Most infertility evaluation tests must be done at particular times during the menstrual cycle. Fertility treatment is seldom employed until the investigation is complete because it is necessary to rule out all potential causes. For example, it does no good to treat the female if there is an undiagnosed male problem. Read about Male Fertility Tests.
When would I need an internal “camera exam”?
Your fertility doctor has suggested that you should get an endoscopic examination as part of your testing for infertility. What does that mean?
Endoscopy is the blanket term for a set of micro-surgeries that include laparoscopy and hysteroscopy – the two most common forms of micro-surgical examination performed in the diagnosis and treatment of infertility. Endoscopy involves the insertion of a miniature video camera with a cold light source into the abdomen. Using this method, your doctor can examine the condition of your internal organs easily, as the images from the camera are displayed larger than life on a video screen.
These are some of the conditions that endoscopy allows your doctor to diagnose and treat. This is not a comprehensive list, as there may be other conditions in addition to these:
- Polycystic ovary syndrome (PCOS)
- Fibroid tumors
- Adhesions and scarring
- Structural abnormalities of the uterus or fallopian tubes
Using endoscopy in combination with forms of endoscopic surgery, a doctor can remove scar tissue and tumors, free adhesions, remove endometrial growths, repair existing abnormalities, and perform reconstructive surgery to reverse tubal ligations. Similar techniques are used when implanting fertile eggs after in vitro fertilization.
Your doctor is first likely to recommend some form of diagnostic endoscopic procedure. After the normal barrage of blood, urine and tissue testing, along with the evaluation of your medical history, but before extensive surgical procedures are planned, endoscopy can allow a doctor to fine tune a diagnosis or clarify and perfect a plan for treatment. Once clear images have been gathered, you and your doctor can work together to decide the very best choice of treatments to give you the outcome you hope for. If endoscopic surgery is your next step, you will have already experienced the ease and fast recovery that is associated with the technique.
When preparing for an endoscopic examination or more extensive endoscopic surgery, you should be aware of the basic procedures. You will be expected to fast prior to your operation, and will be most likely to receive general anesthesia, though some professionals are exploring the possibilities of local anesthetics. Medications should be reviewed with your doctor carefully before your operation, including regular prescriptions, dietary supplements, and specific medications prescribed in relation to your surgery or post-surgical recovery.
You are most likely to have endoscopy as an out-patient procedure. More extensive endoscopic surgery may be an out-patient procedure or may involve a brief in-hospital stay, depending on the extent and risk of the surgery involved and the length of the operation. Expect to spend an additional two or three days at home recovering, in low-exertion rest. There are few risks ordinarily associated with endoscopy and endoscopic surgery: most patients will suffer little more than soreness and aches, in part from the pressure caused by carbon dioxide gas used to inflate the abdomen to provide ease of viewing and surgical motion. This can take a few days to wear off as your body absorbs the gas: the pressure and extension can cause a feeling of bloating, pains in the shoulders, and general soreness.
Hysteroscopy is a method of visually examining the interior of the uterus using a fiber-optic light source and a video camera on a slender probe that your doctor inserts through your cervix – the small opening leading from your vagina to your womb. Your doctor is likely to have suggested a hysteroscopic examination as a way of checking your uterus for physical abnormalities that may be interfering with your comfort, your health, or your fertility.
Hysteroscopy is one of the two main forms of endoscopy used in fertility medicine, along with laparoscopy. Unlike laparoscopy, it doesn’t involve actual surgical penetration of your body. Your doctor will be able to use the natural entries of your body for a basic examination. If further surgical treatment is needed that will include laparoscopy or laparoscopic surgery, your doctor will discuss that with you before taking those steps.
Hysteroscopy does involve the distension of the uterus, using either carbon dioxide gas or any of several fluids, including simple sterile saline solutions. This inflation of your uterus is done to convert your uterus temporarily to a cave or chamber that can be easily lit and examined. This is much more easily done when the uterus is full and extended than when it is folded in on itself like a closed fist.
Conditions that are likely to require hysteroscopy or hysteroscopic surgery are:
- Fibroid tumors
- Abnormal formation of the uterus
- Repair of damage from infections, surgeries or spontaneous abortions and miscarriages
The primary value of hysteroscopy and hysteroscopic surgery in infertility treatment involves physical conditions that actively interfere with the ability to carry a child to term. Unlike endocrine imbalances, infections, or genetic damage, the problems found and treated using hysteroscopic techniques generally involve clear and direct interference: tumors that prevent implantation, or even block fertilization, scarring and damaging to the uterus, polyps and other tissue intrusions on or in the uterus.
Ordinary hysteroscopy can be an in-office procedure, just as ultrasound can be in-office. Because it doesn’t involve actual surgical penetration, there is seldom need to perform the examination in a hospital or clinic. More extensive procedures may occur either in the office or in the hospital, depending on the extent expected. For major repair, removal of tumors or uterine restructure, there is a good chance your doctor will want you to spend a day or two under professional observation just to be sure no secondary complications develop.
