The uterus or womb plays an important role in fertility. It is where the embryo (baby) implants and grows. Having a good environment to grow and nurture the baby is important. No matter what type of fertility treatment is performed, including IVF and donor egg, having a normal uterus is important. Issues such as polyps, fibroids (myomas), and adhesions can interfere with the ability of the embryo to implant and/or grow. Below are some of the tests that can be performed to evaluate the uterus.
Pelvic or transvaginal ultrasound
When most people think of ultrasound they think of having a probe placed on their abdomen to take a look at the baby inside of the uterus. If the probe is placed on the abdomen it is called a transabdominal ultrasound. The good news is that most of our patients will have a transabdominal ultrasound in the near future and see their baby. In order to achieve this goal, we may have to use transvaginal ultrasound to explore the reasons for infertility.
Pelvic or transvaginal ultrasound is where a specialized probe is placed in the vagina to “look" at the pelvic organs. Because the probe is placed inside the vagina this type of ultrasound is often referred to as an internal ultrasound.
The reason we do an internal ultrasound is because the closer the ultrasound probe is to the organs we are looking at the better the images. So if the probe is fairly far away from the uterus, as it is with transabdominal ultrasound, the images are poor. However, if the probe is right next to the uterus, as it is with transvaginal ultrasound, then the images are much better. The better the images are the more accurate a diagnosis we can make. That is why we do transvaginal not transabdominal ultrasound.
Transvaginal ultrasound gives us a lot of information about the uterus, endometrium, fallopian tubes and pelvis. Ultrasound can help us visualize fibroids (myomas), polyps and sometimes hint at adhesions inside the uterus. Using the ultrasound we can determine the size and location of any of the above issues. This can help us determine if there is uterine factor infertility. Transvaginal ultrasound can also help determine the thickness of the lining of the uterus (the endometrium) which can also play a role in infertility.
If the transvaginal ultrasound is abnormal further testing may be helpful. These tests may include saline contrast ultrasound, hysteroscopy and or laparoscopy.
Saline contrast ultrasound
A saline contrast ultrasound (also known as a saline infused sonogram (SIS) and sonohystogram (SHG)) is a specialized ultrasound that helps us visualize the internal cavity of the uterus.
When a standard transvaginal ultrasound is done the uterine cavity is collapsed. For a saline contrast ultrasound a little catheter is placed in the uterine cavity. Then saline is infused into the uterine cavity through the catheter. This causes the uterine cavity to open up.
Once the uterine cavity is open (distended) we can see very nicely the internal details of the uterine cavity (the womb). We can determine if there is anything (such as a polyp or fibroid) that is affecting the cavity itself. Since anything that affects the uterine cavity can play a role with infertility, this test can be very helpful.
The test is done in the clinic and usually only involves minimal discomfort.
Hysteroscopy is a specialized test to evaluate the uterine cavity (womb). This test can be done in our office (no incision is needed) and usually only involves minimal discomfort. Hysteroscopy is considered the “gold standard” or best test for evaluating the uterine cavity.
The hysteroscopy is done by taking a very small camera and threading it through the cervix and into the uterus. The cervix has a natural opening so no incision is made and patients can go home after the procedure. Once in the uterus, saline is used to open (distend) the cavity.
The cavity is then directly visualized. We can see if there is anything (such as a polyp, fibroid or adhesions) that is affecting the cavity itself. Anything that affects the cavity can play a role in infertility.
During the procedure we can also determine if surgery is needed to correct any problems found. If corrective surgery is needed it can usually be done on an outpatient basis with an operative hysteroscopy.
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