ProcreaWinnipeg, Manitoba
Procrea

Evaluation & Tests for Her

If you are experiencing infertility, there are a number of evaluations and tests that can be administered to best determine the cause. Once a detailed medical history and complete physical examination is complete, proper evaluations will be chosen based on your specific and individual needs. Once a full workup is complete, a physician will take the results and those of your partner and put together a treatment plan.

Infertility testing involves the evaluation of ovulation and related hormones, the uterus, fallopian tubes and ovaries. These are methods of evaluation:

Confirmation of Ovulation
Hormone Evaluation
Hysteroscopy
Hysterosalpingogram (HSG)/Tubal Patency
Laparoscopy
Sonohysterogram
Ultrasound

Confirmation of Ovulation

If you are unsure as to when in your cycle you are ovulating, we can evaluate the timing by examining the development and release of a maturing egg though ultrasound and hormone tests.

Hormone Evaluation

Hormone levels vary throughout the different stages of a normal ovulatory cycle. The hypothalamus gland regulates reproductive hormones. It signals the increase or decrease of production, varying the levels of GnRH (gonadotropin-releasing hormone), which in turn stimulate the pituitary gland to manufacture reproductive hormones.

Hormone evaluation measures the levels of three important hormones in the bloodstream: follicle stimulating hormone (FSH), luteinizing hormone (LH) and estrogen. If levels of FSH and/or estrogen are elevated, this can indicate reduced ovarian reserve, aging ovaries and eggs with reduced chance of fertilization.

Abnormal levels of LH (luteinizing hormone), androgens (male hormones) may indicate Polycystic Ovarian Syndrome.

Further testing might include the evaluation of testosterone, progesterone, glucose and insulin levels.

Hysteroscopy

Hysteroscopy is a minimally invasive procedure during which a camera is inserted through the cervix in order to view the inside of the uterus. It is an ideal way to evaluate the uterus for abnormalities such as fibroids or polyps.

Hysterosalpingogram (Tubal Patency)

During a hysterosalpingogram (HSG), the uterus is filled with a dye that is monitored by X-ray as it passes through the fallopian tubes and into the abdomen. If the dye fails to pass through the tubes, this may suggest either tubal obstruction or uterine abnormality.

Laparoscopy

Laparoscopy is a procedure which provides a direct look at the pelvic organs and is often part of a complete infertility evaluation. It can be used for both diagnostic and operative purposes. If an abnormal condition is found during the diagnostic procedure, the surgical procedure can often be performed at the same time, thus avoiding a second surgery.

Diagnostic laparoscopy is used to look at the outside of the uterus, the fallopian tubes, ovaries and internal pelvic area. It is used to diagnose many gynecological problems including endometriosis, uterine fibroids and other structural abnormalities, ovarian cysts, adhesions and ectopic pregnancy. It is usually performed on an outpatient basis, under general anesthesia, and with minimal discomfort. A needle is inserted through the navel and the abdomen is filled with carbon dioxide gas. The gas pushes the internal organs away from the abdominal wall so the laparoscope can be placed into the abdominal cavity without injuring the organs. The laparoscope, a long, thin, lighted telescope-like instrument, is inserted through an incision in the navel and allows the doctor to see the reproductive organs.

If an abnormality is discovered, it can often be treated immediately with laparoscopic surgery. This is a minimally invasive procedure in which the doctor inserts the required additional instruments through two or three small incisions in the area above the pubic bone. This procedure is used to remove minor fallopian tube blockage or scar tissue surrounding the tubes or ovaries, thereby improving fertility. It may also be used to remove ovarian cysts, treat ectopic pregnancy, and to remove fibroids and diseased ovaries.

Postoperative Care

There may be some tenderness and bruising.

Advantages

  • Disorders are corrected on an outpatient basis avoiding major surgery and hospitalization.
  • Patient experiences less discomfort.
  • Normal recovery time is three to seven days for diagnostic procedures and one to three weeks for operative procedures.

Laser Surgery

A laser is a device that produces a very thin beam of light in which high energies are concentrated. In surgery, lasers can be used to operate on small areas of abnormality without damaging delicate surrounding tissue.

Lasers can be used to cut or destroy tissue. We typically use a CO2 laser for laparoscopic surgery for infertility and/or endometriosis. However, it is sometimes preferable to use other instruments such as electrocautery or scissors in these situations.

Sonohysterogram

The sonohysterogram is a type of ultrasound administered by filling the uterus with water or saline thereby pushing the walls of the uterus apart. The ultrasound is then able to reveal any uterine abnormalities that might otherwise be difficult to detect and assess. Not readily available in Manitoba.

Ultrasound

Pelvic ultrasounds are commonly done during your initial evaluation. The ultrasound is done through the vagina and allows a closer look at the ovaries and uterus. It can reveal cysts and fibroids and other abnormalities of the uterus. Results could indicate the possibility of endometriosis or an increased risk of miscarriage. A pelvic ultrasound can also be used to evaluate ovarian reserve.

Lifestyle

Maintaining a healthy, well-balanced lifestyle is helpful to the conception process. Eating a nutritious and wide-ranging diet will help make your body healthy and capable to both conceive and nourish a developing baby. Your well-balanced diet should include plenty of fresh fruits and vegetables, especially greens, as they are rich in folic acid. Folic acid is a form of vitamin B and is very important for conception and throughout the pregnancy.

Supplements of Folic acid are also recommended. For correct dosage and timing, consult your physician in order to gain full benefits of the vitamin.

Sustaining a healthy weight is also an important part of conception as being over or underweight can disrupt the menstrual cycle.

Drinking alcoholic beverages can be damaging to eggs. Women who wish to conceive are advised to limit their alcohol intake. Cigarettes and marijuana can also interfere with ovulation and decrease chances of conception. Other drug use, including some prescription medications, is not safe during pregnancy. If you are unsure about your own medications, please consult your physician.

Environmental toxins have also been known to have adverse affects on fertility. Such toxins include lead, pesticides, paint solvents and car exhaust. It is highly recommended that you avoid exposure whenever possible.

Timing of Intercourse

To increase your chances of conception, it is recommended that you have sexual intercourse every 2 to 3 days around or during the time of ovulation. For a women with a regular cycle of 28 day to 30 days, this means having intercourse between days 10 and 17, around the time of ovulation. Ovulation occurs approximately 12 - 16 days before the next expected period. Abstaining for more than 3 - 4 days does not increase sperm quality.

Procrea

« The general work-up requires that you and your spouse undergo certain tests, which will enable the physician to diagnose your condition and to offer therapeutic solutions. »