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Laparoscopy
The laparoscopy is a common outpatient
surgical procedure that allows the physician to view
reproductive organs such as the tubes, ovary, and uterus,
and diagnose conditions causing infertility including endometriosis
and tubal
blockage. 
The laparoscope is a small "telescope
like" instrument that is placed through a small incision
in the abdomen, usually at the belly button. Small operative
tools are inserted through another small incision at the
pubic hairline. The laparoscope usually does not produce
noticeable scarring. The abdomen is filled with gas causing
it to expand making the internal organs more accessible.
Reproductive
surgeons undergo extensive advanced microsurgical
training with the laparoscope. They are able to perform
many, if not most, fertility operations using the laparoscope,
which dramatically reduces recovery time, pain cost,
and adhesions/scarring. Fertility specialists will
usually treat conditions such as endometriosis during
the diagnostic laparoscopy. This is one reason that
a specialist should perform the laparoscopy when infertility is suspected.
Hysteroscopy
The hysteroscopy is an important
tool in the study of infertility, recurrent miscarriage,
or abnormal uterine bleeding. Diagnostic hysteroscopy
is used to examine the inside of the uterus, also known
as the uterine cavity, and is helpful in diagnosing
abnormal uterine conditions such as internal fibroids,
scarring, polyps, and congenital malformations.
A hysterosalpingogram (an x-ray
of the uterus and fallopian tubes) or an endometrial
biopsy may be performed before or after a diagnostic
hysteroscopy. The first step of diagnostic hysteroscopy
involves slightly stretching the canal of the cervix
with a series of dilators. Once the cervix is dilated,
the hysteroscope, a narrow lighted viewing instrument,
similar to but smaller than the laparoscope, is inserted
through the cervix and into the lower end of the uterus.
Carbon dioxide gas or special clear
solutions are then injected into the uterus through
the hysteroscope. This gas or solution expands the uterine
cavity, clears blood and mucus away, and enables the
physician to directly view the internal structure of
the uterus. Diagnostic hysteroscopy is usually conducted
at HRC and local anesthesia is a possibility. Diagnostic
hysteroscopy is usually performed soon after menstruation
because the uterine cavity is more easily evaluated
and there is no risk of interrupting a pregnancy. A
mock transfer or trial transfer may also be done at
this time.
Ultrasound
Ultrasound measurements
have many applications in the infertility evaluation
and are also used for monitoring during in
vitro fertilization stimulation cycles. The transvaginal
ultrasound (through the vagina) is used frequently because
it allows the physician to view the ovaries, uterus,
and many other internal organs.
The ultrasound produces images similar
to an x-ray; however, sound waves are used instead of
radiation. Many times dense structures, such as uterine
fibroids, are clearly visible on transvaginal ultrasound.
The ultrasound is also able to show the follicles on
the ovaries as they develop and are ovulated. The fertility specialist must know the number and size of the follicles during
drug-stimulated IVF cycles as this information helps in
adjusting medication dosages.
Ultrasound is used to measure
the width of the endometrium, which must thicken and
become more vascular to accept a developing embryo.
It is also used as a means to document pregnancy by
visualizing the fetal heartbeat.
Additional Fertility Tests
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