The following procedures are commonly used in the treatment and diagnosis of infertility. Read this article to learn what they are, why they are performed and what to expect if you have one of these procedures:

• Endometrial Biopsy
• Hysterosalpingogram (HSG)
• Hysteroscopy
• Laparoscopy
• Sonohysterogram

Endometrial Biopsy

What It Is and Why It Is Performed:
An endometrial biopsy is used to diagnose a luteal phase defect (a type of hormone imbalance in which the amount of progesterone produced in your body may be insufficient to sustain a pregnancy).

What to Expect if You Have the Procedure:
This procedure is performed in a doctor’s office and involves inserting a narrow catheter (a thin tube) through the cervix and into the uterus to obtain a tissue sample, which is then sent to a laboratory for analysis. If the sample is found to be "out of phase" (it appears the date of the endometrial lining is off), an endometrial biopsy is often performed again in a subsequent cycle, prior to a diagnosis of luteal phase defect being made.

How You May Feel During and After the Procedure:
You may experience some cramping, ranging from mild to severe. Some spotting may occur after the procedure and continue for a day or two. Doctors often recommend that you take an over-the-counter pain medication such as Aleve or Advil.

A Caution About This Procedure:
An endometrial biopsy is usually performed right before a woman’s period is due. It is important that a pregnancy test be performed prior to having this procedure, as it may cause a pregnant woman to miscarry.

Hysterosalpingogram (HSG)

What It Is and Why It Is Performed:
An HSG is performed to allow a doctor to ascertain whether a your fallopian tubes are fully open and to determine if there are any uterine growths (such as polyps or fibroids) or structural abnormalities.

What to Expect if You Have the Procedure:
The doctor injects a dye through the cervix and into the uterus and fallopian tubes and traces its movement by X-ray. The doctor performing the procedure can view it on a screen as it occurs; if he or she is not a radiologist, the films are sent to a radiologist to view them and offer an opinion. The HSG is generally performed as a hospital outpatient procedure. Some women go right back to work; others take the rest of the day off.

How You May Feel During and After the Procedure:
Women generally experience some cramping, ranging from mild to severe. Some spotting may occur after the procedure and continue for a day or two. Doctors often recommend that a woman take an over-the-counter pain medication such as Aleve or Advil.

A Bonus of This Procedure:
It is not uncommon for a woman to become pregnant one to three months after having an HSG. This may be because the dye injected into the fallopian tubes clears them of mucus.

Hysteroscopy

What It Is and Why It Is Performed:
A hysteroscopy is an outpatient hospital procedure performed when the physician needs to more closely examine the uterus. It can be done for either diagnostic reasons (to determine the cause of unexplained bleeding, to study the uterus or to examine a growth) or for operative reasons (such as treating endometriosis or removing a growth). A hysteroscopy may be performed on its own or in concert with other procedures (such as a laparotomy or endometrial biopsy). It is usually performed under local or general anesthesia.

What to Expect if You Have the Procedure:
Your cervix is dilated and a hysteroscope (a small scope used to examine the uterus) is inserted to allow close viewing of the uterus. Carbon dioxide gas is usually employed to improve viewing.

How You May Feel During and After the Procedure:
It is usual to have some bleeding and pain after this procedure, sometimes for several days. While some women recover within a day or so, many take at least a few days to return to feeling normal. It is normal to have shoulder pain and bloating from the gas used. Generally over-the-counter or prescription pain medication is used to manage pain after a hysteroscopy.

A Caution About This Procedure:
As with any kind of procedure requiring anesthesia, the attending physician will give instructions about not eating and drinking prior to surgery. It is usual to not have anything by mouth after midnight for surgery the next day. Your doctor will generally tell you how long after this procedure you should abstain from intercourse.

Laparoscopy

What It Is and Why It Is Performed:
A laparoscopy is a hospital surgical procedure (usually performed on an outpatient basis) that involves abdominal incisions. It is used for diagnosing and treating a number of conditions that impair fertility, with endometriosis, ovarian cysts and blocked fallopian tubes being among the most common.

What to Expect if You Have the Procedure:
After the administration of general anesthesia, the surgeon makes two to four incisions in your abdomen -- one through the navel, where the laparoscope is inserted, and several near the "bikini line." Gas is used to expand the abdomen. Surgical instruments are used to manipulate organs through the lower incision(s).

How You May Feel During and After the Procedure:
As with other procedures, pain following the procedure and recovery time depend on the individual. It also varies depending on the difficulty of the surgery. A laparoscopy differs from other procedures discussed here in that it is major surgery. Some women who have sedentary jobs may feel ready to return to work in a few days; others, who are recovering more slowly or have more physically demanding jobs, may take longer to return to work.

A Caution About This Procedure:
As with any kind of procedure requiring anesthesia, the attending physician will give instructions about not eating and drinking prior to surgery. It is usual to not have anything by mouth after midnight for surgery the next day. Generally doctors advise that a woman abstain from intercourse until after a two-week checkup following surgery. Patients recovering from a laparoscopy are instructed to get plenty of rest and to avoid heavy lifting.

Sonohysterogram

What It Is and Why It Is Performed:
A sonohysterogram is a relatively new procedure that is often used in place of an HSG.

What to Expect if You Have the Procedure:
A sonohysterogram has the advantage of being performed in a doctor’s office (HSG is performed in a hospital radiology department). A speculum is placed into the vagina, through which a catheter is placed in the uterus. A saline solution is then injected into the uterine cavity while a transvaginal ultrasound is conducted. No X-rays or iodine are used (although these are components of the HSG).

How You May Feel During and After the Procedure:
While some women report about the same amount of discomfort as with HSG, others have had much less; it has been suggested that this may be because the saline is less irritating than iodine.

While Preconception.com hopes that this information will assist in your understanding of the procedures explained here, it is not medical advice. If you’re wondering if one of these procedures should be used in your care, the best advice that we can give you is to discuss any questions or concerns with your OB/GYN or reproductive endocrinologist.

Source: The InterNational Council on Infertility Information Dissemination (INCIID).