Hysterosalpingogram: This is a test done to look at a woman's fallopian tubes and the structure of her uterus. The fallopian tubes are the egg passageway between the ovaries and uterus. If the fallopian tubes are blocked, from scarring or other causes (possibly fibroids or other growths), the egg will not come into contact with sperm. If the uterus is an abnormal shape, (e.g., a heart-shaped or rabbit's head bicornate abnormality) the egg may not be able to attach to the walls and the fetus may not grow correctly.
This test will require going to the hospital or a doctor's office with the necessary x-ray equipment. This procedure involves putting dye into a woman's vagina and then taking an x-ray. The x-ray shows the path of the dye as it travels up the woman's reproductive tract. In a normal woman the dye will demonstrate a circular shaped uterus and two open fallopian tubes. Abnormalities include when the dye fails to get into one of the tubes because it is blocked, or when the dye outline in the uterus shows anatomical abnormalities, fibroids (non-cancerous growths of tissue), or other masses.
During the test the doctor uses a speculum (the same instrument used for pap smears) to access the cervix (the opening that leads from the vagina to the uterus). Prior to the introduction of dye, the doctor will clean the cervix and inside of the vagina. The doctor may also use a clamp to stabilize the cervix while s/he inserts a small plastic tube into it. A tiny balloon is then inflated to keep the cervix open to allow an injection of the dye into the uterus, then the x-rays are taken. During the procedure, you may feel some pressure and cramping. The doctor may have you take antibiotics, and will likely check for infections, such as gonorrhea and chlamydia, before undertaking this test.
There are risks involved with this procedure including infection, bleeding and allergic reaction. It is normal to have spotting and mild cramping after the test. However, if the bleeding is heavy or it is accompanied by severe cramping or fever, women should call their doctor immediately. A small minority of women can experience an allergic reaction to the dye used for the procedure. Doctors can treat these reactions with medication. Most likely, the doctor or nurse will observe you for 20 to 30 minutes after the procedure to watch for signs of allergic reaction.
Laparoscopy: Historically, laparoscopy was a common part of infertility evaluations. Currently, it is used in a minority of cases and is less common. Laparoscopy involves putting a surgical camera through an incision in the abdomen. This camera allows doctors to look at the uterus, fallopian tubes, and ovaries, as well as for conditions such as endometriosis (tissue from the uterus that is growing outside the uterus). Laparoscopy can also help to diagnose pelvic masses, scar tissue, and anatomical abnormalities. On occasion these abnormalities can be treated using laproscopic surgery, which involves putting in an additional 'port' through another incision in the abdomen. A surgical instrument is then placed in the pelvis to remove problem tissues.
Laparoscopy is usually conducted in a hospital setting, but it can also be done in specialized physician offices. Usually laparoscopy is an outpatient surgical procedure, meaning that you typically will not have stay overnight. Doctors will often use general anesthesia ( you will be asleep during the procedure), but local anesthesia is also used. Complications are rare, but possible. They include damage to organs, such as the bladder and urinary tract, the possibility of needing open surgery, infection, bleeding, and anesthesia-related complications. If you undergo laparoscopy you will need to rest for a few days after the procedure. Moderate pain at the incision sites and inside the abdomen is not uncommon for up to one week after the procedure. Heavy bleeding, fever, or other severe symptoms should be reported to a doctor immediately.
During the potentially exhausting round (or rounds) of tests and medical procedures that are used to diagnose infertility, you may start to feel like a human "guinea pig". It is important to stay healthy during this time, as you are likely "prepping" for fertility procedures. Getting adequate rest, and practicing other healthy behaviors such as proper eating, exercise, and stress management can help you cope physically during these tests. Making use of your social supports is also important in order to maintain emotional health.
