2- Ovulation tracking

Most women ovulate between day 11th and day 21st of the cycle, however many women may ovulate at different times or different day each month.

This is why it is important to track your cycles and hence ovulation. One such method that is adopted by doctors is the transvaginal ultrasound follicular tracking or folliculometry.

What Is A Follicular Study?

Follicular tracking is a series of vaginal scans so as to precisely know when you are ovulating. Generally, these scans will start around day 9th of your cycle and continue till day 16th. The doctor will observe the follicle development occurring in your ovaries.

How Long Does A Follicle Scan Take?

The follicular tracking scan will generally take about 5 to 10 minutes, provided you are cooperative with the doctor.

How Many Scans Per Cycle Are Carried Out?

Because the ovulation window is wide, in each cycle about 4-6 scans will be required. The base line scan will help the doctor know the initial stage of the follicle, and from there the development will be closely followed.

The next scan will be scheduled accordingly. As the cycle progresses, the follicle growth and womb lining will be ascertained.

The scan will give a very clear picture of the developments happening and the right time of ovulation will be arrived at.

Is There Anything Else That Follicular Scan Can Help With?

Yes, as a fact, a follicular study will also detect some other issues that may impede a pregnancy. Some of them are:

• The thickening of the womb lining in conjugation with the follicular release

• Follicles that do not grow at all or do not rupture at the correct time

All these parameters help the doctor and you to know what and when things are happening, and what is not happening. It makes it easier to identify the problems and thus impart treatment or corrective measures.

3-Induction of Ovulation

What is ovulation induction treatment?

Inducing ovulation using medication (ovulation induction) allows an egg to mature and be released by the ovary. The cycle is tracked with blood tests and ultrasound, to confirm the best time to conceive.

Ovulation induction medication

There are two types of medication used to induce ovulation: tablets (oral medication) or daily injections of Follicle Stimulating Hormone (FSH). If you are having ovulation induction at the same time as IUI treatment, either type of medication is suitable.

Is ovulation induction right for me?

Ovulation induction may be the best choice if you:

• don’t have a regular cycle

• don’t have periods at all (in premenopausal patients)

• have healthy tubes

• have unexplained infertility.

4-Intra uterine insemination

• Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating.

• IUI is often used to treat

• Mild male factor infertility.

• Couples with unexplained infertility and women with cervical mucus problems.

Insemination is performed at the time of ovulation, usually within 24-36 hours after the LH surge is detected, or after the “trigger” injection of hCG is administered. Ovulation is predicted by a urine test kit or ultrasound.

What is the process of IUI?

In the case of husband insemination, the male partner produces a specimen, at doctor’s office. The sperm is then prepared for IUI.
Sperm from the male partner are “washed” or separated. Separation selects out motile sperm from the man’s ejaculate and concentrates them into a small volume.
Sperm washing cleanses the sperm of potentially toxic chemicals which may cause adverse reactions in the uterus. The doctor uses a soft catheter that is passed through a speculum directly into the woman’s uterus to deposit the semen at the time of ovulation.
IUI may be used in conjunction with ovulatory medications and careful monitoring is essential. Monitoring includes periodic blood tests and ultrasounds beginning around day 6 of the woman’s cycle.
IUI can also used with specially prepared donor sperm, if indicated and if consented by the couple. The sperm bank provides the sperm that is already prepared for IUI.
IUI is a relatively quick procedure and is performed in the doctor’s office without any anesthesia. It should not be painful, although some women report mild discomfort.

5-Endoscopic Evaluation and Treatment

A complete examination of a woman’s internal pelvic structures can provide important information regarding infertility and common gynecologic disorders.
Frequently, problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs.
These procedures may be recommended as part of your infertility care, depending on your particular situation.
Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes.
Diagnostic laparoscopy may be recommended to look at the outside of the uterus, fallopian tubes, ovaries, and internal pelvic area.

Diagnostic hysteroscopy is used to look inside the uterine cavity.
If an abnormal condition is detected during the diagnostic procedure, operative laparoscopy or operative hysteroscopy can often be performed to correct it at the same time, avoiding the need for a second surgery.

6- Laparoscopic corrective surgery

OPERATIVE LAPAROSCOPY

During operative laparoscopy, many abdominal disorders can be treated safely through the laparoscope at the same time that the diagnosis is made.

When performing operative laparoscopy, the physician inserts additional instruments such as probes, scissors, or grasping instruments.

Problems that can be corrected with operative laparoscopy include removing adhesions (scar tissue) from around the fallopian tubes and ovaries, opening blocked tubes, removing ovarian cysts, and treating ectopic pregnancy. Endometriosis can also be removed or ablated from the outside of the uterus, ovaries or peritoneum.

Under certain circumstances, fibroids on the uterus can also be removed. Operative laparoscopy can also be used to remove diseased ovaries and can be performed as part of a hysterectomy

Following operative laparoscopy, patients are generally able to return home the day of surgery and recover more quickly, returning to full activities in three to seven days.

7- Hysteroscopic corrective surgery

Hysteroscopy is a useful procedure to evaluate women with infertility, recurrent miscarriage, or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the uterine cavity, and is helpful in diagnosing abnormal uterine conditions such as fibroids protruding into the uterine cavity, scarring, polyps, and congenital malformations.
Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy.
Operative hysteroscopy is similar to diagnostic hysteroscopy except that narrow instruments are placed into the uterine cavity through a channel in the operative hysteroscope. Fibroids, scar tissue, and polyps can be removed from inside the uterus. Some structural abnormalities, such as a uterine septum, may be corrected

8- HSG

What is hysterosalpingography (HSG)?

Hysterosalpingography (HSG) is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes.
It often is used to see if the fallopian tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape. All of these problems can lead to infertility and pregnancy problems.

During HSG, a contrast medium is placed in the uterus and fallopian tubes. This is a fluid that contains a dye. The dye shows up in contrast to the body structures on an X-ray screen. The dye outlines the inner size and shape of the uterus and fallopian tubes. It also is possible to see how the dye moves through the body structures.

When should HSG be done?

It is best to have HSG done in the first half (days 1–10) of the menstrual cycle. This timing reduces the chance that you may be pregnant.

What should I expect after the procedure?

After HSG, you can expect to have a sticky vaginal discharge as some of the fluid drains out of the uterus. The fluid may be tinged with blood. A pad can be used for the vaginal discharge. Do not use a tampon. You also may have the following symptoms:

• Slight vaginal bleeding

• Cramps

• Feeling dizzy, faint, or sick to your stomach