Culdoscopy
Culdoscopy (also known as transvaginal hydrolaparoscopy or THL) is an alternative to laparoscopy with the major advantage that abdominal incisions are not needed, and the procedure can be done under local anaesthesia with you awake (which also means you can follow the investigation on a colour monitor). The procedure involves inserting a narrow telescope through the back of the vagina into the pelvis to check the outside of the uterus (womb), fallopian tubes and ovaries. Saline (salty sterile water) is slowly instilled which has the effect of allowing the fallopian tubes and ovaries to float in the solution (as in the picture on the right). The aim of culdoscopy is to detect problems such as endometriosis and adhesions (scar tissue) which can both affect your fertility. At the end, use a blue dye is injected into the uterine cavity to check if your fallopian tubes are patent. The whole investigation usually takes less than 15 minutes.
It has to be said that the view at culdoscopy is more limited than at laparoscopy (eg. we cannot see the upper abdomen or the front of the uterus), but this is usually not important in cases of infertility. A further difference between culdoscopy under local anaesthesia and laparoscopy under general anaesthesia is that generally we can only "look" at culdoscopy and cannot "do" if something is found which requires treatment. For instance, if you are found to have endometriosis, adhesions or a blocked fallopian tube, and it is felt that this is best managed by surgery, you will have to come back for a laparoscopy under general anaesthesia. In the majority of cases, however, we are pleased to find that the pelvis is totally normal and there is no need for surgery.