Recovery from hysteroscopic surgery is most likely to be fast and problem free. While your doctor may take additional precautions, this is seldom because difficulty is expected. Hysteroscopic surgery is minimally invasive, involves little risk, and under most circumstances does little related damage. You should expect to spend a few days at home after your hospital stay. Your doctor will want you to rest, and keep your exertion level low until your body has had a chance to recover from the stress of surgery.
Laparoscopy is a form of surgery in which a lighted camera is inserted through a small incision in the abdomen, allowing your doctor to look at your internal organs on a television screen. It is first and foremost a diagnostic technique; however, a doctor can also use associated techniques to perform a variety of small, minimally invasive surgeries. The advantage is that these techniques don’t require a major incision; as a result, they are much, much safer for the majority of patients when they can be used. In infertility treatments, laparoscopy and laparoscopic surgery may provide you with vital information and treatment, while allowing you to take smaller risks and have minimal recovery time from surgery.
In spite of these benefits, laparoscopy remains a form of invasive surgery. It uses a small “keyhole” incision rather than the much larger cuts needed for standard surgery, but the abdomen is still penetrated. After the original penetration, carbon dioxide will be pumped into your abdomen, inflating it to create a chamber that can be lit, studied, and manipulated using micro-surgical instruments. Your body will later absorb the carbon dioxide without effect beyond stretching, aches and soreness from the balloon-like inflation.
Laparoscopy is among the final tests your doctor is likely to suggest, and you are unlikely to undergo this form of surgery unless your doctor is convinced that the technique will help with a firm diagnosis and with treatment later. This surgery is used most often to diagnose and treat such physical conditions as endometriosis, scarring of the reproductive organs, adhesions, fibroid tissues, and abnormality of the ovaries, fallopian tubes, and uterus. These conditions can be most precisely diagnosed through direct visual means, and treated with surgical repair and removal.
• Laparoscopy is micro-invasive, but still involves penetration of the abdomen.
• It is a diagnostic tool, allowing your doctor to visually examine your organs without opening you up with a major incision.
• It can be used with related laparoscopic surgical techniques to remove abnormal tissue and make repairs to reproductive organs.
If your doctor has suggested laparoscopy, you should be ready to undergo a true surgical procedure. Your doctor will offer pre-surgical instructions, including information on when to begin a pre-surgical fast and how to manage any medications involved in your daily care or required for the surgery. The laparoscopy will take place under general anesthesia. You are likely to go home the same day as the surgery, but should expect to spend several more days in rest and recovery.
• Expect to prepare for a true surgery.
• Be sure to check with your doctor whether you will return home, or spend a night in the hospital.
• Be sure to make arrangements to deal with two to three days of convalescence even for a purely diagnostic surgery.
• If your surgery is likely to include further micro-surgical work, be sure to discuss the details of your post-operative convalescence with your doctor, so you can best prepare for your recovery.
Using ultrasound to diagnose the problem
You have probably seen an ultrasound “portrait” of a friend or relative’s growing baby at some time in your life. You may even have experienced an ultrasound yourself. But knowing what ultrasonography is, how it works, and when to use it can expand your understanding of the choices you and your doctor will be making as you work together to deal with a wide range of fertility issues.
Ultrasonography is almost identical to radar and sonar systems, differing primarily in the frequency of the sound waves used. Ultrasound uses very slow, low-frequency sounds that pass through the body in different ways. These sounds, when processed by an interpreting device, can provide the information to show the interior of the body, just as a dolphin’s sonar can help the dolphin “see” the obstacles around it in deep or murky water. So an ultrasound technician will work to position a sound source in or near one portion of your body, a receiver in or near another portion, and will then take frame shots of the images created from the sounds received, illustrating much of your interior workings to provide information for your doctor.
There are two primary methods of using ultrasound for forms of infertility diagnosis. Abdominal ultrasound doesn’t involve any form of penetration by a sensor, but does involve the annoyance of a full bladder, which serves to shift the placement of the bowels making it easier for the ultrasound technician to get good views of your uterus. This is the form of ultrasound used in pregnancy to track fetal growth and development, but it is also used to detect fibroid growths, endometrial growths, and other abnormalities that can cause infertility.
Intervaginal ultrasound lacks the discomfort of the full bladder, but does add the need to insert a sonic probe into the vagina. This is not uncomfortable, but many women find it a bit embarrassing. It is necessary because it allows the technician to get a more exact image of the fallopian tubes and ovaries.
Your fertility specialist is likely to call for ultrasound tests fairly often over the course of infertility therapy. Ultrasound serves as both a diagnostic tool and as an imaging tool during various forms of treatment, allowing the doctor to be sure of correct placement and results as work proceeds.
Conditions commonly diagnosed with ultrasound include:
You and your doctor together can determine many things about your health and the overall health of your reproductive system using ultrasound. However, it can’t determine everything about your organs: there is a lack of resolution you will have noticed in trying to make out the baby in an ultrasound fetal portrait. Your doctor will be very likely to use many additional tests and methods of examining your interior as you work together to find solutions to your fertility problems. Don’t be surprised to find ultrasound suggested regularly throughout your infertility therapy, along with many other forms of testing.