Approximately 15% of couples suffer from tubal subfertility and this is likely to be significantly higher in those with secondary subfertility i.e. struggling to conceive following previous pregnancies.
At the Lister Fertility Clinic, we believe that tubal assessment of the fallopian tubes should therefore form part of first-line fertility investigation.
It may also be of value in those with recurrent cycle failure where a "hydrosalpinx" is suspected. A hydrosalpinx is a collection of fluid within a blocked tube that may flow back into the uterus and negatively impact on the chances of an embryo implanting or increase miscarriage risk. If confirmed the blocked tube will be surgically removed or occluded with a surgical clip to stop it communicating with the uterus.
Some studies have also suggested that there may be a short term increase in the chance of a natural pregnancy following either a hysterosalpingogram or laparoscopy.
Laparoscopy and dye
The gold standard investigation for assessing the tubal patency is a laparoscopy with a dye test. A small telescope is inserted through a tiny 1cm incision inside the umbilicus and dye is injected through the cervix and the tubes are examined to see if they fill with dye and are open to allow dye to pass through into the pelvis. This is a day case surgical procedure which is performed at the Lister Hospital under general anaesthetic. As this is a more invasive test requiring anesthetic we tend to only recommend it when other gynaecological symptoms are present that require assessment.
This is a simpler X-ray based fertility test performed in our imaging department as an outpatient procedure where iodine-based contrast dye is gently injected through the cervix into the uterus while x-ray images are viewed on a monitor. If the fallopian tubes are open the contrast dye will fill the tubes, then spill from the ends of the tubes.