Evaluating the infertility patient’s uterus

In terms of evaluating the endometrial cavity, the site of embryo implantation, direct inspection via a hysteroscope offers the most precise information.  It also allows us to treat any pathology, i.e., adhesions, polyps, fibroids or a uterine septum.  Hysteroscopy gives us information regarding the opening of the fallopian tubes, but does not give us any information regarding the remainder of the tubes.

Hysterosalpingogram (HSG) performed by the injection of a contrast dye into the uterine cavity will detect filling defects, but does not tell us what the pathology is.  Hysterosalpingogram also allows us to assess whether the fallopian tubes are patent, as contrast dye can be seen filling and exiting the tubes.  By examining the course of the fallopian tube we can get an idea as to whether there may be paratubal adhesions, i.e. the tube is often convoluted with poor dispersion of the dye throughout the pelvis.  When the fallopian tube is not a concern sono-hysterosalpingogram can be performed, an office procedure whereby sterile saline is injected into the endometrial cavity and an ultrasound is performed.  This technique is more sensitive in detecting endometrial pathology than a regular hysterosalpingogram, but again does not tell us what the pathology is and does not allow for corrections.  Sono-HSG is often the screening procedure of choice when the fallopian tubes are known to be patent or have been removed.  Will all three diagnostic procedures there is a low chance of infection.  The risk of this is significantly higher if the fallopian tubes are blocked.  Prophylactic antibiotics are often recommended if tube status is unknown.

Kevin L. Winslow, M.D.
Director for Florida Institute for Reproductive Medicine