Tubal Patency Tests

This video, titled "Tubal Patency Tests" by Gynae Consultant, outlines the importance of checking the fallopian tubes during fertility investigations and explains the three standard medical methods used to test if the tubes are open (patent).

Why the Fallopian Tubes Matter

The fallopian tubes extend from the corners of the womb. They play a vital role in natural conception:

• Sperm travels through the womb and into the tubes.
• The egg is released from the ovaries into the tubes.
• Fertilization occurs entirely inside the fallopian tube, after which the resulting embryo travels down to the womb to develop.

The Three Methods for Testing Tubal Patency

1. Hysterosalpingogram (HSG)

• Procedure: Done as an outpatient procedure in a radiology department. Similar to a smear test, a speculum is inserted, and a small catheter is guided into the cervix. A contrast dye is injected, and a series of X-ray images are taken to track the movement of the dye.
• Patient Experience: It can feel uncomfortable, but it is generally well-tolerated.

2. Hysterosalpingo-Contrast-Sonography (HyCoSy)

• Procedure: Generally performed by gynecologists or fertility specialists in an outpatient setting. Like the HSG, a speculum and a small plastic tube are placed through the cervix to introduce a fluid contrast dye, but the pathway is evaluated using an ultrasound scan instead of X-rays.
• Safety Note for HSG and HyCoSy: Because fluid is pushed through the womb, patients are typically screened for existing pelvic infections and given prophylactic antibiotics beforehand to ensure bacteria are not accidentally flushed into the pelvic cavity.

3. Laparoscopy and Dye Test

• Procedure: This is a minimally invasive keyhole surgery performed under general anesthesia as a day case. A surgeon makes a small half-centimeter incision in the belly button to insert a camera, and usually a second small incision to inspect the pelvic organs. A blue dye (methylene blue) is injected through the cervix from below, and the surgeon visually confirms whether it smoothly spills out of the tubes.
• Clinical Use: Because it is invasive and carries surgical risks, a laparoscopy is not standard for every patient. It is reserved for women where internal pelvic issues are strongly suspected—such as a history of severe pelvic infections, previous surgeries, endometriosis, or a past ectopic pregnancy.
• Benefit: It allows the surgeon to diagnose and immediately treat conditions like scarring, adhesions, or endometriosis during the same procedure.