Where can you check the fallopian tubes for patency? How is the patency of the fallopian tubes checked? Modern diagnostic methods. Feedback about the study

Fallopian tube obstruction is a pathology that prevents you from getting pregnant. To determine the cause of infertility, doctors perform various tests, including checking the patency of the fallopian tubes. There are several research methods that differ in execution technique. The doctor will tell you where to make them better.

In what cases is a test for patency of the fallopian tubes prescribed?

Fallopian tubes are a kind of hollow tubes that serve as a connecting canal between the ovary and the uterus. A woman has two of them, they are located on both sides of the uterus. An egg is released from the ovary in which the follicle has matured in a particular month. Its path lies along the fallopian tube. If the cell is fertilized, then through this channel it moves to the uterine cavity to attach to its lining.

When the fallopian tubes are blocked, the egg cannot reach the uterus, causing it to die. Such a violation of the canal can provoke the fixation of the fertilized egg on the wall of the tube - an ectopic pregnancy. Several factors can cause obstruction:

• inflammation;
• sexual infections;
• previous surgical removal of the fetus (abortion);
• operations in the abdominal cavity.

Testing the patency of the fallopian tubes is prescribed when a couple has been unable to conceive a child for more than 6 months. Usually, before this, blood is taken for hormone tests and an ultrasound of the pelvic organs is done to make sure there are no problems with the maturation of the egg. If attempts to become pregnant are unsuccessful, it is necessary to check the condition of the uterus and fallopian tubes. An examination is also prescribed in the following cases:

• there is a history of ectopic pregnancy;
• several miscarriages occurred;
• in preparation for artificial insemination.

Methods for checking the patency of the fallopian tubes and their features

Various methods allow you to find out about the condition of the tubes: hysterosalpingography, hydrosonography, laparoscopy, fertiloscopy, perturbation. These procedures differ significantly in the techniques used. The doctor prescribes one of the types, taking into account contraindications. It should also be taken into account that not all institutions have the necessary equipment and tools to carry out a particular diagnosis.

Carrying out hysterosalpingography

Hysterosalpingography (metrosalpingography) is an x-ray method. It is carried out jointly by a gynecologist and a radiologist. The first ensures the flow of a special liquid into the uterine cavity, for which it installs a catheter or rubber tip into the cavity and connects a thin tube to it. A contrast agent is injected through it. The doctor heats it to a comfortable temperature to eliminate discomfort and other discomfort.

Fluid fills the fallopian tubes and passes into the abdominal cavity. After this, an x-ray photo is taken. It clearly displays the organs filled with the substance, which allows them to be assessed.

If an x-ray is prescribed to detect patency of the fallopian tubes, you must not use birth control pills or suppositories for a week. A couple of days before the test, it is prohibited to consume food products that cause the formation of gases: bread, milk, cabbage, legumes, carbonated drinks, etc. The gynecologist prescribes tests to identify factors due to which the procedure is contraindicated:

• pregnancy;
• uterine bleeding;
• inflammation;
• cystitis;
• ovarian tumor or cyst;
• hyperthyroidism;
• thrombophlebitis;
• allergy to iodine (part of the administered fluid).

HSG is painless. A woman may experience slight discomfort or a tugging sensation in her abdomen. If the patient is sensitive to pain, the doctor recommends taking a painkiller before the x-ray.

The advantage of the method is that it is informative. The photographs clearly show the fallopian tubes and cannot be confused with other organs. You can contact another specialist with the result of the x-ray or leave it for comparison with changes after treatment.

The disadvantage is the low radiation dose. Experts recommend planning conception no earlier than a month after the x-ray. Due to the insertion of the catheter, slight mechanical damage to the epithelium is possible, which may result in bleeding.

Hydrosonography (ultrasound method)

Hydrosonography (echohydrosalpingography) is one of the types of ultrasound. With USGSS, the uterine cavity is filled with saline solution, which moves into the tubes. An ultrasound sensor records the passage of the solution, doctors look at this process on the monitor and, based on this, make an assessment of the condition of the pipes.

An ultrasound of the patency of the fallopian tubes is prescribed a few days before ovulation. On what day of the cycle is it better to perform an ECHO is determined by the doctor based on the duration of the woman’s menstruation and the length of the cycle - on days 5-10. The cervix is ​​quite relaxed during this period. At the preparatory stage, tests are carried out to confirm the absence of pathological processes. Ultrasound examination is excluded if inflammation is detected. The microflora is also checked to ensure the absence of viruses.

ECHO-HSG is safe and does not cause pain. Mild discomfort may occur. The reliability of hydro-ultrasound is slightly lower than that of hysterosalpingography. This is due to the complexity of image recognition. It should be examined on the monitor by a qualified specialist who can make a correct diagnosis.

