A basic infertility evaluation should always involve an assessment of a woman’s uterus. Irregularities in the uterus – including uterine fibroids, which are benign tumors of the uterine muscle – may cause infertility. Irregularities can cause fertility problems when located either within or very close to the uterine cavity or when they are large or the uterine cavity itself is distorted. Other uterine causes of infertility include scarring or sometimes benign glandular tumors inside the uterus which are called uterine polyps.
Because the uterus, like the fallopian tubes, is made of soft tissue, it cannot be seen on a normal x-ray and may not be detected during a physical examination, so specialized imaging tests may be used. These include:
Sonohysterogram (Saline Infusion Ultrasound). When the inside uterus cavity needs to be evaluated, a doctor may want to perform a saline infusion ultrasound. During this procedure, a small amount of sterile solution is placed into the uterus to provide a better look at the cavity.
Hysterosalpingogram (HSG). This procedure provides information about the fallopian tubes and uterine cavity. The doctor injects a special dye into the uterus and then performs an x-ray to visualize the path of the dye through the fallopian tubes. This test allows the doctor to determine if the fallopian tubes are open.
Vaginal Ultrasound. A vaginal ultrasound utilizes a probe that is placed inside the vagina. The probe transmits sound waves that allow visualization of the organs in and around the pelvic cavity. The use of vaginal ultrasound helps the doctor see the wall and lining of the uterus.
Hysteroscopy. This procedure is performed with a small telescope attached to a camera (called a hysteroscope) that lets the doctor look inside the uterus. Because the doctor has a direct view of the uterus, this procedure may provide the most accurate information.