How can we assess whether the fallopian tubes are functioning?

Tubal function tests generally provide evidence of patency only. The earliest work on the subject was published in 1920 when it was demonstrated that if the tubes are patent, oxygen introduced through the cervix would pass into the peritoneal cavity. The concept that investigation of tubal patency may be therapeutic (increase the likelihood of pregnancy) also dates from about that time. In the 1940s hysterosalpingography (HSG) was introduced. A radio-opa Que dye was introduced through the cervix and an x-ray picture was taken to track the dye through the uterus and Fallopian tubes (Figure 9.3).

The arrival of fibroptic light technology and the first reports of the laparoscope (Q23.24) into the English literature opened the world of direct visualisation of the pelvic organs. When combined with methylene blue dye insufflation (the dye is passed through the cervix), a new technique for assessing tubal patency became available (laparoscopy with dye insufflation). Often hysterosalpingography and laparoscopy provide differing evidence on tubal patency.

Figure 9.3 A hysterosalpingogram

In 1984, ultrasound assessment of the Fallopian tubes (hysterosalpingo-contrast-sonography – Hy-Co-Sy) was first reported to demonstrate free fluid in the pelvis after introducing fluid through the cervix; there was good correlation with hysterosalpingography in a series of 35 infertile women.

In 1984, ultrasound assessment of the Fallopian tubes (hysterosalpingo-contrast-sonography – Hy-Co-Sy) was first reported to demonstrate free fluid in the pelvis after introducing fluid through the cervix; there was good correlation with hysterosalpingography in a series of 35 infertile women.

Figure 9.3 A Hysterosalpingogram

Current routine techniques for the evaluation of the tubal factor are basically patency tests; they do not assess other functions such as the ability of the fimbria (Q 2.3) to pick up the oocytes or move them along to the uterus. There have been reports of evaluation of Fallopian tube function by introducing starch suspensions, vaseline droplets and Indigo Carmen into the pelvis and checking to see if the tubes pick these up and transport them into the uterus by looking to see if they appear at the cervix some hours later. These tests never progressed beyond the realms of research (

In a study of 104 infertile couples, the women had both hysterosalpingography and laparoscopy with dye insufflation. There was an overall agreement between the two techniques in 62.5% of cases. It was concluded that whenever the HSG demonstrated tubal patency with free flow of dye, laparoscopic may not be necessary. At one time it was argued that laparoscopy had the advantage as it would allow a diagnosis of minimal endometriosis. This no longer seems relevant as such findings are of no clinical relevance (Q9.11). Several experts have come to the conclusion that in the absence of clinical indicators of significant pelvic disease and a normal hysterosalpingogram there is little to be gained by submitting infertile women to laparoscopy.



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