Laparoscopic and Hysteroscopic Evaluation of Infertility
Office hysteroscopy is a procedure which involves the fertility specialist directly looking at the inside of the uterus (uterine cavity) using a special instrument called a hysteroscope. The hysteroscope has a small telescopic lens which is placed through the cervix into the uterus. Saline is injected into the uterus to distend the uterine wall and allow visualization of the uterine cavity. The hysteroscope is attached to a camera and can be viewed on a video monitor.
The test is performed between cycle days 6-10, with Cycle Day 1 being the first day of the period. If full flow of menses does not occur, a blood pregnancy test will be obtained prior to the procedure. Patients undergoing this procedure will be encouraged to take 800 milligrams of ibuprofen or another over-the-counter pain medicine one hour before the procedure as cramping may be experienced when the hysteroscopy is performed. An antibiotic, doxycycline (100 mg), may also be prescribed to prevent a uterine infection. Doxycycline will be taken twice daily, starting the day before the HSG, and continue for a total of three days—the day before, the day of, and the day after the hysteroscopy.
Laparoscopy is a common diagnostic and surgical procedure for infertility and other conditions. Laparoscopy for infertility usually involves making two small incisions, one at the pubic hairline, and the other at the navel. The laparoscope, which is a small telescope-like device, is inserted in one opening and surgical tools are inserted in the other.
The laparoscope allows the fertility specialist to visualize the internal organs, including the ovaries, uterus, tubes, and other structures. Many complex surgeries that once required opening the abdomen (laparotomy) are now performed using the laparoscope, which is an outpatient procedure. There is little pain associated with a laparoscope and the recovery time is very short. It also costs less compared with other procedures.
A reproductive endocrinologist/fertility specialist should perform the diagnostic laparoscopy. Fertility specialists have years of advanced training performing delicate microsurgical procedures. One major reason for choosing a specialist is that many conditions, such as endometriosis, can be treated during the diagnostic laparoscopy, thus eliminating the need for a repeat procedure.