Surgical intervention - laparoscopy

Laparoscopy involves surgical intervention, so it is rarely used only for diagnosis. It is usually prescribed in conjunction with treatment during which surgery is indicated. During laparoscopy, punctures are made in the peritoneum. The doctor inserts optical instruments through them. Based on the video, he can examine in detail the degree of cross-country ability.

The patient's condition is first checked, because laparoscopy is not performed if there is inflammation or infection. You should also make sure that there are no heart problems, because the operation is performed under general anesthesia.

The reliability of determining patency by laparoscopy is very high. It allows, simultaneously with diagnosis, to perform an operation to eliminate the pathology. Like any surgical intervention, it can be dangerous. The disadvantage of surgical methods is the need for hospitalization. If there are no complications, discharge occurs every other day. Sexual rest is indicated for some time. Sometimes irregularities in the menstrual cycle occur. In no less than a month, when the body has recovered, you can begin to conceive.

Fertiloscopy and its distinctive features

Fertiloscopy is one of the modern types of examination of the genital organs. A puncture is made in the posterior vaginal vault, and a special liquid is injected into the cavity. It promotes the “floating” of intestinal loops. At the same time, the ovaries and tubes straighten. A hysteroscope is inserted into the vaginal opening to check the condition of the tubes.

The procedure is prescribed in the follicular phase of the cycle. Most often, fertiloscopy is performed under local anesthesia, but sometimes general anesthesia is also possible. During the examination, the doctor evaluates the condition of not only the tubes, but also the rest of the genital organs.

The advantage of fertiloscopy is the absence of incisions and the need for sutures. The risk of mechanical damage to blood vessels and other organs is minimal. Fertiloscopy should be performed by a specialist who will prevent damage to the lining of the uterus.

Other methods

There are other ways to determine the patency of the fallopian tubes. One of them is a method involving blowing, which is called perturbation. A carbon dioxide supply device is inserted into the uterine cavity. It is served under a certain pressure. The result is recorded on a device whose task is to determine the pressure level in the pipes. An additional sign of the absence of pathology is a specific noise in the peritoneum. It may hurt a little in the collarbone.

Perturbation is contraindicated in the presence of inflammation, bleeding and a high level of leukocytes in the blood. Preliminary blood tests are carried out and a smear is taken for microflora.

Which methods are the safest and most reliable?

All of the above types of diagnostics are safe. Since hysterosalpingography involves the use of x-rays, the woman receives a small dose of radiation.

Surgical methods require preparation of the body and rehabilitation in the postoperative period. Until the stitches heal, physical activity and sex are contraindicated. Anesthesia is also extra stress for the body. If possible, it is better to choose non-surgical types of diagnostics - hysterosalpingography and hydrosonography.

HSG and laparoscopy are the most reliable. The remaining procedures are quite informative if performed by a highly qualified specialist. The gynecologist must determine the appropriate method of examination, taking into account the woman’s condition, the presence of contraindications and the capabilities of the medical institution.

Can complications occur after checking the patency of the fallopian tubes?

Due to the safety of modern types of diagnostics, they do not lead to unpleasant consequences. Complications are possible due to the inexperience of the doctor performing the procedure. With HSG and fertiloscopy, it may allow perforation of the uterine wall, leading to bleeding. A complication of pertrubation is pipe rupture. This rarely happens in cases where the doctor deviates from the technology.

If there are chronic inflammatory pathologies, a relapse of endometritis or inflammation of the appendages is possible. There are known cases of an allergic reaction to the injected liquid. For patients with bronchial asthma, tubes are checked with caution.

Is diagnostics possible at home?

Currently, many women prefer to analyze their condition without visiting the hospital at home, which is helped by tests for ovulation, pregnancy, etc. Due to the peculiar location of the organs, it is impossible to diagnose the patency of the fallopian tubes at home using any improvised means or equipment.

The fallopian tubes are a pair of organs located in the pelvic cavity. One end of it is adjacent to the uterus, and the other is located in close proximity to the ovary. It is not attached to the ovary, so women who have only one fallopian tube left have a chance of conceiving even if ovulation occurred in the ovary on the opposite side.

A mature egg breaks through the capsule of the dominant follicle and leaves the ovary. With the help of a chemical signal, it is attracted to the funnel of the fallopian tube and begins to move along it towards the uterus.

If at this moment there are viable sperm nearby, then one of them has a chance of fertilization. Thus, the fallopian tube performs the function of transporting the egg and sperm for their fusion, and then the fertilized egg for its entry into the uterus.

In the absence of tubes or obstruction, independent pregnancy is impossible, even if the ovaries consistently produce eggs every month, but how to check the patency of the fallopian tubes?

Indications for testing

The procedure for checking the patency of the fallopian tubes requires special preparation and, in addition, it is very painful. Therefore, the indication for diagnostic procedures may be the absence of pregnancy, when all other tests are normal and the gynecologist has not identified any obstacles to conception. A fallopian tube clogged with adhesions is unable to function normally.

