Diagnostic imaging of female internal structures can help fertility specialists determine the causes of infertility
The pelvic sonogram is often performed early in the evaluation to allow examination of the internal pelvic structures such as the uterus and the ovaries. The tubes are usually not clearly visible on sonogram unless they are abnormally dilated with fluid (hydrosalpinx). Sonograms performed during the first 3 days of the cycle can also give an assessment of the egg reserve. When the ovaries have a total of 6 or fewer antral follicles, the chance of pregnancy is significantly reduced.
The sonohysterogram (sonoHSG) involves instilling a saline solution into the uterus through a thin catheter placed within the cervix. As the uterine cavity is distended with fluid, a sonogram is performed to look for any irregularity in the uterine contour. The sonoHSG is good for detecting lesions such as polyps or submucous fibroid tumors. However, it is not very reliable for detecting abnormal configurations of the uterine chamber or checking the patency of the tubes.
The hysterosalpingogram (HSG) can provide a better assessment of the shape of the uterine cavity while also providing helpful information about the tubes. A radiographic dye is injected into the uterus through the cervix while X-ray imaging of the pelvis is conducted. As the dye fills the uterus it provides a detailed contour of the uterine surface and can reveal polyps, fibroids, adhesions and various forms of congenital uterine anomalies.
The dye subsequently travels through the tubes and eventually spills into the pelvic cavity. In cases of tubal occlusion, the HSG can also indicate the extent of the tubal abnormality. A severely damaged tube, for example, can appear dilated as a hydrosalpinx. The HSG can occasionally cause intense uterine cramping that closes the tubes and gives a false impression of tubal occlusion.
Because it outlines only the internal surfaces of the uterus and tubes, the HSG cannot reliably detect abnormalities that reside within the pelvis such as endometriosis and adhesions. The HSG is usually performed after the cessation of menses (on day 7-10). An antibiotic (Doxycycline) is taken 1-2 days prior the HSG to prevent infection.
Hysteroscopy is a procedure in which a small camera attached to a thin scope is introduced into the cervix to directly inspect the uterine cavity. The examination can be performed easily in the office to confirm suspicious HSG findings before surgery and usually takes only 10 minutes.
Laparoscopy is usually the final diagnostic test in the infertility investigation. Under general anesthesia, a fiber optic scope is inserted into the abdominal cavity via small incisions to allow examination of the pelvic and abdominal organs. Laparoscopy can help to diagnose endometriosis and pelvic adhesions, conditions not detectable by the HSG. Abnormalities found can often be corrected in the same setting.