blood work can aid in the diagnosis of potential cause(s) of infertility as well as assess for optimal maternal health preconceptually. Generally, appropriateness of specific labwork is determined after careful consideration of patient factors and determined in consultation with a clinic provider.
Infertility Testing can include the following:
These conditions can be more severe for pregnant women who contract them, and there is a small risk to health of the fetus if mother contracts these infections during pregnancy; should labwork indicate non-immunity to one/both of these conditions, often times it is recommended to consider vaccination outside of pregnancy
Based on your individual history or findings on ultrasound or HSG, an outpatient procedure called a laparoscopy and/or hysteroscopy may be recommended. Documentation of a normal anatomical relationship between the tubes and ovaries can be accomplished by laparoscopy. Laparoscopy directly visualizes the structures via a fiberoptic telescope placed through the abdominal wall. This outpatient procedure investigates whether endometriosis or scar tissue (adhesions) is present preventing the egg from efficiently traveling from the ovary to the fallopian tube. If these abnormalities are present, they are typically efficiently treated at the same time in an effort to restore the anatomy to a more normal state. This is best scheduled after menses but before ovulation. Oftentimes, a hysteroscopy (visual examination of the interior of the uterine cavity via a fiberoptic telescope) is done at the same time. Laparoscopy and hysteroscopy are not always necessary with the initial evaluations unless your medical history strongly implies endometriosis or scar tissue as likely contributing factors to infertility.