This means that either the sperm is unable to reach the egg, or the fertilized egg is unable to descend into the uterus. Both have very serious consequences:

• – in this case occurs due to mechanical obstacles. The obstruction may be partial, but even then it often happens that the sperm can penetrate the cavity of the fallopian tube, but the egg cannot, because it is much larger and the adhesions do not allow it to move freely.
• - occurs due to the fact that the fertilized egg is not able to penetrate the uterus and is forced to implant itself in the wall of the fallopian tube. This is the most serious complication caused by adhesions and obstruction.

Every year in Russia, 0.4% of the total number of pregnant women die as a result of ectopic pregnancy.

Causes of fallopian tube obstruction

Treatment will directly depend on what caused the problem. The narrowing of the lumen of the fallopian tubes or its complete absence can be either a consequence of their internal blockage or the result of compression from the outside. Gynecologists identify several factors that may cause complete or partial obstruction:

• Adhesions formed as a result of STDs.
• Adhesive processes formed after the urethra, uterus or cervical canal.
• Polyps blocking the entrance to the fallopian tube.
• Disruption of the functions of microvilli, with the help of which the fertilized egg descends down to the uterus.
• Compression of the fallopian tubes by internal organs that initially had an incorrect anatomical position, or took it as a result of prolapse or surgery.
• Mechanical damage to the mucous membrane of the tube cavity as a result of surgical interventions.
• Congenital anomalies of the development of the organs of the reproductive system.

Sometimes the cause of obstruction is difficult to determine through diagnostic procedures. In these cases, laparoscopy is prescribed, which is considered the most informative.

The first signs and symptoms of an endometrial polyp, is it possible to carry a pregnancy to term:

Types of obstruction

After testing for tubal patency, the doctor will determine the type of disease. Further correction of the adhesive process will occur in accordance with how extensive its localization is.

According to the type of prevalence of pathological changes, obstruction of the fallopian tubes is of two types:

1. One-sided - involves disruption of the functioning of one oviduct. In this case, a woman has a chance of conceiving if ovulation occurs in the ovary to which a healthy tube is adjacent. There are cases when pregnancy resulted from the entry of an egg into a healthy oviduct from the opposite ovary.
2. Bilateral – involves disruption of the functioning of the oviducts on both sides. In this case, it is impossible to get pregnant on your own, so the only opportunity to become a mother will be to use the IVF or ICSI method.

Degrees of obstruction

The adhesive process or compression of the fallopian tube by internal organs can have different effects on the degree of narrowing of its lumen. There are two forms of obstruction:

• Partial obstruction - there is a lumen in the tube, but it is so small that a fertilized egg cannot always descend into the uterus. This degree of obstruction is the most dangerous in terms of the occurrence of ectopic pregnancy.
• Complete obstruction - the lumen in the tube is not visible, the organ is completely blocked by the adhesive process and cannot even ensure the fusion of sperm and egg.

Localization of the adhesive process

The fallopian tube has different sections, so they can accumulate and affect the narrowing of the lumen in different places of this organ of the reproductive system.

The oviduct consists of an interstitial section, which is located near the lateral edge of the uterus, an isthmus, an ampulla (the long part), and a funnel that opens into the abdominal cavity. Accordingly, the localization of the adhesive process can be at any of these levels:

• Intramural obstruction - blockage of the fallopian tube occurs in the place where it is adjacent to the uterus.
• Isthmus obstruction - blockage is observed in the narrowed section of the tube closest to the uterus.
• Obstruction of the tortuous section - accumulation of adhesions is observed in the longest part of the pipe.
• Infundibulum obstruction - adhesions are diagnosed in that part of the tube that is located in close proximity to the ovary and receives a mature egg.

According to the observations of specialists, most cases of obstruction are recorded in the tortuous section of the oviduct. The least is in the funnel area.

Inflammation of the uterine appendages, symptoms, diagnosis, complications and methods of treating the disease:

Often a woman does not even realize that the functioning of the organs of her reproductive system is impaired. But it is impossible to check for obstruction of the fallopian tubes at home, so you need to consult a doctor who will choose the most appropriate diagnostic method.

A conventional ultrasound will not be able to provide a complete picture of pathological changes in the fallopian tubes, so it is necessary to resort to endoscopic testing methods and methods that involve filling the cavity of the tubes with a contrast agent.

These procedures are quite painful, and some of them require the patient to be put under anesthesia. Let us consider in detail how the patency of the fallopian tubes is checked.

Studies using contrast media

• Hysterosalpingography (HSG)

The study is carried out using x-rays, is painful and involves filling the fallopian tubes with a special solution. Among the most commonly used are cardiotrust, triombrast, urotrast, verografin.

