Testing for Fallopian Tube Patency in Fertility Evaluation
Hysterosalpingography (HSG) is the standard first-line test to check a woman's fallopian tubes, with 65% sensitivity and 85% specificity compared to laparoscopy, and has the added benefit of potentially improving pregnancy rates. 1, 2
Primary Testing Options
Hysterosalpingography (HSG)
- HSG should be your initial test for evaluating tubal patency in women undergoing fertility workup 1, 2
- Performed in the first half of the menstrual cycle (typically around day 9) using iodinated contrast medium and X-rays 3
- Provides structural information about tubal patency, tube size, irregularities, and peritubal disease 1
- The positive predictive value for detecting patency or occlusion of both tubes is 87.2% 4
- Can be performed with either water- or oil-soluble contrast medium 5
Hysterosalpingo-Contrast Sonography (HyCoSy)
- HyCoSy with echogenic contrast is an equally accurate alternative to HSG and demonstrates 91% accuracy in diagnosing tubal patency, particularly in women with endometriosis 2
- Uses ultrasound contrast agents to visualize the passage of contrast through the tubal lumen and can identify the site of blockage 6
- Recommended by the National Institute for Health and Clinical Excellence as a primary investigation for tubal assessment in patients without positive history of tubal damage 6
When to Use Advanced Testing
Laparoscopy with Chromopertubation
- Laparoscopy remains the gold standard for confirming tubal patency and should be used when definitive diagnosis is required 2
- Particularly indicated when HSG shows abnormalities or when there is clinical suspicion of pelvic adhesions or endometriosis 3
- Superior to HSG in examining peritubal adhesions 3
Sonohysterography (SIS)
- Primarily used for assessing the uterine cavity rather than tubal patency 7
- The presence of increased fluid in the posterior cul-de-sac (pouch of Douglas) following sonohysterography may indicate tubal patency, but has only moderate diagnostic value 2
- More accurate than HSG for detecting intrauterine abnormalities (75% vs 52.6% accuracy for fibroids) 7
Important Clinical Considerations
Antibiotic Prophylaxis
- Consider antibiotic prophylaxis if there is prior history of pelvic inflammatory disease (PID) or if hydrosalpinx is noted during the procedure 7, 8
Common Pitfalls to Avoid
- False positive results for tubal occlusion can occur due to tubal spasm, endometrial polyps at the uterine opening, or excessive contrast injection 3, 5
- The time interval between HSG and confirmatory laparoscopy matters—longer intervals allow for progression of pathology, potentially explaining discordant findings 3
- Transvaginal ultrasound alone is not effective for documenting tubal patency, though it can detect hydrosalpinx with 86% sensitivity 2, 8