Fertility Ultrasound Tests for Structural Problems
Because various conditions in the uterus and ovaries may contribute to female factor infertility, Dr. Douglas may suggest a transvaginal ultrasound, a painless procedure often included as part of a routine fertility workup. Using a probe, Dr. Douglas can visualize the uterine cavity and search for signs of polyps, fibroids, or other uterine abnormalities. On the day of LH surge, we utilize ultrasounds to measure the thickness of the endometrium, monitor follicle development, and assess the condition of the uterus and ovaries. For example, a thin endometrial lining may indicate a hormonal problem. With a transvaginal ultrasound, we can often detect fibroid tumors, abnormalities of the uterine shape, ovarian cysts, and in some cases, endometriosis.
A sonohysterogram, or a saline infusion sonogram, is an ultrasound of the uterine cavity performed after injecting a sterile saline solution vaginally through the cervix directly into the uterus. Dr. Douglas generally recommends this procedure for female patients who are having trouble conceiving. During a sonohysterogram, the saline expands the uterine walls so that Dr. Douglas can more easily identify abnormalities.
With advances in techniques and diagnostic machines, sonohysterograms offer a good first look inside the uterus. Once the uterine walls are visible, Dr Douglas can use the ultrasound probe to look at structures in the uterus. To get the best view of the uterine walls, Dr. Douglas will time the sonohysterogram at a specific point in a patient’s cycle so that the uterine lining is as thin as possible.
With a sonohysterogram, Dr. Douglas can often diagnosis problems relating to:
- Abnormal vaginal bleeding due to polyps and fibroids
- Recurrent miscarriages
- Uterine abnormalities such as a uterine septum or bicornuate uterus
Patients usually tolerate saline sonohysterogram better than hysterosalpingograms (HSGs), and this scan is not a surgical procedure like a hysteroscopy. Some saline leakage and light spotting may occur afterward. Mild over-the-counter pain relievers such as Advil or Tylenol will alleviate any discomfort.
During a hysterosalpingogram (HSG), an x-ray procedure, a doctor injects a liquid, dye-like solution injected through the cervix so that he can view the inside shape of the uterus and fallopian tubes. The HSG is done with the patient awake and requires no IV sedation. It is done as an out patient procedure and the patient is able to leave immediately. An HSG can cause moderate cramping and mild discomfort, but over-the-counter pain relievers such as ibuprofen or acetaminophen will relieve any soreness. At IVF Plano, some patients are treated with an oral antibiotic, doxycycline prior to the procedure if there is a history or a previous pelvic infection.
The results from an HSG study, can tell Dr. Douglas whether the tubes are open or damaged, and whether the uterine cavity appears normal. Sometimes, an HSG may provide a small increase in fertility because the dye solution potentially “flushes out” the system and allows for better movement of the egg through the tubes. However, this temporary correction only appears to impact fertility for two to three menstrual cycles after the HSG.