During your subsequent visits, tests that were not done on the first visit will be completed.

Subsequent visits will be determined on when in the menstrual cycle that the patient came in the first visit.

Usually, your subsequent follow-up will be;

Day2-Day5 if Hormone Assays have not been done. FSH and LH will be performed.

Day8 for a Tubal Patency Test / Ultrasonic Salpingiogram
This is a simple outpatient test used to detect tubal patency (no blockage of Fallopian tubes). The uterine cavity and Fallopian tubes are filled with ultrasonic dense fluid.

If either of the Fallopian tubes is patent, the fluid will flow out from the end of the Fallopian tubes and fill up the adnexa (side of uterus) and pouch of Douglas (the cavity between uterus and rectum). Patient may feel pain and discomfort at pelvic area after the test if her tubes are patent.

The advantages of ultrasonic salpingiogram compared to hysterosalpingiogram (HSG) and laparoscopy are that no radiation or surgery are required.

Day12 for a Follicle Maturity Check / Test
In many instances, having regular menstrual periods is a reliable sign that regular ovulation occurs.

Sometimes, though, ovulation may be premature, incomplete, or altogether absent, despite apparent temperature elevations, positive ovulation predictor kits, changes in vaginal secretions, or mid-cycle cramping. This test is performed around ovulation, usually Cycle Day 11-14.

In these instances, a poorly formed follicle may not release an egg; or may do so but at the wrong time, so when the egg which is released, it is incapable of being fertilized. In other cases, ovulation occurs but subsequent progesterone hormone production by the post ovulatory follicle (called the corpus luteum) may not be strong enough to allow implantation of an early embryo.

The purpose of ovulation and follicle monitoring is to uncover these types of disorders, since these disorders are highly treatable, usually with simple medications. If the timing of your menstrual cycle is irregular, or if your previous monitoring with temperature charts or ovulation predictor kits has been variable, then this type of monitoring is very likely to be very helpful.

Laparoscopy
*If initial investigation indicate that laporoscopy procedure is needed.

Laparoscopy procedure requires general anaesthesia. A small incisions (0.5 to 1.5cm) are made in the abdomen, where a fine telescope is inserted through a small incision at the umbilicus and the internal female organs are visualized. Carbon dioxide is filled in the abdomen to separate the organs so that it is easier for the gynaecologist to see the reproductive organs. The gas will be removed after the procedure. At the same time, the Fallopian tubes are tested for patency using methylene blue dye which is injected at the vagina end. If the tubes are patent, the blue dye will be seen flowing out at the fimbriae (tube) end.

During laparoscopy, the cause of infertility such as endometriosis, adhesion and fibroid can be confirmed. Laparoscopy is diagnostic as well as therapeutic. For an example; at the time of laparoscopy, endometriosis is confirmed and it can be cauterized and treated at the same time. Other treatments that can be done at the time of laparoscopy are release of pelvic adhesion and ovarian drilling (making hole in capsule).

Laparoscopy is indicated for:

1. Ovarian cysts and tumours
2. Myomectomy (removal of fibroids)
3. Tubal surgery
4. Lysis of adhesions
5. Endometriosis
6. Determining the patency of Fallopian tubes
7. Pelvic floor and vaginal prolapse
8. Hysterectomy (removal of the uterus)
9. Sterilization

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