Initial Consultation
This is the first time that we get to know more about you and your specific problems.
We take detailed noted about your medical and surgical history and any tests that
you might have undergone in the past. This helps us to avoid putting you though
unnecessary investigations.
Blood tests like FSH and LH (to check the egg producing ability of your ovaries),
Prolactin (to check for any hyperprolactinaemia) and TSH (to rule out thyroid problems).
Ultrasonography Scan to look at your womb(uterus) and ovaries. Ultrasonography helps
in diagnosing any obvious tumours and also polycystic ovaries. The scan is always
done via the trans vaginal route as it gives the most accurate information.
Follicle Tracking may be done to follow the development of the follicle and to check
if the egg is coming out.
This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected
into your uterus, and an X-ray is taken to determine whether the fluid progresses
out of the uterus and into your fallopian tubes and general peritoneal cavity. Blockage
or problems often can be located and may be corrected with surgery. However it has
its limitations that it cannot comment on the health of the tubes. Sometimes the
tubes may be open but may be wrongly analyzed by HSG as blocked due to spasm of
the mouth of the tubes.
It is the best possible method to evaluate the patency of the fallopian tubes as
well as find out if there are any other problems involved. Performed under general
anesthesia, this procedure involves inserting a thin viewing device into your abdomen
and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision
(8 to 10 millimeters) is made beneath your navel, and a needle is inserted into
your abdominal cavity. A small amount of gas (usually carbon dioxide) is inserted
into the abdomen to create space for entry of the laparoscope - an illuminated,
fiber-optic telescope.
The most common problems identified by laparoscopy are endometriosis and scarring.
We can also detect blockages or irregularities of the fallopian tubes and uterus.
A blue dye is injected into the cervical canal and through the uterus and fallopian
tubes to determine whether they are open. At the end of the procedure, the gas and
laparoscope are drawn out and the incision is closed. Laparoscopy offers far more
information than a hysterosalpingogram and it also helps in making a clear separation
between patients who can benefit from IUI and those who can benefit from IVF. Laparoscopy
generally is done as a "Day Care" procedure, that is you can go back home the same
day and resume normal work and acitivities.
Similar to Laparoscopy, this procedure is done to see the insides of your womb to
diagnose conditions like polyps, etc. which are usually missed by Ultrasonography.
It gives information about the health of the inside of the womb (uterus). In case
of isolated blockage of just the inner ends of the tubes, fine cannula can be passed
via a hysteroscope to remove the blockage. Laparoscopy should ALWAYS be accompanied
by Hysterescopy as it can be done in the same sitting and reduces the overall cost
of the procedure while providing a host of information which is vital.
Although this test was once a standard, basal body temperature charting is used
less often today. Charting a woman's body temperature doesn't give as precise time
of ovulation as earlier believed.
A number of at-home kits are available to test your LH level. Although these kits
may be helpful, they also can be inaccurate and misleading. They are usually used
along with Ultrasonography Follicular studies to try and predict the time of ovulation
more accurately.
This involves inserting a catheter inside the uterine cavity and injecting saline
or a special dye . Ultrasonography and Doppler studies are used to track the flow
of saline through the uterine cavity and fallopian tubes and can provide vital information.
It is intermediate in information between hysterosalpingogram and laparoscopy. It
does not require anaesthesia.
Once a favourite form of investigation to detect ovulation, it has now been abandoned
as non invasive and simple tests like Ultrasonography can detect ovulation avoiding
complications of anaesthesia and infection which do more harm than good. Endometrial
biopsy has a role only as a accompaniment with Hystero laparoscopic procedure especially
when Tuberculosis is suspect.
Not everyone needs to undergo all, or even many, of these tests before the cause
of infertility is found. Which tests are used and their sequence depend on discussion
and agreement between you and our consultants.