Infertility work-up should include examination with TVL, expert says.(care and treatment)

LONDON -- The modern infertility work-up should include a transvaginal hydrolaparoscopic exploration of the tubes and ovaries, said Stephan Gordts, M.D., of the Leuven (Belgium) Institute for Fertility and Embryology.

He pioneered transvaginal hydrolaparoscopy (TVL) in 1998 (later, another group named the procedure "fertiloscopy") and said he's since abandoned tubal assessment by hysterosalpingogram (HSG).

Whereas the HSG can explore tubal patency only, "with TVL you have a more complete exploration of the patient," he told this newspaper.

Speaking at the annual congress of the International Society for Gynecologic Endoscopy, Dr. Gordts explained that TVL can evaluate both the inside and outside of a patient's reproductive organs and can evaluate adhesions and endometriosis by incorporating hysteroscopy, transvaginal hydrolaparoscopy, salpingoscopy, and tubal patency testing.

TVL can be done in an ambulatory setting, under local anesthetic, and requires only an oocyte aspiration room, rather than a full operating theater. The procedure is performed with the insertion of a needle transvaginally into the pouch of Douglas followed by infusion with saline. An endoscope can be introduced, allowing visualization of the outside of the uterus, the ovaries, and the distal part of the fallopian tubes. The scope can be introduced a few centimeters into the distal end of the fallopian tube for evaluation of the ampulla and the inside of the distal tube. A biopsy can reveal the presence or absence of normal cilia movement.

At the ...