Female Infertility

Each month, a female should produce and release an egg. If pregnancy does not occur, then a menstrual period will begin about 14 days after the egg is released from the ovary. It is not only important to have such ovulations each month, but also to have good quality ovulations. Thus, some females will ovulate, but will not prepare the egg properly or maintain a nourishing uterine lining. Other females just do not ovulate at all. The first step is to determine whether or not ovulation is occurring and then, to look at the quality of those ovulations. A blood progesterone level on approximately cycle day 22 will determine whether or not ovulation has occurred. To further evaluate the ovulation process, the developing egg is studied before ovulation with ultrasound and blood testing, beginning around cycle day 12. The uterine lining is evaluated before ovulation by ultrasound and immediately prior to the anticipated menstrual cycle by an endometrial biopsy. These are office procedures.

The status of the female anatomy is evaluated by an X-ray study, the hysterosalpingogram. This is carried out in the Radiology Department of the Reading Hospital around cycle day eight. During this study, dye is injected into the cervix. This will then outline the uterine cavity and the fallopian tubes. If the tubes are open, then the dye will flow into the pelvic cavity. This study will give some general information regarding the pelvis, but will not necessarily tell the whole story. When needed, the pelvis can be more extensively evaluated with surgery, carrying out a hysteroscopy and laparoscopy. During this outpatient procedure, the uterine cavity is directly visualized by passing a telescope, the hysteroscope, through the cervix into the uterine cavity. A similar telescope, the laparoscope, is passed through the umbilicus so that the pelvic structures can be looked at directly. During this procedure, blue dye is injected through the cervix so that tubal patency can be confirmed. Laparoscopy allows for a very careful assessment of the pelvic structures. Scar tissue can be visualized along with endometriosis. The goal of this surgery is to identify problems that might cause infertility and also to treat such disorders. Therefore, when needed, laser surgery or electrical dissection can be carried out to correct the identified problems. This surgery is performed under general anesthesia, as a walk-in/walk-out procedure.