Advanced Examinations




1. Hysteroscopy (H-scopy)

Purpose:
H-scopy uses a hysteroscope to examine if the uterus and uterine lining are normal. There is a direct correlation between the condition of the uterus and embryo implantation.

Procedure:
Patient will be asked to lie on her back on the examination table with feet raised and supported by stirrups, similar to a pap smear or vaginal exam. An optical instrument connected to a video unit with a fiber optic light source is inserted to check the conditions of the uterus.

If only a simple examination is required, there is no need for anesthesia. The whole process takes about 3 mins, after which, the patient is asked to rest for another 30 mins. For further examination and operation, anesthesia will be administered and the process will take about 5 mins. Resting period is an additional 1-2 hours.

When to test:
Best time to test is after the last menstrual cycle and before ovulation takes place for the next cycle. If it is a regular cycle of 28 days, the best time will be in the morning of the 7th to 11th day.

Advantages:
H-Scopy is a higher form of test utilized for difficult pregnancies. It is very safe and accurate. There can be a 100% accuracy rate through visual examination via the hysteroscope.

New advancements in technology in H-scopy uses a smaller, thinner optical instrument of only 2-3mm diameter, thus, the procedure is almost painless.

Disadvantages:
Based on the findings, it is possible that patient will be asked to undergo further tests under anesthesia. There is a slim chance patient will experience some of the risks from the administering anesthesia, such as infection, allergic reactions and bleeding.

Slight bleeding during the period between an H-scopy procedure and the next menstrual cycle is normal.

Reminders:
For couples with continued problems in infertility for a number of years and who have opted for in-vitro fertilization (test tube baby), it is recommended that they undergo an H-scopy exam to determine uterus conditions.

Fasting is required for eight hours prior to an H-scopy exam – no food or water intake.

After the examination, slight bleeding or abdominal pains during the period between an H-scopy procedure and the next menstrual cycle is normal.


2. Cervical cultures

Purpose:
Inflammation of female genital tract includes viginitis, cervicitis, salpingitis and pelvic inflammatory disease (PID). Chronic inflammation may cause endometirum polyp(s), tubal adhesion, obstruction and/ or hydrosalpinx, etc. Bacteria, Chlamydia trachomatis and human papillomavirus (HPV) are 3 most common pathogens.

Procedure:
Similar to getting a pap smear. It takes about five (5) minutes and is not painful.
To collect a sample, the patient will be asked to lie on her back on the examination table with feet raised and supported by stirrups.
The physician will examine the vagina and genital area. A speculum will be inserted, gently spreading the vaginal walls apart to check the cervix. Using a cotton swab, sample will be swiped from the cervix.

(1) Cervical discharge culture
    To check with bacterial infections such as yeast (Candidiasis), Gram-positive bacilli (GPB), E. coli,  Streptococcus, Staphylococcus, etc. Antibiotic treatment is recommend when infection was found.

(2) Chlamydia DNA testing
    Chlamydia is the most common bacterial sexually transmitted disease. Chlamydia DNA testing is done to check if the bacteria Chamydia trachomatis is present and causing any infections. This disease can be passed on from infected mother to baby during vaginal childbirth. It may spread to the upper genital tract causing PID which can cause scarring, infertility and ectopic pregnancies if untreated. Antibiotic treatments for both husband and wife are recommend when infection was found.

(3) HPV DNA typing
     HPV is related to cervical cancer, genital warts (Condyloma) and many different kinds of cancers. HPV DNA typing is to detect if any HPV is present and to identify the type of the HPV. Low risk types: 6, 11, 42, 43, 44...; high risk types: 16, 18, 31, 33, 45, 51, 52, 56...Vaccination is suggested.

When to test:
Best done on the 7th to 11th day of menstrual period.

Advantages:
Easy test, similar to the pap smear, that can eliminate any suspicions of infection or abnormality in reproduction system.

Disadvantages:
Possible bleeding and false negative.

Reminders:
Infections in the reproductive system is very common and causes complications in conceiving, lowering the rates for successful pregnancy.

Most infections may not cause any symptoms in the beginning and may linger inside the body for years. Some symptoms that could eventually manifest are: cervical mucus or discharge, inflammation/ abdominal pain or urgent urination. This disease may remain undiscovered until the Fallopian tubes have become blocked.

Since infections may affect the development of the embryo, it is advisable to undergo this test prior to pregnancy.

Vagina should not be washed prior to testing in order to prevent any false negative results.


3. Laparoscopy (L-Scopy)


Purpose:
To assess the female pelvic organ. Common anomalies include endometriosis, tubal adhesion etc.

Procedure:
L-scopy is done in the operation room with full-body anesthesia. A small incision of about 0.5cm is made in the abdomen near the navel. A laparoscope or telescopic lens system connected to a video camera is then inserted to examine the abdominal and pelvic organs. Additional small incisions may be made to insert other surgical instruments to lift the uterus and fallopian tubes for examination.

L-scopy is an outpatient procedure and takes about 20 minutes.

When to test:
Best time to test is after the last menstrual cycle and before ovulation takes place for the next cycle. If it is a regular cycle of 28 days, the best time will be in the morning of the 7th or 11th day.

Advantages:
L-Scopy is a higher form of test utilized for difficult pregnancies. It is very safe and accurate. There can be a 100% accuracy rate through visual examination via Laparascopy.

After a L-scopy exam, the causes of infertility will be discovered.

Disadvantages:
There is a slim chance patient will experience some of the risks from the administering anesthesia, such as infection, allergic reactions and bleeding.

Small incisions are required during a L-scopy, with 2-3 cuts near the navel of around 3-5mm. Neck pain or stomach discomfort is possible.

Reminders:
Fasting is required for eight hours prior to an L-scopy exam – no food or water intake.

Small incisions are required during a L-scopy, with 2-3 cuts near the navel of around 3-5mm. Wound may be a little painful and there might be minor bleeding but this is normal.

Couples who have undergone all other tests and still remain infertile after trying TSI progressively for a period extending to six months. It is recommended that they undergo a L-scopy. Other tests listed are “indirect tests,” while an L-scopy is a “direct test,” rendering it more accurate.