Blocked fallopian tubes or abnormalities inside your uterus may be two of these, causing you to have trouble getting pregnant. Tests are available to determine the health of your uterus and fallopian tubes that access whether you may have conditions keeping you from getting pregnant. One is called Hysterosalpingogram or HSG and the other is use of a pelvic ultrasound. Part of your first steps toward fertility will include an initial ultrasound to determine the health and wellness of your uterus and ovaries.
This allows Dr. Stephan Krotz and his fertility team to begin the process of evaluation, diagnosis and development of your treatment plan. During this ultrasound, we can measure your Antrial Follicle Count that is an important predictor of egg quality and quantity. Levels less than 8 may suggest a low egg count. In this case, higher hormone medications may be given to correct the problem.
If your doctor sees fibroid cysts or polyps, he may inject a saline substance into your uterus to aid in determining your diagnosis and treatment. It does not involve x-ray or contrast fluid which can rarely cause allergic reactions but instead uses only sterile water or saline and air bubbles. With 3-D ultrasound equipment, we can get an excellent view of the uterus itself as well as the interior cavity and manipulate the image on the screen to get a more complete picture.
It will also show the ovaries and any cysts on them. While the tubes are difficult to see with ultrasound alone, the addition of air bubbles to the water allows us to track the bubbles through the tubes and document that they are open.
It is less effective in testing for adhesions around the tubes than the x-ray test, but for the initial screening of the pelvis, it is an excellent test. The HSG test is mostly used to see if the fallopian tubes are open. It can also be used to check if there congenital uterine anomalies , fibroid tumors, polyps, or uterine scar tissue. Endometriosis is not well seen on either the x-ray or the ultrasound version of the HSG, but if there are cysts of endometriosis tissue in the ovaries called endometriomas , the ultrasound procedure will generally be able to detect those.
As mentioned previously, if there is scar tissue from prior surgeries or possibly from severe endometriosis, the x-ray test may be better at detecting that. Of course, the best test for endometriosis is a laparoscopy, which involves surgery and is best reserved for patients whose symptoms are highly indicative of endometriosis, or who have a history of prior pelvic surgeries. There is absolutely no preparation needed for the HSG test.
It can be helpful to take some ibuprofen about minutes ahead of your appointment time to reduce cramping. If you have someone that can drive you home after the test, a muscle relaxant like Valium may help to relax the openings of the tubes and make it less painful to push fluid into them.
The ideal time to have an HSG is right after your period is over when the uterine lining has been shed and is as thin as it will ever be. This makes it easier to see the uterus and tubes on the ultrasound. You should call the office to schedule the test between days 6 and 11 of your cycle.
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