Once you have decided to do IVF there are several
tests that you need to have to ensure optimal IVF success.
Watch this video to learn about checking the function of the ovaries
Watch this episode to learn about pre-testing the sperm.
In today's episode of InfertilityTV, we will cover
testing the uterus before IVF.
When should testing of the uterus occur?
IVFpre-testing of the uterus does not need to be performed
before stimulation of the ovaries or egg retrieval,
it must be performed before the embryo transfer.
If your plan is to perform a fresh embryo transfer
so there is no gap between the retrieval and the transfer
then the IVF pre-testing for the uterus should be performed before starting the
stimulation. If the plan is to have a frozen embryo
transfer, which by the way, we strongly recommend,
then evaluation of the uterine cavity can be
performed either before or after the egg retrieval. There are two
types of uterine cavity evaluation: direct and indirect. Direct evaluation
involves looking inside the uterine cavity with a fiber optic
scope known as a hysteroscope. Indirect evaluation involves using a
method such as ultrasound or x-ray. Indirect evaluation
is probably more common but we believe that
direct evaluation is better for IVF. In order to get an optimal evaluation of
the uterine cavity, it should be opened up with fluid first.
Remember, the uterine cavity isn't a big open space like a cave. The walls of the
uterine cavity are pressed up against each other.
Think of your tongue pressed up against the roof of your mouth.
Separating the walls of the uterus will increase the ability to identify
problems that could lower your IVF success rate.
With an indirect evaluation, your doctor will place a catheter into the uterus
and squirt some type of fluid inside. The fluid will cause the walls of the
uterine cavity to separate. This opens up the cavity so that now it
really is just like a cave. If your doctor is using ultrasound to
view the uterus, the fluid used is simply salt water or saline.
This type of indirect evaluation is
known as a saline ultrasound or saline infusion sonogram
or simply "SIS". You might also hear it referred to as a
hysterosonogram or HSN. This type of evaluation is good
for determining whether the uterus has a normal shape
and whether there are any structural abnormalities inside the uterine cavity
such as polyps, fibroids or scar tissue. If your doctor is using x-rays to view
the uterus, the fluid used is called contrast.
The fluid contains iodine which can be seen with x-ray imaging. This type of indirect
evaluation is called a hysterosalpingogram or HSG.
An HSG is also good for detecting whether there are abnormalities in the
shape of the uterus but it is not as good for determining
which type of uterine problem is causing the abnormalities in shape.
Here's what I mean. Let's say your uterine cavity has an
abnormal "V" shape instead of a normal triangular shape
Both the saline ultrasound and the HSG
can tell you there is a split. The saline ultrasound can show the cavity
and the muscle of the uterus and therefore can distinguish
between an abnormality called a uterine septum
and another type called a bicornuate uterus.
The HSG only shows the cavity of the uterus, not the muscle
so you wouldn't be able to tell the difference between those two types of
uterine abnormalities. At IVF1, we prefer to use a direct
evaluation of the uterine cavity. We feel there are a few advantages that
hysteroscopy has over the other methods.
First, hysteroscopy is the only method of evaluation
in which you can actually see the uterine lining.
This enables us to see problems that will be missed with either saline
ultrasound or HSG. A second benefit of hysteroscopy is that
it allows us to correct small abnormalities at the same time as
we find them. That avoids having to bring the patient
back a second time for correction. Whatever type of uterine pre-testing
your doctor performs, it is very important to correct those
abnormalities before performing the embryo transfer.
Polyps, fibroids and scar tissue should be removed.
Chronic inflammation should be treated.
Uterine septums should be resected. Women who have a
bicornuate uterus, however, may try an embryo transfer without
surgery first. This is because this type of surgery is
much more invasive.
Hi, I'm Dr. Randy Morris. I give honest
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