Preparation for the procedure: do an enema, empty the bladder, epilate hair on the genitals.

Carrying out the procedure: the patient is placed on a special table so that the x-ray beam passes through the upper edge of the womb. First you need to obtain a relief image of the contours of the uterus. To do this, 3 ml of contrast agent is injected and an image is taken.

Then an additional 4 ml of contrast agent is injected so that the uterus is filled - this manipulation provokes fluid to pour into the fallopian tubes, and from there, if they are patency, into the abdominal cavity. After this, a second photo is taken.

Interpretation of results: The fallopian tubes are considered to be well patent if the contrast agent flows into the abdominal cavity over a long distance.

• Echohysterosalpingography (Echo-HSG)

You can examine the patency of the fallopian tubes using ultrasound. The procedure also involves the use of liquid, but in this case, not a contrast agent is injected, as with HSG, but saline solution (sodium chloride).

Another feature of this method is that it is carried out only in the first phase of the menstrual cycle.

Preparation for the procedure: you need to do an enema, drink half a liter of liquid and epilate your pubic hair.

Carrying out the procedure: A saline solution is injected into the uterus through a catheter, which fills it completely and pours into the cavities of both tubes. After this, the doctor begins to conduct ultrasound monitoring with a vaginal sensor every 3-4 minutes. As a result, it is possible to detect areas of the oviduct whose lumen is narrowed or completely blocked.

Interpretation of results: when the tubes are completely patency, the solution will flow freely into the abdominal cavity.

Adnexitis is acute and chronic. Treatment, prevention and recovery measures after illness:

Endoscopic examination

• Office and surgical hysteroscopy

It involves the introduction of a hysterosocope (camera) into the uterine cavity, the image from which is displayed on the monitor. There are two types of this procedure: office, performed under local anesthesia for diagnostic purposes, and surgical, performed under general anesthesia. Hysteroscopy is performed on days 5-7 of the menstrual cycle.

Preparation for the procedure: empty your bladder and remove hair from the intimate area.

Carrying out the procedure: A hysteroscope is inserted into the uterine cavity. It is designed in such a way that it allows you to simultaneously take pictures and supply fluid with which the body of the uterus is filled. The monitor displays not only an image of the inner layer of the uterus, but also the cavity at the mouth of the fallopian tubes.

• Laparoscopy

The procedure is performed only under general anesthesia. It is a surgical intervention in the abdominal cavity, which simultaneously performs both diagnostic and therapeutic functions.

Preparation for the procedure: The patient should empty her bladder and shave her pubic hair.

Carrying out the procedure: after administering anesthesia along the anterior abdominal wall, the doctor makes 3-4 punctures. They are needed to insert a mini-camera and the necessary surgical instruments. To expand the abdominal space, carbon dioxide is supplied through the navel area.

If laparoscopy is diagnostic in nature, the operation lasts 20-30 minutes. If the surgeon decides to remove adhesions or other obstructions that block the lumen of the fallopian tube, the operation time will increase.

Consequences of checking the patency of the fallopian tubes

Checking the patency of the fallopian tubes is one of the most troublesome procedures in the list of examinations for female infertility. However, in order to avoid the risk of ectopic pregnancy, you should not delay your visit to the doctor and do not try to treat the adhesions yourself.

There are usually no consequences for checking the patency of the fallopian tubes. Only procedures performed without observing the rules of antisepsis and asepsis can cause inflammatory processes in the pelvis.

According to WHO, about 15% of couples experience problems conceiving a child. Moreover, in 50% of cases the cause is the “female factor”. On average, about 1.9% of women of reproductive age are diagnosed with primary infertility. One of the causes of this disease is obstruction of the fallopian tubes. Let us consider in detail the pros and cons of modern methods for studying the patency of the fallopian tubes.

What is tubal patency?

The uterine, or fallopian, tubes are two canals that are located on the right and left in the lower abdomen and connect the uterus and abdominal cavity. The length of each channel is 10-12 cm, the outer diameter is 1 cm, the inner diameter is only 0.1 mm. In the abdominal cavity, the fallopian tubes come into contact with the ovaries. The fallopian tubes play a vital role in the process of conceiving a child: it is through them that sperm move, as well as the fertilized egg. The movement occurs due to the work of special “cilia” covering the inner surface of the channels. If there is a blockage of the fallopian tubes, then at best the sperm cannot reach the egg. In the worst case, the already fertilized egg cannot move into the uterus, which threatens the occurrence of an ectopic pregnancy, and subsequently the removal of one of the fallopian tubes. Thus, every woman who plans to have children in the future should undergo regular medical examinations and, if necessary, tubal patency testing.

Statistics data
Various diseases of the fallopian tubes in approximately 45% of cases are the cause of female infertility (so-called “tubal infertility”).

