Infertility is defined as inability of a couple to conceive after one year of unprotected sexual activity. In such cases having confirmed that the husbands semen profile is normal and that he has no coital difficulty the female partner needs further evaluation with hormone evaluation serm Fsh, Lh and prolactin with Amh levels.
Further studying the tuboovarion relationship is advisable by laparoscopy to check the: tubal patency as in to check if the tubes are patent or open. This is a procedure where a woman has to time it just after her menses. She needs to be admitted in a fasting state with all her recent blood reports which assure her fitness for anaesthesia. Once under general anaesthesia she is given a litotomy position and a hysteroscope is passed through the vagina onto the cervix to check the cavity of the uterus. Then a laparoscope is introduced into the abdomen by a small 5 mm in inscision at the belly button or the umbilicus. The abdominal cavity is distended with gas and the pelvic cavity is inspected thoroughly. The uterus is inspected for its size and shape, the tubes are checked for patency by pushing a dye called methylene blue through the cervix. Appreciating a free spill of the dye from both tubes confirms tubal patency.
The undersurface of the tubes and ovaries is checked to rule out adhesions or early endometriosis, if any early endometriosis is seen it is fulgurated or excised, if there is evidence of PCOD then the ovaries are punctured with a unipolar energy source making 4 punctures, 4 mm deep, at 40 watts energy for 4 seconds each and the ovaries are cooled immediately with saline to prevent thermal insult to the ovaries. Though this is a minor procedure it needs to be performed in a state of the art setup, with good backup facilities with an experienced anesthetist and a dexterous laparoscopic surgeon. Contact Dr. Ranjana Dhanu as she provides the best treatment for infertility in Mumbai and she also does great laparoscopic surgery for infertility in Mumbai.
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