In cases where problems have been detected during the HSG, the gynecologist may proceed with a laparoscopy or hysteroscopy, which are invasive interventions. They require anesthesia: laparoscopy is performed under full anesthesia, while hysteroscopy, performed only for diagnostic purposes, can be performed under sedation. If, however, the latter needs to be performed for surgical purposes, then it usually requires full anesthesia 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, the way it enters and moves through the fallopian tubes, the way it flows out into the abdominal cavity. This can confirm if there is a problem with the fallopian tubes and to detect where exactly it lies, whether there is an obstruction or any other issue that may be causing a problem. 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 anesthesia. In such a case, the telescopic camera is inserted through the cervix in order to check whether the cavity is normal or not. A very thin pair of electric scissors can be inserted through the telescopic camera, so, if there are any adhesions or scars, they may be excised and removed, or, if there are fibromyomas or polyps intruding into the uterus, they can be removed, too.
