Sunday, 12 April 2020

Vol.3 April 2020 - Tubal Patency Tests


For pregnancy to occur naturally, one or both fallopian tubes should be open to allow sperm transport to the egg so that fertilisation can take place. The developing embryo is then transported into the uterine cavity for implantation. Blocked fallopian tubes is a common cause of subfertility. Checking the fallopian tubes patency (whether they are open or not) is of utmost importance. It can be done in one of three methods:
 ▪ Laparoscopy & Dye test
▪ X-ray Hysterosalpingogram (HSG)
▪ Hysterosalpingo-Contrast-Sonography (HyCoSy)

This is a minor key-hole surgical procedure whereby a fibre-optic instrument called a laparoscope is inserted through a small incision usually below the belly button to examine the pelvic organs – uterus, fallopian tubes and ovaries. It is usually performed under a general anaesthetic. Once the laparoscope has been inserted into the abdomen, blue dye (methylene blue) is injected through the cervix into the uterine cavity to see if enters into the fallopian tubes and flows through. Apart from checking patency of the fallopian tubes, laparoscopy provides an opportunity to examine the pelvis and pelvic organs thoroughly to diagnose other conditions such as endometriosis and adhesions. The downside is the risk of damage to abdominal organs and risks of general anaesthetic.

This is probable the most common method used to check tubal patency. In this method, fluid that can be seen on X-ray is injected through the cervix into the uterus so that filling and spillage from the tubes can be seen on X-ray. No anaesthetic is required, many women find it painful.

HYSTEROSALPINGO-CONTRAST-SONOGRAPHY (HyCoSy) This is a much simpler procedure to carry out and does not require a general anaesthetic. In can be done with prior simple painkillers or under intravenous conscious sedation. The principle behind this method is the same as the other two above, the difference is that ultrasound scan is used to check patency (or otherwise) instead of X-ray in HSG or Laparoscope in Lap & dye. The fluid injected can either be a high contrast solution or just normal saline. HyCoSy can also outline the uterine cavity such that endometrial polyps and submucous fibroids can be seen.

Which method is best? We use the HyCoSy method in our facility because it is a simple procedure not requiring general anaesthesia or X-ray. We administer intravenous conscious sedation to minimise pain and discomfort. It allows thorough examination of the pelvis by ultrasound with the patient well relaxed under sedation. However, the best method depends on a patient’s medical history, e.g. if there is a history of pelvic pain, heavy and painful periods, laparoscopy and dye test may be better in order to diagnose or exclude endometriosis or pelvic adhesions. If these conditions are present, they may be amenable to surgical treatment through the laparoscope. Blocked fallopian tubes can be unblocked if there is minimal damage or excised (removed surgically) in cases of significant tubal damage with collection fluid (Hydrosalpinx). Surgical excision of hydrosalpinx improves the chance of success of future IVF treatment.

Mr J. Adeghe
Consultant - Gynaecology & Reproductive Medicine

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