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Hysterosalpingogram
In
the hysterosalpingogram test, radio opaque dye is
injected into the tubes and its passage to the uterus
is observed via x-ray examination. Once the egg is
released from the follicle it must travel unimpeded
to the end of the fallopian tube where fertilization
occurs. It there is an obstruction; the dye will flow
to the point of blockage and stop. Some deformities
in the uterus can also be observed. These include
fibroids or polyps, adhesions, bicornate uterus, or
other congenital structural abnormalities.
The
procedure is performed as an outpatient and is associated
with minimal discomfort.
Hysteroscopy
The
hysteroscope permits a more detailed analysis of the
uterus than the hysterosalpingogram. In the hysteroscopic
procedure, a small fiber optic "tube" is
placed inside the uterus and the uterus is expanded
with gas making the lining more visible to the physician.
Abnormalities in the uterus including polyps or fibroids
can be seen with the hysteroscope.
Documenting
Ovulation
There
are several infertility tests to document that ovulation
will occur or that it has occurred. Ovulation must occur
for the egg to be released and fertilized. Ovulation
is the culmination of several hormonal events occurring
during the menstrual cycle and must occur regularly
for fertilization and pregnancy to occur.
Basal
Body Temperature (BBT)
The
BBT chart is used to document ovulation and to time
intercourse. It is less accurate than some of the
newer hormone monitoring kits but is still used by
some physicians. In our practice, our infertility
patients are advised to utilize the LH monitoring
kits which are much more accurate.
Urinary
LH Assay
The
hormone evaluation/ test kits (Ovu Quick and others)
predict ovulation by monitoring the surge in the level
of luteinizing hormone (LH) that occurs approximately
twenty-four
hours before ovulation. The level is monitored by
measuring the LH concentration in the urine via a
simple home test.
Intercourse
or intrauterine insemination can be timed to insure
the best chance for pregnancy. This test does not
rely on historical tracking data unlike the BBT chart
and is a much better gauge of the most fertile times.
A
direct way to document ovulation is by ultrasound examination
of the follicles before and after release of the egg.
Ultrasounds are performed sequentially and the growth
of the follicles is accessed. This process is most useful
in predicting ovulation when the follicles are monitored
to a particular size and an ovulation inducing medication
is given.
Progesterone
Levels
An
elevated progesterone level indicates that ovulation
occurred. Progesterone supports the developing embryo
and is produced by the corpus luteum, which is a structure
on the ovary that develops where a mature egg was released
at ovulation. Progesterone levels decline if fertilization
does not occur.
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