” The examinations carried out as part of the investigation of female infertility aim to assess both the hormonal functioning of the ovaries, which must allow monthly ovulation of a mature ovocyte, and the state of the reproductive organs, such as the uterus and fallopian tubes. The latter play a crucial role in the transport of gametes, the initial implantation of the embryo, and the smooth progress of the first phases of pregnancy.”
1 HORMONE ASSAY
Hormone assays are performed on a blood sample taken between days 2 and 5 of menstruation. Some are used to assess ovarian reserve: FSH, LH, estradiol and AMH. Others are designed to investigate the cause of menstrual irregularities: Prolactin, delta4-Androstenedione, testosterone, 17 Hydroxy-progesterone.
2 PELVIC ULTRASOUND – HYSTEROSONOGRAPHY
An indispensable examination, pelvic ultrasound enables morphological analysis of the internal genitalia, uterus and ovaries. Normal fallopian tubes are not seen on ultrasound. 2D ultrasound, supplemented by 3D examination, assesses the uterus and any pathologies such as fibroids, adenomyosis, synechiae, endometrial polyps and uterine malformations. Pelvic ultrasonography can be combined with hysterosonography, which provides a more detailed analysis of the uterine cavity and can sometimes replace HYSTEROSCOPY.
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3 HyCoSy: HYSTEROSALPINGO CONTRAST SONOGRAPHY
This examination enables evaluation of the fallopian tubes and is performed by trained operators at the same time as pelvic ultrasound.
An echogenic foam gel is injected into the cervix and gradually fills the uterine cavity. The progress of the product is monitored in the fallopian tubes, enabling us to ascertain whether they are permeable or, on the contrary, to diagnose tubal obstructions.
HYSTEROSALPINGOGRAPHY – SELECTIVE SALPINGOGRAPHY and TUBAL REPERMEABILIZATION
Hysterosalpingography is a radiological examination which, after injection of an iodinated contrast medium into the uterine cavity, indirectly evaluates the uterine cavity and the permeability of both fallopian tubes. It is performed by a radiologist in the first part of the menstrual cycle, without any episode of genital infection.
When a tube appears to be obstructed at its birth, in its proximal part, an attempt can be made to repermeabilize it by selective tubal catheterization. Under fluoroscopic control, a very thin preformed probe is introduced into the uterine cavity up to the birth of the tube. The contrast medium is then injected directly into the tube to perform selective salpingography.
If obstruction of the tube is confirmed, the radiologist will attempt to remove the obstacle by gently pushing the catheter into the proximal portion of the tube.
DIAGNOSTIC HYSTEROSCOPY
Unlike hysterosonography or hysterosalpingography, which only allow indirect exploration of the uterine cavity, hysteroscopy enables direct visualization of the interior of the uterine cavity.
This examination can be performed in the gynecologist’s office without anesthesia. It takes place in the first part of the menstrual cycle, outside any episode of bleeding or genital infection. The diagnostic hysteroscope can be flexible or rigid, with a diameter of around 3.5 mm. In all cases, it is introduced first into the vagina, then into the uterine cavity, under visual control. The hysteroscope is connected to a video system, enabling both the operator and the patient to follow the progress of the examination.
The uterine cavity is gently distended by injecting a small volume of saline. Its shape and volume, the appearance of the uterine mucosa and the existence of polyps, synechiae or intracavitary fibroids can then be assessed.
The examination may be completed by an endometrial biopsy, which is a small sample of the uterine mucosa. This sample is analyzed for signs of inflammation (endometritis) or abnormal cells.