Laparoscopy evaluates the condition of
the outside of the uterus, fallopian tubes, and ovaries. The laparoscopy
checks for the presence or absence of adhesions, endometriosis,
and other di sorders
that cause infertility.
Laparoscopy is an outpatient surgery performed
in the hospital under general anesthesia. A telescopic device is inserted
into the abdominal cavity through a small incision made in the naval.
Surgical instruments are inserted through another little incision at the
top of the pubic bone.
The laparoscopy is best performed by a
reproductive specialist as surgical treatment can often be done during
the diagnostic evaluation. This may reduce or eliminate the need for a
second laparoscopy. Adhesions or endometriosis, if present, can be treated
during the same procedure. Since the entire laparoscopy typically takes
less than an hour, the vast majority of patients are released from the
hospital within three to four hours after surgery.
There are three basic methods for evaluation
of the uterine cavity, including hysterosalpingography ( HSG ), transvaginal
ultrasound or transvaginal ultrasound with saline contrast ( sonohysterography
), and hysteroscopy. Each has advantages and disadvantages; the choice
among them should be tailored to the needs of the individual patient.
HSG is the traditional method and still often the best initial choice
because it also evaluates tubal patency.
HSG accurately defines the size and
shape of the uterine cavity as well as the patency of the fallopian tubes.
Having blocked fallopian tubes or a growth
in the uterus can reduce the chances for pregnancy. If the fallopian tubes
are blocked, sperm cannot reach the egg.
A hysterosalpingogram is a test that uses
x-rays and a special dye to detect scar tissue, polyps, fibroids, and
other growths that may be blocking the tubes or preventing an embryo from
implanting properly in the uterus.
The HSG is usually done in the radiology
laboratory at the hospital, but at the Jones Institute, we perform the
procedure in our office. The test takes between 10 to 30 minutes. A speculum
is inserted into the vagina ( like for a Pap smear ), and then a thin
plastic tube is inserted into the cervix. A special dye is injected through
the plastic tube. The dye fills the uterus and fallopian tubes and spills
out of each fallopian tube. During the injection, x-rays are taken to
evaluate the anatomy.
Transvaginal ultrasonography is another
method for evaluation of uterine factors that produce high - resolution
images, which allow accurate identification of even small abnormalities.
Endovaginal probes placed in the vagina, just millimeters from the internal
reproductive organs, yield highly detailed images of the uterus and ovaries;
normal fallopian tubes cannot be seen.
Sonohysterography, involving transvaginal
ultrasound during or after introduction of sterile saline with a plastic
cannula ( also known as hydrosonography and saline infusion sonography
), crisply defines cavity contours and readily demonstrates even small
intrauterine lesions. However, sonohysterography cannot be used to detect
blocked fallopian tubes. Newer three - dimensional transvaginal ultrasound
units yield images having diagnostic accuracy comparable to MRI or combined
laparoscopy and hysteroscopy but are not widely available.
Hysteroscopy is the definitive method for
both diagnosis and treatment of intrauterine
pathology, such as fibroids or polyps, that can adversely affect fertility.
Endoscopic surgery allows direct visualization of the size, shape, and
location of any intrauterine pathology.
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Phone
800-515-6637 or 757-446-7100