Session 1: Primary investigation of the infertile couple

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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).





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