The ultrasound examination will focus on looking at the muscular wall and shape of the uterus as well as the endometrial lining and cavity of the uterus.
Sometimes the shape of the uterus or the cavity can be different or abnormal leading to infertility and miscarriages. There may be fibroids or growths in the wall of the uterus which can affect the cavity or the tubes.
Endometrial polyps, which are a growth of the lining of the uterus, can affect implantation and may cause infertility.
Uterine fibroids, which are a growth on the muscular wall of the uterus, may block the tubes or affect the cavity leading to miscarriages.
This is a disorder where the ovary is enlarged containing multiple small cysts which lead to abnormal hormone production affecting the cycle and fertility.
This condition is commonly associated with extra weight gain, acne and abnormal hair growth. Generally, the diagnosis depends on the finding of multiple small cysts in the ovary as well as abnormal hormone levels.
Any pelvic infection can affect the pelvis leading to damaged or blocked tubes. Sometimes this will not be associated with any symptoms or very vague symptoms.
Infection can occur following intercourse, from previous surgery or from complications of surgery leading to adhesions and damage.
Occasionally the tubes will be blocked and full of fluid. This is called a hydrosalpinx and is easily seen on an ultrasound examination. Specific testing with dye can be done to check if the tubes are open.
Endometriosis is a common condition affecting women in their reproductive years and still menstruating. It is a very common condition affecting between 10-15% of women. The symptoms can be quite vague and the average time to diagnosis can be prolonged at six or seven years.
Endometriosis may run in families and therefore will be sometimes diagnosed in young women in their teenage years who present with increasing period pain or pain with intercourse. Overall the incidence of endometriosis appears to be increasing as more patients delay having their pregnancies.
Therefore, young women under the age of 40 who present with difficulty falling pregnant, or problems with their periods such as pain or heaviness as well as pain with intercourse need investigation to exclude endometriosis. Symptoms can often be confused with those of irritable bowel syndrome.
The diagnosis of endometriosis is generally made by firstly obtaining a clear history from the patient. A pelvic examination by a gynaecologist and an ultrasound examination may be helpful. However, the best way to diagnose endometriosis is by laparoscopy. This is a day surgical procedure where the patient is asleep for 20 to 30 minutes. A telescope is inserted into the abdomen to look at the uterus, tubes and ovaries. The procedure can be used to diagnose the condition but also treatment can be undertaken at the same time.
Generally treatment will revolve around the use of hormones or surgery to remove the endometriosis. Hormonal treatment can be very effective for relief of pain, but surgery is generally better for treatment for fertility.
This is one of the main areas of surgery undertaken by Dr Raymond. Most of the treatment can be undertaken by laparoscopic or keyhole surgery with radical excision of all the areas of endometriosis. This has been shown to be the most effective way to relieve pain, but also to assist in achieving a pregnancy.
In a recent study, undertaken by Dr Raymond, of patients treated for infertility within the last three years, almost 80% were able to achieve a pregnancy within a year of treatment by surgery alone or with a combination of surgery and Clomiphene or IVF.
A special test called sonohysterography can be helpful if an abnormality of the lining of the uterus is suspected.
Fluid is introduced into the cavity of the uterus and this gives a much better picture of the lining. Women can sometimes be born with an abnormal shape uterus such as bicornuate uterus or a uterus with a septum. This can interfere with the implantation of embryos and lead to miscarriages or infertility.
This type of test is best done by a gynaecologist who specialises in the treatment of infertility and can advise about the best type of treatment required. This would usually undertaken as a keyhole or laparoscopic procedure.
A special investigation – HyCoSy – meaning hysterosalpingo-contrast-sonography can be undertaken to assess whether the tubes are blocked.
This means the introduction of a special type of fluid into the uterine cavity which is then observed with colour Doppler ultrasound to assess the fallopian tubes. Colour doppler Ultrasound can check if the fluid passes through the tubes.
Ultrasound plays a very important part in the management of patients undergoing infertility treatment.
These examinations are used to measure the number and size of follicles produced by the ovaries when hormones are used to induce ovulation. Serial measurements are used to monitor the growth of the follicles to allow the timing of intercourse or insemination of sperm.
Ultrasound also plays a very important part in IVF treatment where it is necessary to monitor the growth of the ovarian follicles and of the lining of the uterus.