Tubal patency testing is used to assess whether the fallopian tubes are fully accessible, clear of obstructions and in good communication with the uterine cavity. It involves injecting a dye through the cervix and visualizing its passage through the uterine cavity and the fallopian tubes.
Fallopian tubes are fine tubal structures that connect the ovaries to the uterus. In every cycle, one of the two fallopian tubes allows passage of an egg from the ovary to the womb. For this egg to become fertilized before it reaches the womb, sperms need to travel the opposite direction, through the cervix, the uterine cavity and into the fallopian tubes, where they meet and interact with the egg. If the fallopian tubes are blocked, egg and sperm cannot come together, resulting in infertility.
The fallopian tubes may be blocked because of:
- Previous infection (for instance chlamydia, which can cause formation of scar tissue)
- Chronic Inflammation due to infections (for instance salpingitis)
- Endometriosis (presence of tissue that behaves like endometrium outside the womb).
- Previous surgeries in the abdominal cavity.
- Endometriosis and infections are the most frequent reasons for tubal obstructions.
Tubal patency testing can benefit women who are under routine infertility investigation and their husband’s fertility (male factor) is normal. This diagnostic test shows us whether your fallopian tubes are clear or blocked, so we can give you suitable treatment. If the tubes are patent, then we may consider an easy Assisted Reproductive Technique (ART), such as Intra-Uterine Insemination (IUI). Otherwise, if a blockage is found, In-Vitro Fertilization (IVF) will be a better option for your case.
Tubal patency can be checked with a number of techniques, but the most frequent are:
It is performed by a radiologist doctor and essentially, it is a real-time X-ray examination.
An opaque, radiology-contrasting dye is injected through your cervix, uterine cavity and into the fallopian tubes, while you are under an X-ray source. The radiologist monitors movement of the dye through a connected screen, and by the flow and the pressure applied for the dye to go through, the patency of your tubes can be assessed. If the dye flows unobstructed through your fallopian tubes and spills into the abdomen, everything is normal. However, if a spillage in the abdomen is not seen, then the point where the flow of the dye has stopped is indicative of an obstruction or anomaly.
The examination lasts about 20 minutes, and it may cause some discomfort, similar to the cramps that you experience during your period. After a short recovery time (up to an hour), you may return to your daily activities as normally.
HSN is carried out by a gynecologist doctor in our day AAFC clinic. It follows exactly the same rationale, as HSG, but instead of X-ray for visualization, an ultrasound transvaginal scan is used.
To create a high resolution view, the doctor inserts an ultrasound probe connected to a screen through the vagina making visible the inside of the uterus and fallopian tubes. Next, expands the uterine cavity and the fallopian tubes with a saline solution or an ultrasound contrast media administered with a fine tube (catheter) through the cervix.
HSN is a very detailed technique, especially for diagnosing abnormalities within the uterine cavity, and in comparison to HGS, it is less risky, since it does not involve X-ray radiation. Usually, HSN is also less painful than an HGS, although some minor discomfort may still be sensed.
An HGN lasts about 10-15 minutes, and it can cause a minor discomfort, similar to your period pains. You may return to your daily activities as normally.
Laparoscopy can also be used for checking tubal patency, if this procedure has been planned for another reason.
Laparoscopy is a type of a ‘keyhole surgery’, minimally invasive, and is performed under general anesthesia by a surgeon gynecologist. A laparoscope, which is a small tube with a light source and a camera connected to a monitor, is inserted to the abdomen or pelvis through a small incision. The doctor pumps gas into the abdomen to increase the resolution and performs his examination from the projected images. At the end of a laparoscopy, the gas is let out of the abdomen and the incision is closed with a few stiches.
After a short recovery period with close supervision, you may be allowed to go home the same day. Alternatively, depending on your individual circumstances and the reason for a laparoscopy, you may be kept here overnight.
A hysteroscopy is a technique by which we can see the inner part of the uterus. We use a small fiber optic tube, connected to a video camera. This procedure can be done at the doctor´s office without anesthesia (office hysteroscopy), or at the theater (usually with conscious sedation).
A hysteroscopy is done in the following cases:
- endometrial polyps (usually diagnosed by ultrasound)
- Implantation failure (as a part of the investigation)
- Submucosal fibroids
- Uterine anomalies
- Cervical stenosis
- Intrauterine adhesions
At the same time, we can take an endometrial biopsy to be analyzed if it is necessary.
Hysteroscopy can be diagnostic (only to see how is the endometrial cavity), or surgical (when we intend to excise a polyp, fibroid, or adhesion).