During your subsequent visits, tests that were not done on the first visit will be completed.

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Subsequent visits will be determined on when in the menstrual cycle the patient came in the first visit.

 

Usually, your subsequent follow-up will be;

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Day 2-Day 5 if Hormone Assays have not been done. FSH and LH will be performed.

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Day 8 for a Tubal Patency Test / Ultrasonic Salpingiogram
This is a simple outpatient test used to detect tubal patency (no blockage of Fallopian tubes). The uterine cavity and Fallopian tubes are filled with ultrasonic dense fluid.

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If either of the Fallopian tubes is patent, the fluid will flow out from the end of the Fallopian tubes and fill up the adnexa (side of the uterus) and the pouch of Douglas (the cavity between uterus and rectum). Patients may feel pain and discomfort in the pelvic area after the test if their tubes are patent.

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The advantages of ultrasonic salpingogram compared to hysterosalpingogram (HSG) and laparoscopy are that no radiation or surgery is required.

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Day 12 for a Follicle Maturity Check / Test
In many instances, having regular menstrual periods is a reliable sign that regular ovulation occurs.

 

Sometimes, though, ovulation may be premature, incomplete, or altogether absent, despite apparent temperature elevations, positive ovulation predictor kits, changes in vaginal secretions, or mid-cycle cramping. This test is performed around ovulation, usually Cycle Day 11-14.

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In these instances, a poorly formed follicle may not release an egg; or may do so but at the wrong time, so when the egg is released, it is incapable of being fertilized. In other cases, ovulation occurs but subsequent progesterone hormone production by the post-ovulatory follicle (called the corpus luteum) may not be strong enough to allow implantation of an early embryo.

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The purpose of ovulation and follicle monitoring is to uncover these types of disorders, since these disorders are highly treatable, usually with simple medications. If the timing of your menstrual cycle is irregular, or if your previous monitoring with temperature charts or ovulation predictor kits has been variable, then this type of monitoring is very likely to be very helpful.

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Laparoscopy
*If the initial investigation indicates that laparoscopy procedure is needed.

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The laparoscopy procedure requires general anesthesia. A small incision (0.5 to 1.5cm) is made in the abdomen, where a fine telescope is inserted through a small incision at the umbilicus and the internal female organs are visualized. Carbon dioxide is filled in the abdomen to separate the organs so that it is easier for the gynecologist to see the reproductive organs. The gas will be removed after the procedure. At the same time, the Fallopian tubes are tested for patency using methylene blue dye which is injected at the vagina end. If the tubes are patent, the blue dye will be seen flowing out at the fimbriae (tube) end.

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During laparoscopy, the cause of infertility such as endometriosis, adhesion, and fibroid can be confirmed. Laparoscopy is diagnostic as well as therapeutic. For example; at the time of laparoscopy, endometriosis is confirmed and it can be cauterized and treated at the same time. Other treatments that can be done at the time of laparoscopy are the release of pelvic adhesion and ovarian drilling (making a hole in the capsule).

 

Laparoscopy is indicated for:

 

1. Ovarian cysts and tumors

2. Myomectomy (removal of fibroids)

3. Tubal surgery

4. Lysis of adhesions

5. Endometriosis

6. Determining the patency of Fallopian tubes

7. Pelvic floor and vaginal prolapse

8. Hysterectomy (removal of the uterus)

9. Sterilization