Accurate diagnosis is a necessary step before the correct treatment can be identified.
There is a category of infertile women with abnormalities or damage to the upper part of their reproductive tract who at present remain undiagnosed, at least until they receive IVF. These patients comprise approximately 25-30% of total infertile women, and the specific causes are, firstly endometriosis (growth of tissues like the lining of the womb) in the cavity surrounding the ovaries and fallopian tubes, and secondly “adhesions” (bands of connective tissue that may grow from points damaged by genital infections) in this cavity.
These abnormalities cannot be diagnosed externally, but only by surgical examination. The current method of surgical examination is laparoscopy, i.e. the same procedure that was used originally in IVF for harvesting eggs. As outlined above, this is a major procedure, requiring deep general anaesthetic, an overnight hospital stay, a visible scar on the abdomen, and a low but finite risk of serious complications. For these reasons it is unusual to carry out purely diagnostic laparoscopy, and therefore this group of women remain undiagnosed, and are treated inappropriately.
There is another abnormality, called Polycystic Ovary Syndrome (PCOS) that can be diagnosed either by hormonal diagnostic tests over several cycles, or by surgical inspection.
For women with these problems, IUI is of no use until the problems are corrected. In the case of endometriosis and of adhesions, surgery is the only remedy (short of IVF), and in the case of PCOS, although it can be treated by hormonal stimulation, it has been shown that a form of surgery called ovarian drilling is the best treatment.
Because it is very uncommon to carry out diagnostic laparoscopy (on account of the cost and severity of the procedure, this means is that these women remain undiagnosed, and receive many months of completely useless treatment. They are then selected for IVF, which could have been avoided if there had been an early diagnosis and appropriate surgery.
Fertiloscopy is a modified form of laparoscopy, performed with a specialised instrument inserted via the top end of the vagina, where there are very few nerves, and there is easy access to the upper reproductive tract. The operation is much less traumatic (local anaesthetic or light general anaesthesia), less inconvenient (carried out on out-patients in two hours), less dangerous and less costly than laparoscopy. In fact the procedure is very well suited to being carried out in any ObGyn clinic.
In addition, the instrument is designed so that, if endometriosis, or adhesions are found, or if the subject has PCOS, these can all be surgically treated as part of the original diagnostic Fertiloscopy procedure, which can still be completed in less than 20 minutes in total.