Testing and Diagnosis

Hysterosalpingogram (HSG)

A Hysterosalpingogram or HSG is a procedure whereby an x-ray film of the internal contours of the uterus and fallopian tubes is produced. These pictures are used by the doctor to determine if your tubes are open (tubal patency) and to diagnose irregularities inside the uterus.

The HSG should be done a few days after menstruation when the uterine lining is thin and to avoid the possibility that you may be ovulating or exposing an early pregnancy to x-rays. We suggest that you take an ibuprofen tablet (Motrin, Advil, Nuprin) or two anaprox (Aleve) 1-2 hours before the procedure. This helps diminish the cramping or discomfort that may be caused by the procedure. Inform the physician or radiologist if you have had any recent pelvic infection.

The procedure begins with the radiologist taking a preliminary x-ray of the pelvis. A speculum is placed in the vagina and the cervix is cleaned. This is typically done with betadiene solution. (Note: If you are allergic to betadiene or iodine or shellfish, notify the doctor or radiologist well before the procedure.) An instrument is then placed on the cervix to hold it in position, which pinches slightly. Another instrument is then placed on or into the cervical canal and radiopaque iodine contrast dye is injected slowly. You may experience some discomfort similar to menstrual cramps when the dye is injected. X-ray pictures will be taken as the dye fills the uterus and goes through the tubes, eventually spilling into the pelvic cavity.

After the test, you may experience cramping from 12-24 hours. You may take ibuprofen or anaprox for the discomfort. There may also be some bleeding, spotting and/or brownish discharge for 12-24 hours after the procedure. You may also experience shoulder pain.

Although an HSG is not quite as good as hysteroscopy (see General Operative Procedures) in evaluating the uterine cavity, if done properly, it can reveal a significant amount of information. An outpatient HSG is considerably cheaper than going to the O.R. An HSG should reveal tubal patency as well as most uterine cavity irregularities.

Endometrial Biopsy (EMBx)

The gold standard for evaluating the synchronization of endometrial (uterine lining) development with the egg is the endometrial biopsy. The biopsy is routinely performed 7-8 days after a positive urine LH surge test. It is hoped that you have not attempted unprotected intercourse during this month in order to avoid the 5% chance of disrupting an early pregnancy. To minimize discomfort, take two Aleve or similar non-steroidal medication one hour before the biopsy. Just prior to the biopsy, the doctor will apply a topical anesthetic to the cervix and then clean the vagina with betadiene solution. If you are allergic to betadiene, iodine, or shell fish, tell the doctor prior to the procedure. An instrument is placed on the cervix to hold it in place while a small plastic tube is inserted through the cervical canal. At this point, moderate menstrual-like cramps will begin and continue until the tube is removed. This lasts approximately 10 seconds. If adequate tissue is obtained, the procedure is over and you may go home. Avoid intercourse for two days after the procedure. Watch for excessive or prolonged bleeding, temperature in excess of 100.6 degrees, pulse greater than 100 or excessive or prolonged pain.

GYN Vaginal Ultrasound

For patients who have never had a vaginal probe ultrasound, the unknown before the procedure can be anxiety producing. The vaginal probe is no more invasive than a speculum exam. The actual probe has been described by our patients to look like a "curling iron". The probe is covered with a latex cover and a small amount of lubricant is applied to the outside. The process should not be uncomfortable. The doctor or technician will teach you to recognize different images as the exam progresses. Occasionally, you will be asked to press on your lower abdomen in order to enhance the images. Depending on what is present, the actual exam should take no more than 10 minutes.

Vaginal ultrasounds are used to determine follicular growth on the ovaries as well as endometrial development. The probe is also used in IVF, GIFT, ZIFT, or ICSI to guide the doctor in retrieving eggs from the follicles.

Human Immuno Deficiency Virus (HIV)

The Society of Assisted Reproductive Technology recommends that you be screened for HIV (AIDS) virus, Hepatitis B and C, Syphilis (RPR), blood type and RH, Chlamydia and Gonorrhea prior to Assisted Reproductive Technologies Procedures (IVF, GIFT, ZIFT, ICSI). We do HIV testing as an added precaution to our patients as well as to our staff. Being sero-positive for HIV does not exclude you from treatment in our office. We will counsel sero-positive patients as to the risk of having a child that is HIV positive to make sure they understand the magnitude of their decision to procreate. HIV cannot be circumvented with our current technology and washing sperm does not remove the virus. Sero-positive individuals should warn persons who may come in contact with their blood or other body fluids including urine and semen, etc. This fortifies the need for infection control precautions which should always be in place.

HIV testing screens for the presence of antibodies in the serum for the HIV virus, not for the actual virus. You should be aware that there is a possibility of false positives and false negatives. All individuals who test sero-positive will be retested to confirm the results. You should also be aware that it is impossible to predict the development of AIDS from an HIV positive test alone.

You should be aware that although the American Disabilities Act has been passed to protect individuals from the loss of employment or insurance, the possibility still exists that a sero-positive individual may incur a loss of insurance or employment if the insurer or employer becomes aware of the results. We will make every effort to keep the test results confidential unless we are forced to release the results under certain legal circumstances.

Semen Analysis

An integral part of the infertility evaluation of a couple is the examination of the man's semen, or what is commonly referred to as "semen analysis". A semen analysis is an accurate measurement of the number of sperm, their motility, and their normality. The information gained from this examination is probably the single most important test in the evaluation of the male partner.

INSTRUCTIONS:

1. Refrain from any form of ejaculation for 2-3 day prior to the test but no longer than 7 days.

2. The semen specimen should be collected by masturbation. Do not collect in a condom as these contain spermicidal agents which may alter the results of the test.

3. The specimen should be collected in a sterile container provided by the doctor.

4. Bring the specimen to the laboratory within one hour after collection. Do not expose the sample to extremes in temperature. Sperm are happy at room temperature. If you are unable to deliver the specimen within the specified time, a private room is available at IVF Phoenix for collection.

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