A basic infertility evaluation should always include an assessment of the uterus to check for irregularities. Uterine fibroids affect fertility when located in the uterine cavity or when they are so large that they distort the shape of the uterine cavity. Other infertility issues caused by the uterus are scarring and benign glandular tumors inside the uterus called polyps.
The uterus is made of soft tissue (like the fallopian tubes), so it cannot be seen on a normal X-ray and specialized imaging tests may need to be performed. These include:
A probe that transmits sound waves is placed inside the vagina to allow visualization of the organs in and around the pelvic cavity. This allows the doctors to see the wall and lining of the uterus.
To evaluate the inside of the uterus, a doctor may perform a saline infusion ultrasound, where a small amount of sterile saline is inserted into the uterine cavity to produce a better image during an ultrasound. By distending the cavity, this test can show fibroids, polyps, scar tissue and congenital uterine abnormalities such as uterine septa (a wall between two sides of the uterine cavity.
In order to analyze the fallopian tubes and uterine cavity, the doctor injects contrast material into the uterus. On X-ray, the path of the dye through the uterus and fallopian tubes provides a visual assessment of uterine shape and presence of abnormalities and whether the fallopian tubes are open.
This procedure is performed with a hysteroscope – a small telescope attached to a camera. This tool allows the doctor to take a direct look inside the uterus, and therefore may yield the most accurate information. Hysteroscopy can be performed for diagnostic purposes in the clinic using local anesthesia. More often, it is performed in the operating room using deep sedation or general anesthesia. Many abnormalities such as fibroids, polyps, scar tissue and even uterine septa can be removed with hysteroscopy.