What are the main causes of tubal obstruction? First of all, these are various inflammatory diseases caused by the development of pathogenic microflora. As a result of the inflammatory process, the canal may “stick together.” Inflammatory diseases of the fallopian tubes include the following: salpingoophoritis (adnexitis), salpingitis and hydrosalpinx. With adnexitis, inflammation forms in the uterus, and then the infection moves through the fallopian tube and spreads to the ovaries. Salpingitis is an isolated inflammation of the fallopian tube, which leads to adhesions and the development of obstruction. With hydrosalpinx, fluid accumulates in the fallopian tube, forming a kind of bubble, which, increasing, stretches the fallopian tube and disrupts the functioning of the cilia, thanks to which the egg moves to the uterus.

Another common cause is the so-called “adhesions” - threads of connective tissue that exert external pressure on the fallopian tubes and disrupt their patency. Congenital defects, polyps and tumors of the fallopian tubes can also be the cause. Another dangerous disease that affects the patency of the fallopian tubes is endometriosis, in which tissue similar to the mucous membrane of the uterine cavity grows in a woman’s body. An examination of the patency of the fallopian tubes can be prescribed if any of the above pathologies are detected, as well as if there are problems with conceiving a child.

Symptoms
The main signs of obstruction of the fallopian tubes: pain during sexual intercourse, nagging pain in the lower abdomen (including during menstruation), as well as profuse yellow discharge.

Tubal patency study

Any method of checking the patency of the fallopian tubes, be it an ultrasound examination, x-ray diagnostics or surgery, consists of the following: a certain substance (liquid or gas) is introduced into the uterine cavity, after which the doctor checks the degree of penetration of this substance into the abdominal cavity through the fallopian tubes . If the substance moves freely, then the permeability is good. If it is delayed, then we can talk about obstruction of one or both fallopian tubes. Diagnosis can be either invasive or non-surgical. Non-invasive methods include HSG (X-ray), ultrasound and pertrubation, while laparoscopy and fertiloscopy are surgical procedures. Invasive methods for checking the patency of the fallopian tubes are more accurate, but in most cases ultrasound or x-ray is sufficient.

X-ray diagnostics (hysterosalpingography)

X-ray diagnostics of fallopian tube patency is called hysterosalpingography, abbreviated as HSG. Before taking the image, the doctor injects a contrast agent into the uterine cavity - a fat- or water-soluble drug, usually containing iodine or barium. If the tubes are passable, this will be visible on the image (fluid will enter the abdominal cavity). The accuracy of this type of examination is 70-80%. The procedure should be carried out on certain days of the menstrual cycle - on days 5-9.

The HSG procedure has a number of features and contraindications:

• HSG cannot be performed in the presence of any inflammatory processes of the pelvic organs, therefore, before the procedure it is necessary to take tests for HIV, hepatitis B and C, syphilis, as well as a general smear for flora);
• after undergoing HSG, it is necessary to use protection for 1 menstrual cycle;
• HSG should not be done during pregnancy or if you are allergic to the contrast agent;
• 1-2 days before the examination, you must avoid sexual intercourse; for a week you must not douche, use intimate hygiene products or any vaginal medications.

In general, X-ray diagnostics of fallopian tube patency is a painless procedure. After the test, you may experience discomfort in the lower abdomen and some spotting, but this is normal. Today, HSG is considered the optimal way to check the patency of the fallopian tubes.

Ultrasound diagnostics (echohysterosalpingography)

Ultrasound diagnostics of fallopian tube patency (another name is hydrosonography) is carried out like any other ultrasound examination. Using an ultrasound scanner and a special gel, the doctor examines the abdominal area. A sterile saline solution is first injected into the cervix using a thin catheter, the movement of which is monitored on the monitor. Like HSG, ultrasound is performed on days 5-9 of the menstrual cycle, that is, on the eve of ovulation. This type of diagnosis is less accurate than GHA, but has a number of advantages over it:

• there is no radiation that is undesirable for the human body: the study can be completed several times, as it is absolutely harmless;
• there is no need to use protection after the procedure;
• there are no pain or allergic reactions to saline solution.

Ultrasound diagnosis of fallopian tube patency cannot be carried out in the presence of inflammatory processes. In general, the entire procedure lasts about 15 minutes. The disadvantage of ultrasound is that in some cases the saline solution does not penetrate into the abdominal cavity due to uterine spasm, and not due to obstruction of the fallopian tubes. In this case, the diagnosis may be erroneous. That is why HSG is considered a more accurate method than ultrasound examination.

Diagnostic laparoscopy and fertiloscopy

Laparoscopy and fertiloscopy are, in fact, surgical procedures with varying degrees of trauma, which are often combined with each other. However, they are rarely prescribed only to assess the patency of the fallopian tubes. These methods are more therapeutic than diagnostic, since during the procedure the surgeon has the opportunity not only to assess the condition of the pelvic organs, but also to remove some pathological changes (for example, adhesions of the fallopian tubes).

