The uterus is lined by a specialized layer of cells called the endometrium. It is to this lining that embryos implant and begin to develop in pregnancy. It is critical to thoroughly evaluate the uterine cavity for potential defects or obstacles to implantation of the embryo. Examples of such would be uterine scar tissue (from previous pregnancies or procedures), polyps (benign glandular growths), fibroids, or other structural defects in the uterus. Depending on your specific situation, the evaluation may include the following tests:
- Complete physical examination and external palpation of the uterus. This will also include a Pap’s Smear (if not done within the last year), breast examination, and cervical cultures.
- Baseline Pelvic Ultrasound: this is a transvaginal ultrasound examination usually performed at the onset of your menstrual cycle on Day 2, 3, or 4. It gives the physician information on the direction and length of the uterine cavity.
- Hysterosalpingogram (HSG): as described in the tubal evaluation, may provide some information on structural defects of the uterine cavity. This test is performed by Dr. Zoneraich or Dr. Larsen in the Scottsdale or Mesa offices and Dr. Troché in the Glendale office.
- Sonohysterography (saline sonography): sonographic evaluation of the uterine wall and inner uterine cavity performed while filling the uterus with a very small amount of sterile fluid. Performed by Dr. Zoneraich, Dr. Larsen or Dr. Troché in the office, this test provides information on abnormalities of both the uterine wall and endometrial cavity which may affect implantation of an embryo, increase miscarriage rates, and interfere with subsequent delivery of the baby. In some cases, findings on this test prompt the physician to recommend further evaluation with office/diagnostic hysteroscopy (see below) or proceed to surgical correction of an abnormality.
- Office Diagnostic Hysteroscopy: this test may be recommended for patients undergoing reproductive treatments such as IVF or for those who have an equivocal or suspicious finding on sonohysterography. Performed by Dr. Zoneraich, Dr. Larsen or Dr. Troché in the office, this test uses extremely high resolution fiber optic cameras to visualize and provide color pictures of the inner lining of the uterine cavity and openings of the fallopian tubes.
- Endometrial Biopsy: this test is only performed in certain circumstances in order to diagnose problems in development of the endometrium, called luteal phase defect, or to diagnose possible infection of the endometrial lining.
- Trial (or Mock) Transfer: this is a very quick and painless test performed on patients undergoing IVF in which a very thin plastic catheter is used to assess the length and curvature of the cervical canal and uterine cavity in order to facilitate placement of embryos in the uterus at the time of actual embryo transfer.