How To Diagnosis Infertility

Melanie Raposo: Hi! And welcome to The Pregnancy Show everybody, I am Melanie Raposo. Now if you are a couple experiencing infertility problems, it’s important to make sure, you get the right diagnostic test and making sure, that you are seeing the right professionals. And with us today is Dr. Lawrence Sanders to discuss some of these issues. Hi! Thank you for being with us. Dr. Lawrence Sanders: It’s a pleasure thank you for having me. Melanie Raposo: What therapeutic procedures are performed by a radiologist? Dr. Lawrence Sanders: So from a therapeutic point of view Radiology is limited most of what we do is diagnostic, we do Hysterosalpingography, Hysterosonography, obviously, Ultrasound, CT, MRI and that’s all to do with diagnosis. Occasionally form a therapeutic stand point, we will do something called a fallopian tube recanalization which is very rare, that we actually have to do it and that’s really limited to women that we sure have got obstruction to the fallopian tubes, real close to the uterus. What we do in that situation is we -- while the women is sedated, we will canalize the fallopian tube with a very tiny wire about, the size of a hair open the tubes up and it’s fairly successful. As I say it's extremely rare, most patients refer to me for that when we do the regular diagnostic work up the Hysterosalpingogram, I'll find that the fallopian tubes are actually not obstructed and they don’t really need it. Melanie Raposo: Now, how is radiology effective in the diagnosis of the infertility? Dr. Lawrence Sanders: Well, we have a certainly a very small roll to play most of what we do is because we have referrals from either Obstetricians or Infertility specialist, occasionally from family doctors who want to see why the lady isn’t getting pregnant. So our part of it is mostly to do with the anatomical part, to see if the uterus, the fallopian tube is in the ovaries or anatomically correct in doing what they are suppose to do. So the test that we do -- there are a few test. One of them is called the Hysterosalpingogram, one of them is called the Hysterosonogram and of course, there's all the usual radiological things involved like ultrasound occasionally CAT scan, people do MRI. So from a diagnostic point of view most people that are referred to us, they are being referred to make sure that everything is correct. So the first thing that we do and that's not everyone that does is, that the women have a Hysterosonogram which is an under ultrasound we basically, canalize the womb -- the opening of the womb of the uterus and after, that's done under ultra sound guidance, we look inside the uterus while we inject saline, while we are injecting the saline the uterus opens up and we can see if there is any polyps or adhesion, because a lot of these ladies have had D&C in the past and we want to make sure they haven’t got adhesions which is causing the infertility problems. The polyps can be a problem too and they had a lot of polyps act like IUDs and they go misdiagnosed if you go just straight Hysterosalpingography, which is what we follow with still in, we in our place remove the patient to an X-ray room and under X-ray guidance, we inject die and while the die is going in I can see the inside of the uterus can we can sieve the fallopian tubes or patent, whether they dilated, blocked whatever is going on. So we do it all as one sort of procedure, but it’s exactly two procedures. Melanie Raposo: Okay now what are the advantages to doing procedures like this? Dr. Lawrence Sanders: Well, I think the advantage is all that it tells us that one that the women is normal and that there is no blockages. I think the other thing that I found over the years is that often women just by having the procedure will get pregnant, within a few cycles, I am not sure why that it is, my guess is that the fallopian tubes can have deposits in them and what we are doing is flashing the system out. So we'll see sometimes women that have been trying for many years to get pregnant unsuccessfully have all these procedures which are diagnostic procedures, everything looks fine and low and behold they get pregnant within a cycle or two or three. So it does work. Melanie Raposo: And do you have a statistic of sort of how many women gets pregnant. Dr. Lawrence Sanders: I would -- it's hard to say, but probably 30%-40% get pregnant very shortly or may be 30% is more realistic. Melanie Raposo: Wow! Now are there any risks to doing procedures like this? Dr. Lawrence Sanders: I think risks are involved in any procedure, I think the most important thing when you are going to do this is to make sure, you are seeing some one who knows what they are doing, because these procedures can be quite painful. I recommend that the women take an advil or something like that, 30 minutes to an hour before the procedure, because they can get cramping and again, you have to be dealt with someone who really knows, what they are doing, because if they don’t that can be extremely painful, that’s the one thing. The second thing is obviously, if the person is not good there are risk like you try in perforation, which is very rare and I have never seen it, but I can occur. There are any other thing with Hysterosalpingography there's a risk of contrast allergy because we use contrast. I have done thousands of these and I have thank a lot have never actually witnessed to seeing that happen. But it's something people should be aware of. Melanie Raposo: Okay, are there any minor side effects that women will experience afterwards? Dr. Lawrence Sanders: I think there is, as I said that it can be painful so they can get some cramping in the right ends, that can be minimal. The only other thing that I usually mention to ladies is that there is a possibility of getting some bleeding or spotting for a couple of days afterwards. Melanie Raposo: Okay, now for a patient to come and see you. How is that done are they referred by other doctor or how they go about seeing someone like yourself? Dr. Lawrence Sanders: They are always referred, it’s usually by a Gynecologist or an Infertility specialist occasionally, from family doctors. It's all on referral. Melanie Raposo: Alright, is there anything else you would like to add that we really haven’t talked about? Dr. Lawrence Sanders: I think the only other thing that we do as Interventional Radiologist is occasionally, out drain a variant cyst. It’s not that they are necessarily a cause of infertility unless, they are really large and blocking the fallopian tube, it’s more for symptomatic relief or occasionally, because the women has the endometrium and they want it drained prior to them, getting into the fertility procedures they want to drained and rather than having them cut open surgically, we do it from below. Also and sometimes women who are going into the In Vitro programs, they have a large cyst and they want that cyst drained prior to stimulating the ovaries so that it doesn’t become very large. Okay. Melanie Raposo: Okay, great. Well, if you would like any more information on anything we have discussed today or on infertility, please visit thepregnancyshow.com. Thank you. Dr. Lawrence Sanders: Thank you. Melanie Raposo: It's great to have you. Dr. Lawrence Sanders: Thanks a lot.