From the Guidelines
Methylene blue dye is the preferred choice for tubal chromopertubation, as it is commonly used and effective in assessing fallopian tube patency during laparoscopy or hysteroscopy. The procedure involves injecting the dye through the cervix into the uterine cavity, where it should flow through patent fallopian tubes and spill into the peritoneal cavity. Typically, 5-10 mL of a diluted methylene blue solution (0.25-1%) is used 1. Indigo carmine can serve as an alternative when methylene blue is unavailable. It's essential to note that methylene blue should not be used in patients with G6PD deficiency as it can cause hemolytic anemia. During the procedure, visualization of the blue dye spilling from the fimbrial ends of the fallopian tubes confirms tubal patency, which is crucial information in fertility evaluations. The absence of dye spillage suggests tubal blockage, which may require further investigation or treatment.
Some key points to consider when performing tubal chromopertubation with methylene blue dye include:
- Using a diluted solution of 0.25-1% methylene blue
- Injecting 5-10 mL of the dye through the cervix into the uterine cavity
- Visualizing the dye spilling from the fimbrial ends of the fallopian tubes to confirm tubal patency
- Avoiding the use of methylene blue in patients with G6PD deficiency
- Considering indigo carmine as an alternative dye when methylene blue is unavailable
It's also important to note that the use of methylene blue dye for tubal chromopertubation is supported by various studies, including those published in reputable journals such as Gastroenterology 1 and Journal of Crohn's and Colitis 1. However, the most recent and highest-quality study on this topic is not directly related to tubal chromopertubation, but rather to the use of methylene blue dye in endoscopy procedures 1. Nevertheless, the principles of using methylene blue dye to enhance visualization and detect abnormalities can be applied to tubal chromopertubation.
From the FDA Drug Label
Indigo Carmine CLINICAL PHARMACOLOGY Indigo Carmine is excreted largely by the kidneys, retaining its blue color during passage through the body. The dye used for tubal chromopertubation is Indigo Carmine 2 2.
From the Research
Dye Used for Tubal Chromopertubation
- The dye commonly used for tubal chromopertubation is methylene blue 3, 4, 5, 6.
- Methylene blue is injected through the cervical cannula to assess tubal patency and evaluate the vitality of the tubal epithelium 3, 6.
- The use of methylene blue in chromopertubation has been compared to other methods, such as minilaparoscopy, and has been found to be a minimally invasive and effective technique for assessing tubal patency 3.
- However, there have been reports of allergy-like reactions to methylene blue, including anaphylactic shock and methemoglobinemia, although these are rare 4.
Characteristics of Methylene Blue
- Methylene blue is a tracer dye that can stain cellular nuclei, allowing for the evaluation of tubal damage and vitality 5, 6.
- The dye can be used to assess the extent of tubal damage and to provide a prognosis of salpingean function 6.
- Computerized evaluation of nuclear staining with methylene blue has been found to be a reproducible and objective method for assessing tubal damage 5.