Laparoscopy:

• performed in a hospital using anesthesia;
• to undergo the examination you need to go to the hospital for 1-2 days;
• During the operation, 2 small incisions are made on the abdominal wall through which surgical instruments are inserted;
• to assess the patency of the fallopian tubes, chromotubation is performed - the introduction of a sterile solution into the uterine cavity;
• 8 hours before surgery it is recommended to refuse food and drink;
• recovery occurs within 2-3 days, quite severe pain is possible, which is natural when the stitches heal;
• for a month after the procedure, it is necessary to avoid sexual intercourse, lift heavy objects, drink alcoholic beverages and foods that are difficult to digest;

Fertiloscopy:

• performed on an outpatient basis under local anesthesia;
• To insert the laparoscope, a small incision is made on the vaginal wall;
• it is possible to perform sapingoscopy - assessing the patency of the fallopian tubes using a camera;
• After the procedure, the incision is not sutured and heals on its own, recovery lasts 3-5 hours:
• procedure duration: 15-30 minutes;
• the procedure is strictly contraindicated for women with endometriosis and uterine fibroids;
• Preparation for the procedure is similar to the requirements for laparoscopy.

note
Most women rate the pain of fertiloscopy at 4.2 on a scale of ten.

Pertrubation

During pertrubation, the patency of the fallopian tubes is checked by introducing gas into the uterine cavity (air, oxygen, carbon dioxide, nitrogen, xenon or others). The procedure is practically painless and lasts no more than 5 minutes. After gas is introduced, the fallopian tubes naturally contract, and this process is recorded by special equipment in the form of a graph. 10-15 minutes after pertrubation, pain may appear in the epigastric region and under the collarbones, which indicates normal patency of the fallopian tubes. Before the procedure, it is necessary to cleanse the intestines and bladder. Like HSG, pertrubation is performed before ovulation occurs.

Contraindications:

• inflammatory diseases of the pelvic organs;
• diseases of the cardiovascular system;
• tuberculosis, infectious diseases;
• inflammatory processes (flu, sore throat, furunculosis, etc.).

The average cost of HSG in Moscow: 7500-9000 rubles, hydrosonography – 6000-8000 rubles, pertrubation – 4000-6000 rubles. Prices for laparoscopic and fertiloscopy can vary from 20-40 thousand to 100 thousand rubles. depending on the complexity of the operation. In general, the HSG method is the most informative, accurate and relatively inexpensive for diagnosing fallopian tube patency. Ultrasound, in turn, is the most painless and safe method, and pertubation is the cheapest and fastest.

Tuesday, 04/10/2018

Editorial opinion

Whatever method of checking the patency of the fallopian tubes you “like”, prescribing for the study is the absolute prerogative of the attending physician. You can express your preferences to him and ask him to make a joint choice of the type of diagnosis, but the final decision is made by a specialist based on a detailed analysis of the clinical picture, indications and contraindications for the procedure.

Checking the patency of the fallopian tubes is one of the first diagnostic measures in identifying the causes of infertility. After all, medical statistics claim that obstruction of the fallopian tubes is the cause of almost half of all cases of infertility. Let's take a closer look at the features of this procedure.

The fallopian tubes (oviducts, fallopian tubes) are two thin tubes that connect the uterus to the ovaries. It is through them that the egg enters the uterus. But if there are adhesions in the tubes, spasms or tumors occur, the egg cannot reach its destination and conception does not occur.

Methods for checking the fallopian tubes: preparation, implementation and interpretation of the results

Is it difficult to diagnose tubal obstruction? For modern medicine this is not a particular problem. Thanks to the development of new and improvement of old diagnostic methods, doctors can accurately determine the causes of infertility. The reliability of methods for checking the fallopian tubes is 80-90%, and if the doctor is not sure of the result, a repeat examination will help eliminate all doubts.

Before diagnosing the condition of the fallopian tubes, it is necessary to undergo a routine gynecological examination, as well as a series of tests: a smear to determine the flora, a blood test for HIV, syphilis, hepatitis B and C. Only after this the doctor usually prescribes one of the following diagnostic examinations.

Hysterosalpingography

Hysterosalpingography, or HSG, is an X-ray examination of the uterus and fallopian tubes with contrast. The contrast agent is injected into the uterus through a special thin tube - a cannula. It fills the uterus and moves through the fallopian tubes. The substance is clearly visible on x-rays, and by how the contrast spreads in the cavities, the doctor assesses the condition of the oviducts and the inner surface of the uterus. This method gives very clear images in which the specialist can see adhesions and other pathologies: fibroids, polyps or synechiae in the uterine cavity, hydrosalpinx and peritubular adhesions (that is, adhesions pressing on the fallopian tube from the outside). The results of this examination are accurate in approximately 80% of cases, and if the doctor has doubts, he may order additional research using a different method.

