To get to the root cause of infertility, you’ll go through several tests. Doctors begin with the least invasive tests, after the initial blood tests and physical exam. That usually means imaging, such as ultrasound, which uses high-frequency sound waves to assess the condition of your uterus and ovaries. Then your doctor moves on to other tests.
Two common tests for infertility are hysteroscopy and fluid ultrasound. The fluid ultrasound takes a detailed assessment of the inside of your uterus. The hysteroscopy looks at the way a fertilized egg would travel to your uterus through your fallopian tubes. It determines whether or not that path is clear. Here is a breakdown of what these tests look for and what they can’t look for.
Fluid Ultrasound
A fluid ultrasound uses a thin tube to infuse the uterus with a sterile saline solution. The technician uses a transvaginal ultrasound to image the inside of your uterus. They look for things like uterine polyps, adhesions, scar tissue, the condition of your uterine lining (thinness or thickness), and fibroids that might cause miscarriage or prevent implantation.
However, there are other conditions that a fluid ultrasound simply can’t assess. These are:
- A Thorough Assessment of Your Fallopian Tubes: A fluid ultrasound can’t pinpoint any blockages, and it can’t determine the full condition of your fallopian tubes. If your doctor suspects there are problems with your fallopian tubes, they typically move on to a test that takes a more thorough assessment of your fallopian tubes, such as a laparoscopy or hysterosalpingogram (HSG).
- Ovarian Function and Ovarian Reserve: A fluid ultrasound can’t determine the number of eggs you have or their quality, and only provides limited information on the condition of your ovaries.
- Endometriosis: While a fluid ultrasound may detect fluid-filled endometriomas, or cysts, it can’t detect the smaller endometriosis lesions, which are the most common type of endometriosis.
- Some Types of Uterine Scarring or Adhesions: A fluid ultrasound is the best way to find polyps, fibroids, and some scarring. However, it’s not the most effective way to make a full assessment of the uterus. If larger adhesions, such as those symptomatic of Asherman’s syndrome, are present, it can prevent the uterus from becoming distended enough to get a detailed view. In that case, your doctor recommends a hysteroscopy.
Hysteroscopy
A hysteroscopy is more invasive than a fluid ultrasound, but it provides your doctor with a much more thorough look inside your uterus. The procedure takes place, generally, in the office under light sedation. Your doctor uses a thin tube with a lighted telescope to view, diagnose, and treat conditions like fibroids, polyps, and scar tissue. This scope helps your doctor visualize and identify structural issues within your uterus that may cause recurrent miscarriage or prevent implantation. Certain conditions aren’t identifiable through a hysteroscopy, and your doctor may recommend a different procedure in that case. They are:
- Most Forms of Endometriosis: A hysteroscopy can’t view all presentations of endometriosis. The only way to diagnose endometriosis and its severity is through a laparoscopy.
- Ovarian Function: A hysteroscopy doesn’t provide any information about ovarian function or ovarian reserve. Your doctor can’t diagnose ovulation issues, cysts, or polycystic ovarian syndrome (PCOS).
- Overall Fallopian Tube Health: A hysteroscopy can view the opening of the fallopian tubes into the uterus, but can’t fully view the tubes to identify blockages. You will need a hysterosalpingogram to assess fallopian health.
- Adenomyosis: When the endometrial tissue grows into the muscular wall of the uterus, it’s called adenomyosis. As the hysteroscopy focuses primarily on the inside of the uterus, your doctor can’t diagnose adenomyosis through a hysteroscopy.
- Outer Abnormalities of the Uterus: While a hysteroscopy diagnoses a septum within your uterus itself, it can’t diagnose or differentiate between a septate uterus (when a wall divides the uterus into two separate cavities) or a bicornuate, or heart-shaped, uterus. In that case, your doctor requires further testing.
Each Case is Unique
It’s important to remember that each and every infertility diagnosis is unique. While these tests are the gold standard for identifying specific conditions, your doctor usually requires a comprehensive series of tests to diagnose infertility.
Your doctor may recommend starting with a fluid ultrasound or hysteroscopy to determine what’s going on with your fertility. Or they may use other tests to determine the cause of your infertility. Trust that your doctor bases any tests ordered on your individual case.
At LA IVF, we take your trust in us very seriously. You can rest assured that our doctors and clinic staff will do everything we can to help you overcome your infertility and realize your dream of growing your family. Please reach out and schedule a consultation today.
