The evaluation of female infertility focuses on two key aspects: hormonal function and reproductive organ health. The ovaries must produce and release a mature oocyte each month, a process regulated by a delicate hormonal balance. At the same time, the uterus and fallopian tubes play a vital role in facilitating fertilization, transporting gametes, and ensuring optimal conditions for embryo implantation and early pregnancy development. A thorough assessment of these factors helps identify potential challenges and guide the most effective treatment approach.
HORMONE TESTING
Hormone testing is a crucial step in assessing female fertility. It is performed on a blood sample taken between days 2 and 5 of the menstrual cycle. Certain hormones, such as FSH, LH, estradiol, and AMH, help evaluate ovarian reserve, providing insight into egg quantity and reproductive potential. Others, including prolactin, delta-4 androstenedione, testosterone, and 17-hydroxy-progesterone, are analyzed to detect hormonal imbalances that may cause menstrual irregularities. These tests offer valuable information to guide fertility treatment and optimize the chances of conception.
PELVIC ULTRASOUND and HYSTEROSONOGRAPHY
Pelvic ultrasound is an essential imaging technique for assessing the morphology of the uterus and ovaries. While normal fallopian tubes are not visible on ultrasound, this examination—especially when enhanced with 3D imaging—allows for the detection of uterine conditions such as fibroids, adenomyosis, synechiae, endometrial polyps, and congenital malformations. In some cases, pelvic ultrasound is combined with hysterosonography, a procedure that provides a more detailed evaluation of the uterine cavity. This technique can sometimes serve as an alternative to hysteroscopy, offering a less invasive yet highly informative approach to diagnosing intrauterine abnormalities.
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HyCoSy: HYSTEROSALPINGO-CONTRAST-SONOGRAPHY
HyCoSy is a specialized ultrasound examination designed to assess the patency of the fallopian tubes. Performed by experienced operators alongside a standard pelvic ultrasound, it involves injecting an echogenic foam gel into the cervix. As the gel gradually fills the uterine cavity, its passage through the fallopian tubes is monitored in real-time. This allows for the detection of tubal obstructions, which can be a significant factor in infertility.
SELECTIVE SALPINGOGRAPHY andTUBAL REPERMEABILISATION
Hysterosalpingography is a radiological procedure used to evaluate the uterine cavity and fallopian tube patency. It involves injecting an iodinated contrast medium into the uterus, providing an indirect visualization of the tubes. This exam is typically performed in the early phase of the menstrual cycle, ensuring no active genital infection is present.
In cases where a tube appears blocked at its proximal end, selective tubal catheterization can be attempted to restore its patency. Under fluoroscopic guidance, a fine preformed catheter is carefully introduced into the uterus and advanced toward the blocked tube. A contrast agent is then injected directly into the tube, and if the obstruction is confirmed, the radiologist may gently attempt to clear it using the catheter.
HYSTEROSCOPY: Direct Visualization of the Uterine Cavity
Unlike hysterosonography or hysterosalpingography, which provide indirect imaging, hysteroscopy allows for direct visualization of the uterine cavity. This procedure can be performed in a gynecologist’s office without anesthesia and is scheduled in the first phase of the menstrual cycle, avoiding periods of bleeding or infection.
A thin, flexible, or rigid hysteroscope (approximately 3.5 mm in diameter) is carefully inserted through the vagina and into the uterine cavity under visual control. Connected to a video system, the hysteroscope enables both the doctor and the patient to observe the examination in real time. A gentle infusion of saline expands the uterine cavity, allowing for detailed assessment of its shape, volume, and the presence of abnormalities such as polyps, synechiae, or fibroids.
In some cases, the procedure may be complemented by an endometrial biopsy, where a small tissue sample from the uterine lining is collected. This sample is analyzed for signs of inflammation (endometritis) or abnormal cellular changes that could impact fertility.