The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques

Abstract

Key content The pathogenesis of infertility is multi‐factorial; investigative and treatment approaches should therefore be individualised. There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function. There is often a clear need for in vitro fertilisation (IVF) in the management of infertility. This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART). Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans‐vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency. To understand the role of Chlamydia trachomatis serology in tubal patency testing. To evaluate the role of tubal patency test in the hierarchy of investigations for infertility. To understand the role of tubal surgery in modern management of infertility. To understand the importance of medical history taking in infertility. Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception. Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF? There may be psychosocial issues or anxiety so a multidisciplinary approach is important.

Fibroids and Infertility

“…All patients should complete preliminary investigations to ascertain causation of infertility; the important domains include assessment of ovarian reserve and ovulation, as well as seminal fluid analysis. Tubal patency tests are invasive, and in the presence of fibroids are inaccurate [ 28 ]. Accordingly, patency should be assessed opportunistically at time of myomectomy, or if indicated, by HSG or HyCoSy as appropriate.…”

Hysterosalpingo-Foam Sonography, Less Painful and More Instructive as Compared with Hysterosalpingography: A Prospective Study

“…Various tests nowadays are available for the purpose of patency test; of these tests are hysterosalpingography (HSG), Salpingography, diagnostic laparoscopy with dye hydrotubation test and HysterosalpingoContrast Sonography (HyCoSy) [6]. HSG is the most common first-line and widely available diagnostic test [5][6][7]. Although HSG assesses tubal status and provides an image of the outline of the uterine cavity, the intracavitary abnormalities are not visualized clearly due to the opacity of the dye used for the procedure [8][9][10].…”

“…Although HSG assesses tubal status and provides an image of the outline of the uterine cavity, the intracavitary abnormalities are not visualized clearly due to the opacity of the dye used for the procedure [8][9][10]. Besides, the other main disadvantages are patients' exposure to ionizing radiation that is significantly greater than that of a usual chest X-ray, the unpleasant pain experienced during the procedure and the risk of pelvic infection (1-3%) [7]. Moreover, laparoscopy with a dye test combined with hysteroscopy is considered the gold standard in diagnosing uterine abnormalities and tubal patency in infertile women.…”

Three-Dimensional HyCoSy With Perfluoropropane-Albumin Microspheres as Contrast Agents and Normal Saline Injections Into the Pelvic Cavity for Morphological Assessment of the Fallopian Tube in Infertile Women

“…Although a variety of factors can contribute to infertility, tubal disorder is identified as a frequent cause of female infertility, accounting for approximately 20% of infertile women . Therefore, the evaluation of the fallopian tube is an important and mandatory step before assisted reproductive techniques are started …”

“…3,4 Therefore, the evaluation of the fallopian tube is an important and mandatory step before assisted reproductive techniques are started. 5 Currently, several techniques can be available for examination of the fallopian tube, including laparoscopy with chromopertubation (lap and dye), x-ray hysterosalpingography (HSG), and hysterosalpingocontrast sonography (HyCoSy). 6 Although laparoscopy and HSG are traditionally regarded as the standard methods in diagnosing the tubal occlusion, they have several disadvantages.…”