Session 1: Primary investigation of the infertile coupleBack to Index
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Up to page 3. Female infertility diagnostics and treatment.
3.1. Hysterosalpingography HSG
Hysterosalpingography is still an accepted examination for gross
anomalies in the genital tract.
The premisses for a well-performed HSG are that uterus is photographed
in one plane (it is often presented in an angle so that fundus and cervix
overlay one another). The opposite photograph shows a well-performed HSG.
At the top with fine outflow and contrast filling in Fossa Douglasi (2).
Two slim fallopian tubes are seen (1), a suspicious area in the left side
of cavum uteri (3), normal cavum uteri (5) and a good-looking cervix (4).
In the middle a HSG with a nice presentation. Closed bilateral
fallopian tubes (medial occlusion) are seen here.
At the bottom a HSG with normal fallopian tube on the right side (3) ;
but medial occlusion on the left side (2). Normal cavum uteri (1).
As a supplement to HSU - or in skilled hands probably a better
examination of the uterine cavity - a hysterosonography can be performed.
This is carried out by visualizing the urterine cavity with a transvaginal
ultrasound scanner and simultaneously install physiological saline in the
cavity through a balloon catheter. In this first photograph a uterine
cavity, where conventional transvaginal ultrasound scan raised doubts
about a pathologic finding. A HSU was thus performed - see next
photograph. This shows a normal cavity with smooth walls and no pathology.
This examination can be concluded by visualizing a possible outflow
through the fallopian tubes like a lake of fluid behind uterus. (This is
not illustrated in this photograph).