A brief review of Tests to assess the tubes.
Understanding the health of your fallopian tubes is crucial for fertility. These tubes play a vital role in conception by recruiting the egg, facilitating sperm travel, and guiding the fertilized embryo into the womb. In this blog, we’ll explore the tests used to assess the health of your fallopian tubes, focusing on their patency—whether they are open and functional. Watch this video before reading on.
Why Assess Fallopian Tubes?
To answer this question we need to understand the Fallopian Tubes and Their Functions first. Fallopian tubes are key structures in the reproductive system where fertilization occurs. They have three essential functions that the tubes are required to perform:
- Egg Recruitment: The tubes capture the egg released during ovulation.
- Sperm Transport: Provide an un-obstructed path for sperm to travel and meet the egg.
- Embryo Transport: Tiny hair-like structures called cilia lining the tubes push the fertilized egg into the womb for implantation and growth.
What are Tests available for Assessing Tubes?
While we can’t directly measure the tube’s three functions, we can assess their patency. Patency refers to whether the tubes are open at both ends—the uterine end and the ovarian end. Several tests can evaluate this:
1. Hysterosalpingogram (HSG):
HSG is an X-ray-based test where:
- A dye is injected into the uterine cavity.
- The dye creates a radio-opaque shadow visible on X-rays.
- This test can be painful but offers clear images that can be reviewed by other doctors.
Why HSG is not a preferred mode of Tubal testing now:
HSG is an old method of tubal testing has been the cornerstone of tubal testing in the past century before the advent of USG based tubal testing. It is a painfull procedure that involves insertion of an HSG canula into the Uterus through the Cervix.
Although some clinics claim to offer “Painless HSG” by using localized anesthesia, the pain is subjective and most women with high pain (low tolerance to pain) index shall find the procedure extremally painfully despite of anesthesia. Besides this, there is also the risks of exposure to X-rays, The radio contrast chemical dye used can damage the uterine lining, there is the risk of infection post HSG. This was the only affordable tubal patency testing method until a decade ago, but since then advancements in ultrasound imaging has enabled better and affordable tubal patency testing methods without the risks associated with HSG.
Adverse effects of HSG: Adverse effects include pain, vasovagal episode, venous or lymphatic intravasation, infection, bleeding, uterine perforation, pregnancy irradiation, and allergic reaction. Higher iodine concentration and slow clearance of the oil-soluble contrast medium used in HSG may induce subclinical hypothyroidism, which has been associated with an increased risk of pregnancy complications, including preeclampsia, perinatal mortality, and miscarriage (1,2).
2. Ultrasound guided Tubal assessments :
Ultrasound guided Tubal testing are a far better and comfortable option compared to HSG. They also come with additional benefits :
- real-time visualization of the flow of the contrast medium
- 3d visualization improved diagnostic capability and efficacy
- greater detection accuracy than HSG
- can detect a wider range of problems other than patency of the tubes that cannot be seen in x-ray
- Very little discomfort compared to that of HSG.
There are two types of tests that can be done:
a) Saline Infusion Sonography (SIS):
SIS is an USG based Tubal Imaging test that involves:
- Injecting saline (saltwater) into the uterine cavity.
- A transvaginal ultrasound is used to monitor the flow of saline through the tubes.
- This method is relatively comfortable and widely used for tube assessment.
b) Sono Salpingogram (SSG):
SSG is similar to SIS but may use a different contrast medium. like SIS it also:
- Utilizes ultrasound to visualize the saline flow through the tubes.
- Provides a comfortable experience for many women.
3. Laparoscopy:
Laparoscopy is considered the gold standard for assessing fallopian tube patency. During this procedure:
- A camera is inserted through a small incision near the umbilicus (belly button).
- A dye is injected into the womb, flowing through the tubes and into the abdomen.
- This test provides a direct visual of the tubes’ openness but requires anesthesia.
When is Laparoscopy recommended: although it is the gold standard, it is not always the first line of investigation. Laparoscopy is suggested when the doctor suspects any defect in the firstline tests and needs to confirm it.
Conclusion:
Choosing the right test to assess fallopian tube patency depends on factors such as comfort, accuracy, and careful consideration of your doctor. Each method offers valuable insights into reproductive health, helping to guide further treatment or fertility planning.
References:
