Evaluation of the Uterus and Fallopian Tubes
The fallopian tubes are organs leading from each upper corner of the uterus to the area of the ovary on each side. Each fallopian tube is about 10 cm in length with finger-like structures at the end called "fimbria" that are involved in capture of the oocyte ("egg") after ovulation. The lining cells of the tube have many functions including nutritional secretion for maintenance of the oocyte and facilitation of the fertilization process. The dividing fertilized egg ("preimplantation embryo") travels through the fallopian tube into the uterus approximately five days after fertilization at which time the uterus should be adequately prepared by the ovarian hormones to receive the embryo for implantation and continuation of the pregnancy.
In order to evaluate the patency of these fallopian tubes, we perform a test called hysterosalpingogram or HSG. This test is usually performed between 2-7 days following the end of the menstrual period. In order to schedule the test, we ask the patient to call the office on day 1 of her menses so it will give our team a time to schedule the procedure with the Radiology Department. The patient is instructed to take 600-800 mg Ibuprofen two hours before the procedure to prevent cramping. The procedure is performed under fluoroscopy to allow the gynecologist, radiologist, and assistants to visualize the uterine cavity and fallopian tubes during injection of a radio-opaque medium. The hysterosalpingogram has been very valuable in showing the uterine cavity, the presence or absence of polyps, fibroids, and other abnormalities of the uterine cavity including a septum. It also shows the length of the fallopian tube and any abnormalities in the form of stenosis or obstruction. The data that we get from such test are very valuable for the management of infertility.
The patient returns home after the procedure. This is usually followed by an appointment in the office to review all the results of the work up that has been completed and the proposed management.
Laparoscopy is another procedure that is used to evaluate the pelvic cavity including the uterus, tubes, and ovaries. This is usually done under anesthesia in the operating room. The procedure may identify conditions such as endometriosis, uterine fibroids, tubal disease, including adhesions. During laparoscopy we will always be able to treat many of these conditions and thus we have accomplished both diagnosis and management of factors leading to female infertility.
Hysteroscopy (HSG) is another procedure in which an endoscope is introduced into the uterine cavity through the cervical canal. This is also done under anesthesia. This usually evaluates any lesions inside the cavity of the uterus; i.e. submucous fibroids and polyps that interfere with infertility and could be easily treated. Another condition is uterine septum which divides the uterine cavity and leads to recurrent miscarriages and premature deliveries. We usually resect that septum hysteroscopically using a special type of laser or unipolar or bipolar electrodes. By doing hysteroscopic surgery for these conditions, we avoid any incisional scar in the wall of the uterus. Thus, this allows these patient, when they achieve pregnancy, to deliver vaginally unless there is an obstetric indication for cesarean section