Advanced Procedures
- Invitro Maturation
- Fertility Preservation
- Egg Freezing and ovarian tissue freezing
- Vitrification
- Cytoplasmic transfer
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INVESTIGATIONS
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LAPAROSCOPY For this operation it is necessary to be admitted to the hospital in the evening previous to the operation. She will not have anything to eat or drink from the midnight on the day of admission. The operation is done under general anaesthesia. A small needle is first passed into the abdomen through a one centimetre long cut just below the umbilicus so that the gas ( CO2) is introduced into the abdominal cavity. This will keep the bowel and other structures away from the pelvic organs so that we can get a good view of the uterus, both the ovaries and fallopian tubes. A trocar is now inserted through which the laparoscopic telescope is introduced. For proper visualization there is a very bright light source, which gives illumination of the pelvic organs to identify problems clearly. The uterus, both the ovaries and the tubes are carefully evaluated to identify the cause of infertility. The tubal patency and the condition of the fimbriae in particular are looked at. Presence of endometriosis and adhesions ( scar tissue) is also looked for. Any minor procedure to increase the chances of a pregnancy is performed at the same time, like division of adhesions. If the adhesions are excessive then there is no benefit in performing further procedures as these invariably return. Normally it is possible to go home the same evening after the operation. HYSTEROSCOPY This procedure is similar to laparoscopy except that we look inside the cavity of the uterus to identify submucus fibroids, endometrial polyps, intrauterine adhesions or uterine septum etc. This operation is done through vagina. The uterine cavity is distended with a very thick special solution (Glycine). Hysteroscopy is also done in recurrent pregnancy loss to identify the possible cause. ENDOMETRIAL BIOPSY We normally do not do the endometrial biopsy prior to infertility treatment. If there is a past history of tuberculosis it will be necessary to exclude this infection in the uterus before starting the treatment. The endometrial tissue is sent for culture in the laboratory which takes at least three weeks. It is also sent for histology. If tubercular infection is detected immediate treatment is started with appropriate antibiotics. This treatment may last from three to six months. Only after the infection has cleared up the infertility treatment could be started. HYSTEROSALPINGOGRAPHY /SONOHYSTEROSALPINGOGRAPHY The first one is an X-ray that is done to check the shape of the uterus and the patency of the fallopian tubes. HSG is done in the X-ray department. HSG or sono HSG is done soon after the menstrual bleeding has stopped, preferably before day 11 of the cycle. The procedure is normally done without the anaesthesia. A speculum ( a metal instrument ) is inserted into the vagina to expose the cervix (neck of the womb). A cathter is introduced through the cervix and a dye is injected into the uterine cavity. The doctor will see the shadow of the uterus on the X-ray or the ultrasound machine. If the solution is injected continuously it will enter the tubes and come out of the free end of the tubes if they are patent It is not possible to see endometriosis, tubal fimbriae or adhesions by HSG. Hence it is only done in selected cases because of the limited information one can get from this procedure. |
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