Transvaginal ultrasound examinations allow the physician to check the endometrial lining, measure the length and diameter of the uterus, and check for many ovarian or uterine abnormalities, but is not a very good test to evaluate the inside of the uterine cavity or the patency of the fallopian tubes. An “intra-uterine” and tubal evaluation is essential to every fertility evaluation.
INTRA-UTERINE AND TUBAL EVALUATION METHODS
A hysterosalpingogram (HSG) allows the physician to check for blockage or damage to the fallopian tubes or growths inside the cavity of the uterus. Fortunately, the doctors at ARCH have performed thousands of HSG’s to evaluate the uterine cavity and fallopian tubes. During this test, an iodine-based contrast fluid is injected into the uterine cavity and tubes. X-ray pictures are taken over the abdomen of the dye filling the cavity and tubes. It is an excellent exam to determine the caliber of the fallopian tubes and their patency as well as the general shape of the uterine cavity. It only does a fair job of evaluating the inside of the uterine cavity, sometimes missing subtle or small cavitary abnormalities.
Saline infusion sonohysterography (SIS) is an excellent test to reveal the presence of intra-uterine abnormalities if your history suggests it is warranted. SIS is an ultrasound procedure performed to assess the presence of uterine polyps or fibroids or abnormalities of the shape of the uterine cavity.
The doctors at ARCH perform this test a little differently than most programs. During this test a gentle catheter is inserted into the uterine cavity and normal saline is infused into the cavity while a transvaginal ultrasound is performed. Usually a balloon is inflated to hold it in place. At ARCH we have found that this balloon even when deflated at the end of the procedure can hide some filling defects in the lower part of the uterus, so we use a different type of catheter without a balloon. These defects can make it more difficult to conceive and can cause bleeding during a procedure. The added benefit is that the procedure is usually more comfortable than catheters that have a balloon.