The infertility “work up” consists of an evaluation of the entire female reproductive tract, including the uterus, ovaries and fallopian tubes. In addition to diagnostic blood work, visualization of these anatomic structures is an important step in determining the cause of your infertility. In most cases, your doctor will start with an ultrasound evaluation and a hysterosalpingogram. However, if these diagnostic tests do not determine the cause of your infertility or if your doctor notices an abnormality on your imaging (e.g. a polyp, fibroid, or cyst), you may need to undergo a surgical procedure such as a hysteroscopy or laparoscopy.
A hysteroscopy is a minor surgical procedure in which a thin telescope-like viewing device, called a hysteroscope, is inserted in the vagina, through the cervix and into the uterine cavity. This procedure allows your doctor to directly visualize and evaluate the inside of the uterus and to correct any abnormalities that are identified, such as scar tissue, endometrial polyps or fibroids. The procedure is most often performed under anesthesia in a surgical center or hospital, however it can also be performed in the office without sedation. Your doctor will determine which method is best for you based on your medical history and infertility diagnosis.
A laparoscopy is another surgical procedure in which a camera (the size of a pencil) and instruments are inserted through small incisions (approximately 0.5-1 inch) in your abdomen. Typically, at least one and up to four small incisions are needed for this procedure. A laparoscopy allows your doctor to evaluate the uterus, ovaries, and fallopian tubes and repair any abnormalities identified within these structures. This procedure is usually reserved for women with symptoms of pain or heavy bleeding or for women with infertility due to ovarian cysts, uterine fibroids, tubal blockage or endometriosis. In some circumstances, if there is a high suspicion of endometriosis based on your initial work up, your doctor may recommend a laparoscopy to confirm the diagnosis, however it is not always necessary and will be based on your medical history and work up.
A laparoscopy is usually done under general anesthesia in a surgical center or hospital, and most women go home the same day of the surgery.
Dr. Taraneh Gharib Nazem is Senior Fellow in Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York. She is a board-certified Obstetrician Gynecologist. Dr. Nazem completed her residency in Obstetrics and Gynecology at the New York University School of Medicine, where she was elected administrative chief resident and graduated with the Robert F. Porges Honor Resident Award, for outstanding performance.