When to move to advanced fertility tests
The basic fertility tests include a semen analysis, a physical examination and pelvic sonogram, an HSG, and bloodwork. If these are normal, or treatment did not fix the couple’s issues, they have unexplained infertility. The next step is to consider advanced fertility tests like laprascopy.
Advanced fertility tests like laparoscopy
In the 1970s, two clinical studies offered laparoscopies to couples who had unexplained infertility. These women had no symptoms other than that they were sexually active and unable to conceive. In both clinical studies, 40% of the women had something abnormal. In the group of women who had abnormal findings at laparoscopy, 2/3 of these women had endometriosis and 1/3 had adhesions. Some women had a combination of each. Because of these studies, laparoscopy became a routine diagnostic procedure for evaluating couples with infertility.
A laparoscopy is a minor surgical procedure in an outpatient surgical unit. The patient is under a general anesthetic during the procedure. A doctor makes a small incision just below the belly button. The doctor then inserts a camera to visualize the pelvic cavity.
Next, the doctor make one or two additional incisions are made in the pubic area so that he or she can move the ovaries and uterus while viewing the area. Patients typically leave the after a few hours. Patients should take off from work the following day to fully recover. Usually patients are ready to resume treatment in the following cycle.
One of the most important things about undergoing a laparoscopy is to realize that it is best to have a physician who can make the diagnosis and correct the problem. Doctors can correct most cases of endometriosis and/or adhesions with a laser at the time of the diagnostic procedure.
Making the decision
When a patient is trying to decide whether to undergo a laparoscopy or move to one of the treatments for unexplained infertility, there are several important considerations. Some patients might prefer to undergo the initial treatment with clomiphene/IUI. If couples do not conceive, they may undergo a laparoscopy at a later date.
On the other hand, some patients choose to undergo a laparoscopy first. Some patients are influenced by their insurance coverage. It is not uncommon for patients to have insurance coverage for diagnosis of their infertility, but not have coverage for treatment. These patients may choose to undergo the diagnostic laparoscopy first to be sure that everything has been evaluated prior to undergoing treatment.
When a couple with unexplained infertility has come to this decision in their evaluation for infertility, it is a good idea to make an appointment to visit with your physician to discuss the pros and cons of all options for your particular case.