Tubal Patency Test

• HSG
• Sono Salpingo Graphy (SSG)
• Endoscopy
• Laproscopy (Endoscopy)
• Hysteroscopy (Endoscopy)
• Salpingoscopy (Endoscopy)

HSG

It is a radiological procedure in which x-ray films are taken to demonstrate the endometrial cavity & spill of dye from the fimbrial end of both tubes.

HSG should be done postmenstrually because the endometrial thickness during this period of cycle is less & hence sensitivity of the procedure increases. HSG has the advantage of being a cost effective, OPD procedure which is done without anaesthesia. It also pin points the site of tubal block & outlines the endometrial cavity. Filling defect gives an idea about pathologies of endometrial cavity such as synaechiae & submucous myoma. Some studies claim of the therapeutic advantage of lavage of the tubes to clear cell debris. Disadvantages of HSG can be that of injury to cervix , hyper sensitivity to dye & hyper response which leads to spasm of the tube & gives false positive results. When the duration of infertility is less & the patient cannot afford the expensive option of endoscopy, HSG can definitely help to outline the further management in such couples.

Sono-salpingography

SSG uses TVS to confirm the tubal patency by visualizing the spill of fluid from the fimbrial end of fallopian tubes. This test is not a substitute for HSG or laparoscopy but is a non-invasive, inexpensive outdoor screening procedure which can be done in patients who have bronchial asthama or any cardiac problems & are temporarily unfit for surgery.

Salpingoscopy

In most centers, diagnostic scopy includes hysteroscopy & laparoscopy but we at our centre include Salpingoscopy in this basic evaluation.

Salpingoscopy is defined as visualization of mucosa of the ampullary portion of the tube by a telescope. In this procedure 1.8 mm telescope is introduced from the fimbrial end of the tube to evaluate the lumen.

Salpingoscopy is an advanced surgical procedure which requires specialized training & skill. It involves the handling of fallopian tubes which is a unique & delicate structure - especially the fimbriae. Here, we would like to state that any surgeon performing Salpingoscopy should have adequate training & experience. Otherwise iatrogenic complications may arise. Remember Hutchisons prayer

We grade the tubes according to brojen's classification.

These changes have been classified as follows (12)

• Grade 1 Normal fold pattern
• Grade 2 Separation and flattening of major folds
• Grade 3 Peripheral filmy and focal adhesions
• Grade 4 Fibrous adhesions across more than 50% of the lumen
• Grade 5 Fibrosis of the tubal walls with loss of the fold system

Salpingoscopy helps us to decide the further treatment modality. Findings above grade 2 may be better treated by IVF. Salpingoscopy has a role to prevent ectopic pregnancy which still continues to be one of the commonest causes of maternal mortality in first trimester.

Salpingoscopy is a newer technique but we believe that it has good prognostic values & it will soon become an integral part of infertility evaluation in all centers.

Falloposcopy

Just to complete the list we mention falloposcopy. Like salpingoscopy, it is an endoscopic diagnostic procedure which involves the visualization of lumen of fallopian tube in the interstitial part & isthmic part. The technical skill required to perform this procedure is much higher as compared to the practicallity of this procedure to affect fertility outcome. The instrumentation is also very expensive & delicate. These are perhaps the reason why this test has not become popular. Tubal microsurgery has poor outcome in cases where falloscopy shows any pathology & IVF is a better outcome.