The purpose of uterine cavity evaluation is to make an accurate diagnosis of the cause of abnormal uterine bleeding, in order that therapy can be appropriately tailored to the woman. This chapter reviews the accuracy and efficacy of currently available tests used to evaluate the uterine cavity. Uterine size can be assessed on bimanual examination; if the uterus is greater in size than 12 weeks of gestation, it may be palpable abdominally. Women with amenorrhoea (no menstrual bleeding for 6 months) should have a full history and examination. Dilatation and curettage (D&C) used to be the method of choice for assessing the uterine cavity. Other methods for assessing the uterine cavity include hysteroscopy, ultrasound, Doppler ultrasound, and outpatient endometrial biopsy. Women presenting with postmenopausal bleeding require urgent referral for pelvic ultrasound and further testing, with endometrial biopsy and/or hysteroscopy undertaken depending on the initial ultrasound result.

Usually investigation for infertility is carried out by gynecologists, because if a couple failed to conceive it has been traditionally expected that the woman has a problem and should visit a doctor. The general examination starts when the patient comes into the consulting room from observations of body habitus, skin, hair excess, gait and posture. Ultrasonography is a more accurate method compared with bimanual examination so more precise data about ovaries and uterus may be obtained with a transvaginal ultrasound probe than with palpation. The assessment of ovulation involves history, examination and investigation. At hysterosalpingography (HSG) radio-opaque dye is injected through the small canula via the cervix into the uterine cavity under X-ray screening. In patients with infertility, diagnostic hysteroscopy is usually combined with laparoscopy. X-chromosome abnormalities may affect fertility in women with Turner syndrome, especially in mosaic form.

This chapter discusses the usefulness of ultrasound in diagnosing normal and abnormal fallopian tubes using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasonography (TVS) and hysterosalpingo-contrast sonography (HyCoSy). HyCoSy involves the introduction of fluid into the uterine cavity and the fallopian tubes. The role of HyCoSy as a first-line procedure for the assessment of tubal patency has been examined in several studies. In most of the studies, the diagnostic capabilities of HyCoSy have been compared with the established reference methods of hysterosalpingography (HSG) or laparoscopy with dye insufflation, or both, and in the majority of the studies Echovist was used as the ultrasonographic contrast medium. A multicenter study in Scandinavia compared laparoscopic salpingectomy with no intervention prior to the first in vitro fertilization (IVF) cycle. The study demonstrated significant improvement in pregnancy and birth rates after salpingectomy in patients with hydrosalpinges that were large enough to be visible on ultrasound.

This chapter reviews evidence on various investigative modalities and management planning for women presenting to the gynaecology clinic with post-menopausal bleeding. It discusses some of the issues to be considered when planning a cost-effective, clinic-based service for these women. Dilatation and curettage (D&C) was for many years the investigation of choice in women presenting with post-menopausal bleeding. The Pipelle de Cornier is a widely used system. The system is a narrow plastic catheter, which is passed through the cervical canal into the uterine cavity. Transvaginal ultrasound (TVS) is an accurate, non-invasive diagnostic modality that enables examination of the uterine cavity and endometrium in the outpatient setting. With the uterus visualised in a longitudinal plane, the thickness of the endometrial echo can be measured. Endometrial polyps are a common finding in post-menopausal women and when they occur in association with post-menopausal bleeding they should be removed for histopathological diagnosis.

Public awareness of the scientific progress made in the field of assisted conception has led to an increased number of people seeking treatment. The first consultation between an infertile couple and the clinician specializing in infertility is a crucial starting point for collecting the medical history, clinical examination and the evaluation of the appropriateness of a range of investigations to establish the cause of infertility, following which a strategy for treatment can be planned. When the full history has been taken, a clinical examination must be performed. The ovulation is confirmed by measuring progesterone in the mid-luteal phase. Clinical history and assessment of basal follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin can be sufficient for the diagnosis of the majority of causes of anovulation. The evaluation of tubal patency and the uterine cavity is of crucial importance in the preliminary assessment of infertile women.