Why do we check fallopian tubes in infertility patients? And what are the methods to check fallopian tubes?

In a person who has infertility, the following factors are checked. One is Semen analysis; the ovary function; the uterine function; the hormone function and the tubal function. When we come to the tubal evaluation there are essentially 3 ways of checking the fallopian tube. One is by hysterosalpingography, the 2nd is by Laparoscopy and the third is by Sonosalpingography. These are the 3 methods that are used to check the fallopian tubes. When it comes to hysterosalpingography it is the simplest investigation available to check the fallopian tubes. It is usually done by the radiologist or by the gynecologist and it is done in the following manner as part of the infertility evaluation and it is done in the first 10 days of the menstrual cycle to check the status of both tubes by taking an x-ray after injecting a contrast dye into uterus and tubes. A prophylactic antibiotic is given before the procedure. So that there is no risk for infection. 

The information we obtain with the hysterosalpingography is One-the uterine cavity for any congenital anomalies, Two- the tubal outline, whether both the tubes are normal or one tube is abnormal. The third is the free flow of dye. So Essentially hysterosalpingography checks the uterine cavity and the tubal patency. 

When it comes to the 2nd investigation which I mentioned, that is laparoscopy. This investigation is done under anesthesia. It is done when the period of infertility is longer or when the X-ray of hysterosalpingography is abnormal. Also when there is a previous surgery on the abdomen like a cesarean section or any other surgery. Sometimes when the ultrasound shows abnormality of the uterus or the abnormality is the ovary. In these situations, a laparoscopy investigation is done. What exactly happens in Laparoscopy is- under anesthesia, a video telescope is passed through the umbilicus and then the uterus and tubes are visualized directly. The relation of the fallopian tube to the ovary is checked. Both the ovaries are also analyzed. Then, a blue dye called methylene blue is injected into the uterine cavity. The tubal status is assessed by directly seeing how the dye passes out of both tubes. If everything is normal, it is reported as chromotubation normal. Sometimes, if one of the tubes is abnormal we try to reposition the catheter to recheck it. 

The third method that is used to check the fallopian tubes is sonosalpingography which is of recent origin compared to laparoscopy which is 4 to 5 decades old. It is a similar method to HSG but ultrasound imaging is used instead of an x-ray. In this sonologist or the gynecologist injects a contrast media or a liquid-based media or saline, so sometimes it is also saline sonography in which as the fluid is injected the sonographer looks at the cavity of the uterus in 3D ultrasound and flow of the dye in 3D ultrasound to check the patency of the tube. Compared to laparoscopy, the sensitivity and specificity or the 100% accuracy of sonosalpingography are not as equal. If there is a doubt in this investigation, then we proceed to laparoscopy to check and confirm. Essentially when one is checking the fallopian tubes in an infertile couple there are 3 modalities of investigations 1) HSG, 2)laparoscopy, 3)sonosalpingography. Depending on the necessity and the situation of the patient, a relevant investigation is selected.

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