Hysterosalpingography can be performed only in the absence of inflammation, so before the examination you should be tested for HIV, hepatitis B and C, syphilis and a smear for flora. Pregnancy is also a contraindication. HSG is performed without anesthesia, it is relatively painless (only some patients report some nagging pain in the lower abdomen during the administration of contrast). The radiation dose for HSG is very low, but doctors strongly recommend not planning conception for 2-3 weeks after the examination. Usually this procedure is carried out no later than the 14th day of the menstrual cycle, but in some cases - after ovulation.

Hydrosonography

This method involves performing an ultrasound. After a routine gynecological examination, the doctor, under the supervision of a sonologist, injects a sterile saline solution into the uterine cavity. At this moment, both the uterus itself and the fallopian tubes are very clearly visible on the screen. Thus, this method is very similar to hysterosalpingography, but the patient does not receive radiation. Therefore, with almost equal information content, ultrasound with contrast is considered safer. The hydrosonography procedure is recommended to be performed before the 9th day of the menstrual cycle, when the endometrium is thinnest and the doctor can examine the uterine cavity in as much detail as possible.

The procedure takes 20-40 minutes, does not require special preparation (other than routine tests for STDs and pregnancy) and is well tolerated. The injected liquid is quickly absorbed by the peritoneum. Hydrosonography is often prescribed instead of HSG in cases where a woman is allergic to the contrast agent (usually it contains iodine).

Diagnostic laparoscopy and fertiloscopy

When conducting a laparoscopic examination of the patency of the fallopian tubes, the doctor makes small incisions on the abdominal wall and inserts optical instruments through them to assess the condition of the inner surface of the fallopian tubes. One of the types of diagnostic laparoscopy is fertiloscopy - the introduction of fluid into the pelvic area through a puncture of the posterior wall of the vagina and subsequent examination of the tubes using an endoscope. The liquid allows for better visualization of adhesions.

The punctures during diagnostic laparoscopy are very small, they leave no scars, but the operation, of course, is performed under anesthesia. Laparoscopy is one of the most accurate methods for diagnosing fallopian tube obstruction. With its help, you can not only detect obstruction, but also find out what is causing it - adhesions or spasms. Usually the operation is well tolerated, but just in case, the patient should spend a day in the hospital, and can return to normal life after 2-3 days. However, you will have to give up trying to conceive for 2-3 weeks.

It is important
The most common cause of fallopian tube obstruction is inflammation caused by infections. Typically, the culprit of such problems is chlamydia, which many consider to be a relatively harmless disease. It is really easy to cure, but this must be done on time, since the causative agent of chlamydia quickly spreads and penetrates deeply into the tissue of the fallopian tubes, damaging the mucous membrane, causing fibrosis and very active adhesive processes not only in the pelvis, but also in the abdominal cavity, and even around the liver.

Pertrubation

Perturbation is called blowing of the fallopian tubes. During this diagnostic procedure, air is introduced into the uterine cavity, and special equipment records its pressure. Before the procedure, you must do a cleansing enema and empty your bladder. Perturbation is not performed after certain gynecological manipulations that can cause tubal spasm, otherwise the results will be inaccurate. In other cases, this is a very informative method for diagnosing obstruction of the fallopian tubes.

What is the best way to assess patency?

All methods for diagnosing fallopian tubes are equally reliable, but there are differences between them.

HSG exerts a certain radiation load on a woman’s body, but this method is informative and convenient - after the study, the patient receives pictures that her attending physician can use to make a diagnosis, even if she decides to be treated in another clinic. However, the contrast used during the examination contains iodine, a fairly common allergen. Therefore, if there is a risk of an allergic reaction, ultrasound is not prescribed. Hydrosonography is safe, but often it is impossible to record the results of the examination - only the most modern equipment allows this to be done. The examination takes place in real time, and the patient receives only a medical report.

Laparoscopic methods are rarely used as the very first examination; they are resorted to only in cases where other diagnostic methods have failed.

Perturbation is used infrequently these days, since the reliability of this method, although very little, is lower than that of other diagnostic methods.

The method for determining the patency of the fallopian tubes is prescribed by the doctor, who takes into account many indicators, including age and general health, test results and previously performed diagnostic procedures.

Tuesday, 04/10/2018

Editorial opinion

Most women suffering from blocked fallopian tubes are unaware of this pathology until they decide to become pregnant. Tubal obstruction develops unnoticed and in most cases asymptomatic. Nevertheless, it is very dangerous - adhesions in the tubes lead not only to infertility, but also to ectopic pregnancies.

Tubal patency is not always ideal. Obstruction of the fallopian tubes causes infertility in 20-60% of cases. This disorder can be detected thanks to modern diagnostic techniques. There are several of them. Depending on the specific clinical case, the doctor chooses one or another examination method. A woman facing problematic conception should know how experienced doctors check the patency of the fallopian tubes and what is the best procedure for diagnosing patency.

