Ultrasound Scan

An ultrasound scan (USS) examination allows investigation of the inside part of the body using high frequency sound waves that are reflected as echoes and form a picture on the TV monitor. Ultrasound is a safe, non invasive and painless diagnostic technique. Many parts of the human body, including the pelvic organs (uterus, tubes and ovaries) can be investigated by ultrasound. Abnormalities which may be shown by ultrasound include abnormal thickness of the endometrium (lining of the uterus) fibroids, polyps, ovarian cysts, fluid in the tubes (hydrosalpinx). Cyclical development of the ovarian follicles and the uterine lining can be assessed accurately during specific days of the menstrual cycle. Pregnancy can be easily monitored from very early stages by ultrasound scan, and complications such as miscarriage and ectopic pregnancy can be diagnosed.

Abdominal ultrasound

This approach requires a full bladder in order to better visualise the pelvic organs. Some clear gel is put on the lower abdominal skin and a scan probe is moved in various directions and over the area of interest to allow appropriate visualisation of the organs.

Transvaginal ultrasound (internal)

There is no need to have a full bladder when the transvaginal approach is used. The probe is inserted very gently into the vagina and it feels very similar to having an internal gynaecological examination. When performing a transvaginal scan the probe is close to the pelvic organs, so a good view is obtained and the pictures are much clearer. The use of colour Doppler at the same time as a standard transvaginal ultrasound enables the blood flow to the organs to be studied.

Indications for ultrasound in gynaecology

• Suspected ovarian cysts
• Infertility
• Pelvic pain
• Period problems
• Fibroids
• Bleeding after the menopause
• Ovarian cancer screening
• Ovarian reserve screening
• Early pregnancy

This technique involves the use of fluid to distend the uterus (womb) coupled with high-resolution transvaginal (internal) scan. A standard speculum is inserted into the vagina and a fine catheter (tube) is gently fed through the neck of the womb and placed into the uterine cavity. The speculum is then removed, an ultrasound internal probe inserted and fluid injected into the womb under direct ultrasound observation.

SIS allows tremendous diagnostic enhancement with a relatively simple and well-tolerated outpatient procedure. It is easily and rapidly performed in the overwhelming majority of patients and virtually devoid of complications.
SIS provides a degree of image magnification similar to performing ultrasound through a microscope. Structures that would not be appreciated with the naked eye can easily be identified through enhanced ultrasonography performed by a trained operator.

Assessment of the endometrial cavity and thickness is very accurate. The need for invasive procedures such as biopsy (taking a sample of tissue), hysteroscopy (inserting a telescope into the uterus through the neck of the womb) and dilatation & curettage is greatly reduced in women with abnormal bleeding. SIS can be used as an investigation of infertility and recurrent miscarriage, and to further study the presence of a mass (fibroid or polyp) in the uterine cavity.

The report of the scan highlighting the findings is available straightaway and will be sent to the referring doctor and a copy to the patient.

HyCoSy consists of a transvaginal (internal) ultrasound scan during which air and saline (sterile water-like fluid) or a solution of D-galactose (sugar-like solution) is infused into the uterine cavity (womb) and observed to flow along the fallopian tubes in order to investigate their patency. The echoes (images) produced by the contrast allow visualisation of the tubes. The addition of colour Doppler to the standard ultrasound scan further improves the quality and accuracy of the image.

HyCoSy has increasingly been used instead of other more invasive methods such as hysterosalpingography (HSG) and laparoscopy & dye test. Many fertility clinicians consider HyCoSy the first line investigation to assess the status of the tubes, especially in women who do not suffer from pelvic pain or do not have a history of previous pelvic infection or repeated surgical operations. HyCoSy is a reliable, convenient and safe outpatient test. Of note, other pelvic organs (uterus and ovaries) can be visualised at the same time by this dynamic ultrasound examination, thus reducing the number of tests in the investigation of infertility.

This technique can cause mild lower abdominal discomfort, especially if the fallopian tubes are damaged or blocked and if there are adhesions in the pelvis. Due to the small risk of spreading infections to the pelvis, it is recommended to take antibiotics for 5 days.

The information about the status of the fallopian tubes is available to the patient straightaway after the test. In the context of a "one-stop fertility clinic" it will be possible to discuss further management accordingly. The report of the scan including details of the HyCoSy test will be sent to the referring doctor and a copy to the patient.