There are a number of tests that we often use prior to the start of any treatment, in order to check for tubal patency (openness) and to look in more detail at the other reproductive organs for possible anatomical problems that may be interfering with your ability to get pregnant.
The simplest test to check a woman's tubes is with an X ray and dye test called a hystero-salpinogram or HSG (hyster = uterus; salpinges = tubes). The radio-opaque dye is inserted through the cervical opening, so this is similar to having a smear test. The x-ray pictures give an outline of the womb and tubes. The HSG can identify areas of adhesions (scarring), polyps and fibroids, as well as congenital abnormalities. The dye may show up blockages anywhere along the tube. The dye itself may clear very minor blockages and some women will conceive purely as a result of this procedure.
We also use a similar, slightly more sophisticated test known as a HyCoSy. This stands for hystero-salpingo-contrast sonography and uses an ultrasound scan and contrast medium to get a more detailed image of the womb, ovaries and tubes. The test is used to check for polycystic ovaries, fibroids, polyps and other problems in the pelvis, as well as checking that the tubes are patent.
Some women may need a laparoscopy and dye test. This is a more invasive investigation, but it is often considered the "gold standard" test. It is usually performed if a woman has a history of pelvic surgery (such as an appendicectomy), pelvic pain or other symptoms, or if an HSG highlights a possible problem. A laparoscopy requires a general anaesthetic and two or three very small incisions - one around your belly-button and one or two lower down either side of your pelvis (lower abdomen). A small instrument known as a laparoscope is used to take very detailed photographs. Laparoscopy has the advantage of being able to look all around at the outside of the tubes and womb to check for adhesions (scarring) and endometriosis. In order to get a good view of your insides, we first use carbon dioxide gas to inflate your abdomen. A dye is usually passed through the inside of the tubes to check they are open (patent). An exploratory laparoscopy gives us the opportunity to treat conditions such as endometriosis or adhesions at the same time. A hysteroscopy may be performed at the same time as laparoscopy.
This involves inserting a very narrow endoscope through the cervix to view the uterine cavity. It is not normally done in the first round of any investigations, but may be suggested to provide a more detailed view of the size and shape of the inside of the womb and to get a particularly detailed view of the endometrium (lining). This may be suggested prior to IVF and is usually done under a general anaesthetic. Hysteroscopy also allows us to diagnose or treat conditions such as polyps, fibroids, adhesions or a congenital septum.