Care of women

Following your first meeting, your doctor will propose a number of examinations for you. These are decisive in then determining the medically assisted reproduction treatment that is best for you as a couple.

All these examinations are undertaken at CHUV's Maternity Unit.

In general, the investigations start with a vaginal ultrasound scan, which is painless and is undertaken to examine the ovaries, Fallopian tubes and uterus.

This non-surgical type of examination uses sound waves to evaluate the size and shape of the reproductive organs. It is particularly useful for the diagnosis of ovulation disorders and to monitor follicle development during infertility treatment.

In addition, blood tests are performed in women to determine their hormonal status.

Hormonal status (or endocrine status) is a laboratory examination which consists of assaying hormones in the blood (generally between the 2nd and 4th days of the cycle).

Several hormones are involved in the regulation of fertility in women. These hormones come from different organs:

• The base of the brain, where the hypothalamus (GnRH) and the pituitary gland (prolactin, FSH, LH, TSH) are located;
• Both ovaries (oestradiol, AMH, progesterone);
• The thyroid (thyroid hormones).

All these organs may be the source of disruption of the menstrual cycle and thus of female fertility.

Depending on the case, hysterosalpingography may be required. This radiographic examination, used together with a contrast medium, can detect any obstruction of the Fallopian tubes.

The introduction of the probe is the most painful moment, but this only lasts for a few seconds. Injection of the contrast medium may cause pain identical to period pain. This is temporary, and analgesics will be prescribed if needed.

To obtain a more precise diagnosis, it is sometimes necessary to inspect the internal genital organs as well as the permeability of the Fallopian tubes. A laparoscopy is then performed. This operation also provides the opportunity to assess any lesions and to repair them, thus combining both diagnostic and surgical objectives.

Laparoscopy consists of introducing a camera through the umbilicus into the abdominal cavity under general anaesthesia. The abdomen is inflated with carbon dioxide to separate the intra-abdominal organs and to create space to provide a risk-free procedure. Depending on the type of operation envisaged, one to three small complementary incisions are made to allow the instruments to be introduced.