Diagnostic - invasive Laparoscopy and/or Hysteroscopy
If problems are noted in the HSG, then the gynaecologist may proceed with a laparoscopy or hysteroscopy, which are interventions that require full anaesthesia. Laparoscopy requires full anaesthesia, while hysteroscopy is performed only for diagnostic purposes and may be performed under sedation. If, however, the latter needs to be performed for surgical purposes, then it usually requires full anaesthesia as well. Laparoscopy and hysteroscopy are performed 3 days after the end of menstruation; therefore, for most women this is around the 10th or 11th day of their menstrual cycle.
In laparoscopy a small incision is made in the navel, through which a telescopic camera is inserted into the abdominal cavity; a smaller incision is also made where the pubic hair begins and an assisting tool is inserted so as to monitor/move the fallopian tubes in order to better study them. At the same time a blue dye is injected through the cervix. This allows the doctor to observe the blue dye, how it enters and how it moves through the fallopian tubes, how it exits and flows into the abdominal cavity, and this way it can be exactly confirmed whether there is a problem in the fallopian tubes and to identify exactly where it lies, if there is obstruction and where exactly the fallopian tube is obstructed or any other problem that may be present. Laparoscopy provides an external look of the uterus and the fallopian tubes. At the same time, its invasive part allows the removal of any fibromyomas from the uterus, or its walls or projecting outwards, as well as rectifying any fallopian tube problem. Through the laparoscope, using laser beams or electric scissors, one may cut adhesions (fibrous bands that may obstruct the fallopian tubes) or open up their end section so they can once again become patent.
As far as hysteroscopy is concerned, if it is performed only for diagnostic purposes, then only sedation is required; however, if it is speculated or known that an intervention may be required, then this is also performed under full anaesthesia. In such a case, the telescopic camera is inserted through the cervix and it is examined whether the uterus cavity is normal or not. A very thin pair of electric scissors may be passed through the telescopic camera tube, so that, if there are any adhesions or scars it will be possible to excise and clean them; if there are fibromyomas or polyps projecting into the uterus, they can be removed or, if there is some congenital abnormality (e.g. septum) it can be corrected.