Radiology provides investigative tools to help in the diagnosis of female infertility.
Trans-Vaginal Ultrasound – A trans-vaginal ultrasound is an internal scan that gives a more detailed look at the uterus, ovaries, cervix and fallopian tubes. A transducer ultrasound probe is placed into the vagina and transmits a picture to a television screen. The doctor will be able to see different areas of the pelvic region by moving the probe.
It can be used to diagnose the source of any unusual vaginal bleeding (in between periods), pelvic pain, ovarian cysts, fibroids, uterine cancer and pelvic inflammatory disease. It can look at the shape of the uterus. An irregular shape may be a cause of pelvic pain or infertility as it could impede the growth of a foetus.
If the woman has had IVF it can also be used to locate the position of the baby in the uterus and make sure it is not in the tubes (an ectopic pregnancy). It can also be used to see if an early embryo has a heart beat. This provides reassurance after assisted reproduction or when a woman has had a history of miscarriage.
A trans-vaginal ultrasound is usually painless but it can feel uncomfortable if the woman has a gynaecological condition or infection or if she is tense.
Hysterosalpingogram – A hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. It is used in conjunction with a dye that is put through the uterus and fallopian tubes. If the dye cannot move through, this highlights a blockage in the tubes. It can also illuminate any injury to the area.
The test is carried out by placing a catheter through the cervix and into the uterus. X-ray dye is then put into the catheter. If there is nothing blocking the fallopian tubes, it will then flow through them. The dye’s path is shown on the TV screen.
To reduce cramping during the procedure, a painkiller can be taken. A sedative can also be given to keep the patient comfortable. It is normal to experience mild discomfort that feels like period pains afterwards.
If the hysterosalpingogram shows that the fallopian tubes are blocked, depending on the type of blockage a laparoscopy may be advised.
Blockage to the tubes prevents the egg from reaching the uterus and prevents conception. However, it may be treated with laparoscopic (keyhole) surgery. It can be performed to remove a hydrosalpinx (a fluid filled fallopian tube) to improve IVF success rates, to re-build damaged ends of the tube to allow the fimbriated ends to pick up the egg normally (known as fimbrioplasty) or to repair diseased parts of the tube.
If an ectopic (tubal) pregnancy is discovered, it can be removed via laparoscopy. Removal is necessary due to the life-threatening risk of tubal rupture and excessive blood loss. Sometimes it is possible to preserve both fallopian tubes and safeguard the woman’s fertility. In other cases, the tube will have to be removed as well.