Baby, Pregnancy, and Parenting Information

Diagnostic Procedures

Diagnostic Procedures in fertilitySeveral tests performed by your doctor or reproductive endocrinologist will help diagnose the cause for your infertility. We already covered the tests your partner will go through in the section titled “Visiting Your Doctor.”

The tests for you range from very simple in-office tests no more invasive than a PAP smear or ultrasound to surgical procedures.

Post Coital Test
During the Post Coital Test the doctor takes a sample of your cervical mucus. The doctor will examine the cervical mucus under a microscope to determine if it is hospitable to sperm.

Timing is everything with this test; it must be performed four to 10 hours after sex when just prior to, during, or immediately following ovulation (i.e., your fertile period, or the time of your cycle when you should be able to conceive.) Use an ovulation predictor kit to be certain, although you can certainly use other timing methods, including tracking BBT (Basal Body Temperature) and cervical mucus.

Do not:

  • Use lubricant during sex
  • Douche after sex
  • Bathe or swim after sex (a shower is okay)

The doctor will take a small sample of cervical mucus and examine it for:

  • Quantity – There should be more plentiful amounts during your fertile period;
  • Consistency and clarity – It should be very thin and clear and also very stretchy, almost rubbery;
  • Ferning – Under a microscope, the doctor should see a fern-like pattern in the dried cervical mucus, indicating the presence of estrogen without progesterone hormones;
  • Cellularity – Few cells, other than sperm, should be present.

If any of these factors show problems, this could be the reason you are having difficulty conceiving. The doctor may recommend artificial insemination by means of intrauterine insemination in order to bypass the cervix all together.

However, the number one reason this test fails is poor timing; if the test was not done four to 10 hours after intercourse or was not done while you were ovulating, then the cervical fluid may not show a favorable environment for sperm to survive, swim and fertilize an egg. If this is suspected to be the case, a second test should be performed at the time of ovulation.

Other causes for an unfavorable cervical environment include:

  • Infection or irritation. If this is the cause, testing will show white blood cells in the mucus.
  • Procedures performed on the cervix to treat an abnormal Pap smear, such as freezing or laser treatment.
  • Medications. Clomid (generic: clomiphene) a fertility drug used to treat infertility caused by anovulation, can have adverse affects on cervical mucus. If your doctor prescribes the drug or increases your dosage, he should perform a post-coital test to be sure the cervical environment is still hospitable to sperm.

Ultrasound
Most people think of ultrasounds as a non-invasive, painless procedure performed on pregnant women in order to see the unborn baby. True, an ultrasound can determine the gender, size (give or take 2 pounds), and often the general health of a fetus, but it can also give a doctor information about why you haven’t been able to conceive yet.

Your doctor will use an ultrasound to evaluate the condition of your ovaries and fallopian tubes, and check for cysts, tumors and uterine fibroids. He will be looking for Polycystic Ovarian Syndrome, endometriosis, and anything else that may be impairing your ability to get pregnant. An ultrasound can show the doctor if your eggs are developing properly and are being released from the ovaries and if the endometrial lining thickens sufficiently to permit implantation.

An endometrial biopsy is used to detect cancerous cells, precancerous cells, infections or any abnormalities that may be affecting your ability to conceive. The doctor inserts a thin catheter, called a pipelle, into the uterus and uses it to draw out cells for testing.

You may experience mild to intense cramping during and after the test. The doctor may recommend you take ibuprofen, such as Motrin or Advil, before and after the test to minimize cramping, or he may offer a prescription painkiller. You may have minor bleeding following the test.

You should take a pregnancy test prior to an endometrial biopsy since the procedure may terminate a very early pregnancy.

Hysteroscopy
A hysteroscopy is an out-patient procedure performed that will allow your doctor to spot abnormalities in the uterus such as:

  • fibroid tumors
  • polyps
  • scar tissue

A hysteroscope is a very thin telescope with a camera on the end that can enter the cervix with no dilation. The uterus is expanded by means of saline solution or carbon dioxide, permitting the doctor to view the inside on a television monitor in the office. Minor cramping may result from the introduction of saline or carbon dioxide into the uterus, but the procedure is not considered especially painful.

Falloposcopy
Cleared by the U.S. FDA (Food and Drug Administration) in 1997 for use to diagnose fallopian tube blockages in women trying to conceive, falloposcopy is regarded as a relatively new and complicated procedure. However, since nearly 35 percent of all female infertility cases are related to fallopian tube damage, this procedure may be invaluable in determining the cause of infertility. Your doctor will probably order less invasive tests first, however, including an ultrasound.

Because the fallopian tubes are located so deep within the reproductive system, past diagnostic procedures carried a 40 percent rate of false diagnoses. The STARRT Falloposcopy procedure, patented by Conceptus, Inc., shows a much greater accuracy rate.

The procedure takes about 45 minutes and is performed with local anesthesia or intravenous sedation. Another benefit of the test is that tubes can be repaired at the same time, with the same equipment, if the doctor finds any abnormalities. Tubal repair can take as long as two hours and your doctor will use a general anesthesia. If abnormalities are found but the tubes cannot be repaired, your doctor will discuss the possibility of in vitro fertilization with you and your partner.

Similar to a hysteroscopy, a falloposcopy views the inside of the fallopian tubes by means of a camera inserted into the body. It enters through a catheter that travels through the cervix and uterus and finally, into the fallopian tube. A fiber optic endoscope with a camera on the end is then inserted through the catheter, so the doctor can view images on a television monitor in the office.

Risks include infection and bleeding, so your doctor may prescribe an antibiotic as a preventative measure.

Laparoscopy
Laparoscopic surgery is an advance in medical technology which permits diagnostic surgery through a very small incision, into which a thin instrument (laparoscope) is inserted in order to take pictures of the abdomen. Carbon dioxide is used to expand the abdomen, permitting the doctor with a clear view of the uterus, cervix, and ovaries and fallopian tubes on a television monitor in his office or in the operating room.

Doctors in the late 20th century commonly recommended this diagnostic procedure in couples trying to conceive. Today, however, other procedures are recommended first. Although laparoscopy is simpler and safer than traditional surgery with a full-size incision, it is still surgery, and often performed under general anesthesia. Rarely does a laparoscopy turn up any abnormalities not spotted by other fertility screening tests.

Hysterosalpigogram (HSG)
According to the Advanced Fertility Center of Chicago, a hysterosalpigogram is a common infertility diagnostic procedure that is helpful in detecting tubal infertility. Since 25 percent of all infertility is caused by tubal abnormalities, this test may be an important one. Less invasive than a laparoscopy, top fertility clinics makes it part of its basic fertility screens.

The test is performed in the radiology department of the fertility clinic, hospital or medical center between days six and 13 of the patient’s menstrual cycle.

Dye is injected into the uterine cavity, through the vagina and cervix. If the fallopian tubes are normal, the dye should spill out into the abdominal cavity. If there is a tubal blockage, the dye will stop at that point. The X-rays will be available for evaluation that day.

An HSG test also detects:

  • uterine anomalies
  • polyps
  • fibroid tumors
  • uterine scar tissue
  • tubal defects
  • scar tissue around the fallopian tubes

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