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Diagnostic Procedures

Diagnostic Procedures
• Post Coital Test
• Ultrasound
• Hysteroscopy
• Endometrial Biopsy
• Falloposcopy
• Laparoscopy
• Hysterosalpingogram (HSG)

Post Coital Test

The Post Coital Test involves a sampling of your cervical mucus between four to ten hours after you and your partner have intercourse, to determine whether the mucus in your cervix is "hostile" to is sperm.

With this particular test - timing is everything, since only mucus during your ovulation period isn't usually deemed hostile. This, of course, involves a visit to your physician so a sample of your mucus can be taken and be examined for the evidence of live sperm.

If you are using an ovulation predictor kit, this kit will be the determining factor as to when you will have intercourse. Remember, to have sex that MORNING ,and do not use any lubricants, douche - or bathe (a shower is acceptable) and be sure and contact your physician to schedule a time to come in after intercourse.

Once in the doctors office, you will be examined with a spectulum with a small amount of cervical mucus being withdrawn from your cervix. This will then be examined under a microscope and the doctor will be looking for some of the following characteristics:

1. Ferning - When the cervical mucus dries on a microscope slide, it should take on the appearance of ferns. This assures that the mucus has been exposed to adequate levels of estrogen without any exposure to progesterone. In other words, that the timing is correct.

2. Amount - Cervical mucus production normally increases dramatically just prior to ovulation.

3. Clarity - It should be very clear, almost watery.

4. Cellularity - There should be relatively few cells present, other than sperm.

5. Spinnbarkeit - This is the stretchiness of the cervical mucus. It should be almost elastic and may stretch 10 cms or more.

If your results are poor after the post coital test, there may be several reasons:

1. Infection - The lining of your cervix could be irritated or infected. This is indicated by the presence of white blood cells in the mucus.

2. Poor timing - This is the most common reason that a post-coital test is unsatisfactory. This test has to be performed right before ovulation occurs, when the cervical mucus is at it's best.

3. Prior procedures on the cervix - Procedures which can result in a poor post coital test could include freezing and/or laser to the cervix, lleetz or leep procedures and cervical conizations, all of which are performed to treat abnormal Pap smears.

4. Medications - The most common of is clomiphene. Clomiphene can dramatically impair cervical mucus quantity and quality and anyone on clomiphene, or anyone who has had her dose of clomiphene increased, should have a post-coital test checked.

Ultrasound

Ultrasounds are excellent not just during pregnancies, but on women who are trying to conceive. These tests usually reveal information about tumors and cysts, evaluating the gallbladder and related organs, and for noninvasive evaluation of vascular disease.

Your physician will always give you specific direction on how he or she may want you to prepare for your exam. As always, it is important to follow their instructions to the letter in ensuring the most accurate diagnostic results that can be determined.

Hysteroscopy

This procedure allows your physician to determine whether there are any abnormalities such as fibroid tumors, polyps, scar tissue, a uterine septum, or some other uterine problem.

This procedure is an out-patient procedure that is done in a hospital or your physicians office. The actual procedure takes 2-5 minutes - and no anesthesia is needed for most cases of diagnostic hysteroscopy if a microhysteroscope is used. If operative work is required, then general or local anesthesia is used.

If you have this procedure, you normally are discharged home approximately 15-30 minutes after the procedure is done.

Return to work or resuming your normal daily activities by the next morning if general anesthesia was used, or immediately if no anesthesia (or local) was used, is the norm. Mild pain and cramping is common after operative hysteroscopy, but it usually is brief (lasting perhaps 30 minutes, possibly up to 8 hours).

Endometrial Biopsy

The endometrial biposy is performed to determine if the lining of your uterus is sufficiently developed and can support pre-embryonic implantation. This procedure is performed by a thin flexible catheter is entered into the uterus, and a small piece of tissue is removed.

There will be heavy cramping, since the catheter is a foreign entity of sorts, entering into your body, so you will feel cramping during this procedure. It takes a minute, maybe less to perform, and you will be given over the counter Advil or maybe prescription pain killer for the cramps. After this procedure, the tissue sample is sent to the lab for results to determine whether your uterus is sufficiently developed.

Falloposcopy

The falloposcopy is a visual exam of the inside of the fallopian tubes. This involves the insertion of a tiny catheter through the cervical canal and into the uterus to the fallopian tubes. It is then , an even smaller fiber optic endoscope is threaded through the catheter, into the fallopian tube. From here, the your fallopian tubes can be examined on a monitor from which a camera is attached on the outside end of the fallopscope.

This procedure takes anywhere from thirty to forty-five minutes to perform. The falloposcopy is sometimes followed by tubal reconstructive surgery, which extends the time to one - two hours.

The benefits of having this procedure done can be determined from the many abnormalities it detects from inside the fallopian tubes. These abnormalities include obstruction of the tubes, scar tissue, and damage to the inner lining. Your physician will be able to begin treatment immediately - once specific abnormalities - if any - are discovered. If determined that damage is too severe - it is then that In Vitro Fertilization is considered to be the next logical step.

Laparoscopy

The laparoscopy is an instrument which looks like a miniature telescope with a fiber optic system which brings light into the abdomen. It is has the circumference of a fountain pen and twice the length. This instrument is placed in the vagina and carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier your physician to see your reproductive organs during this procedure. The gas is removed at the end of the procedure.

The newest laparoscopy is a microlaparoscopy. This is a new diagnostic procedure which uses telescopes and instruments that are much smaller than normal.

This new procedure is said to revolutionize diagnostic laparoscopy. It's been compared to advances in electronics where computers are now a fraction of their original size, and similar advances in surgical instrumentation now offer new opportunities to diagnose and treat surgical diseases.

Hysterosalpingogram (HSG)

This test is done in your radiology department, where radiographic dye is injected into your uterus vaginally. Your uterus then fills with this dye, and if your fallopian tubes are clear - this dye will spill into your abdominal cavity.
This can determine whether your fallopian tubes are open or blocked - and can determine whether your blockage is located at the junction of the tube and uterus - proximal or whether its at the end of the tubes - distal.

This test lasts approximately five minutes, but time may be extended since this is usually done in the radiology department, and there may be additional forms/questionnaires to fill out.

Normally, results are immediately available - and xrays can be reviewed right after the procedure, along with your physician. If there are any complications, it could be allergic reaction to the dye - which is a very common reaction, and the symptoms are usually no more than a rash.

Other complications, which are more uncommon, but still possible, pelvic infection or unterine perforation.
Be sure to discuss all areas, including complications with your doctor.


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