If you cannot get pregnant for a long time, your doctor may refer you to check the patency of the fallopian tubes.

Who is indicated for tubal patency testing?

The condition of the fallopian tubes needs to be assessed for those women who have been unable to conceive a child for a long time. However, such a study is not prescribed immediately. First, the doctor must make sure that infertility was not caused by other reasons, for example, hormonal imbalance.

If it is not possible to identify the factor preventing conception, the doctor will refer the patient for an examination to assess the patency of the fallopian tubes. The uterine appendages are thin branches from the reproductive organ. Their diameter is 0.1-1 mm, depending on the specific area of ​​the appendage. Spikes can be concentrated anywhere. Classic ultrasound examination does not detect the proliferation of connective tissue, so it is difficult to identify adhesions. At the same time, we must remember that infertility is not always caused by obstruction of the tubes. Women from the “risk group” are recommended to undergo research on this matter. These include:

1. Women who have previously undergone abdominal surgery.
2. Patients who underwent uterine manipulation.
3. Women with pelvic organ disease. Chronic pathologies are especially dangerous in terms of the formation of adhesions.
4. Women with abnormal development of the fallopian tubes and tumors in the pelvic area.
5. Patients with endometriosis.
6. Women who have previously had an ectopic pregnancy.

If, during a study on the passage of the fallopian tubes, adhesions were discovered in a woman, then she is diagnosed with “tubal infertility.” What matters is the location of their concentration, the presence of strands in one or both pipes. This will allow you to assess the chances of successful treatment and conception.

How to check the patency of the fallopian tubes

Regardless of which method was chosen to assess tubal patency, the woman will need to prepare for the study. The procedure is carried out in a hospital. However, not every patient is hospitalized. Most often, the woman is sent home after the examination. Only those patients who have undergone either fertiloscopy or laparoscopy are kept in the hospital.

Each diagnostic procedure has its own advantages and disadvantages. To minimize all possible risks, you must strictly follow your doctor's instructions. It will be possible to decide on a specific method based on the collected anamnesis. It is also necessary to take into account the indications that are available for each procedure.

If there is a high probability that the pipes are blocked by adhesions, it is recommended to give preference to surgical diagnostic methods. During their implementation, the doctor is able to remove adhesions. If the doctor believes that the tubes can remain passable, then the least traumatic diagnostic procedure is chosen.

Hysterosalpingography (HSG)

HSG involves taking a series of x-rays. They are done after a contrast agent has been injected into the tubes. Two doctors take part in the diagnosis - a radiologist and a gynecologist. Before the examination, the woman will need to undergo tests. It is important to exclude pregnancy, inflammatory processes, uterine bleeding, tubal tumors and allergies to iodine.

Please note that in the picture one fallopian tube is obstructed. The contrast simply cannot pass through the adhesions.

Half an hour (or an hour) before the procedure, the woman is given an injection with an antispasmodic. Anticholinergics may also be prescribed, depending on the individual characteristics of the patient. After the injection of an anesthetic drug, the woman is placed on a couch. An X-ray machine is located above it. A contrast solution is injected into the uterus. This is done using a very thin catheter. Having filled the organ, the solution enters the pipes. At this time, the doctor takes a picture. If the contrast agent is evenly distributed throughout the pipes, then there are no adhesions in them. If only one pipe was filled, then the second one is considered impassable. The doctor has the opportunity to see exactly where the solution stopped.

HSG cannot be called a pleasant procedure. To minimize discomfort, you need to try to relax. If the muscles of the pelvis and uterus are tense, the test results may be unreliable.

Provided that no adhesions were found in the fallopian tubes, you cannot immediately begin trying to conceive. You need to wait at least a month. This will prevent the negative effects of x-rays on the germ cells.

Advance preparation is very important. If you perform the procedure without it, the risk of infection of the fallopian tubes increases. There is also a possibility of developing serious allergies and organ injury.

Hydrosonography (echohysterosalpingography)

Hydrosonography is a diagnostic method that allows you to assess the condition of the fallopian tubes. A contrast agent is injected into the uterine cavity, and its distribution is monitored using an ultrasound machine. Doctors recommend this diagnostic method to those women who are allergic to iodine or have thyroid disease. During the study, the body does not receive a dose of radiation, but the information content of such manipulation is lower compared to x-ray control.

This is what the uterus and fallopian tubes look like after injection of a contrast agent during hydrosonography.

Preparation for the procedure comes down to taking a smear. It is important to make sure that the woman is not pregnant. During the study she does not experience pain. The optimal time to implement the procedure is 10-13 days of the cycle. At this time, the cervix is ​​maximally dilated under the influence of hormones, so it will be easier to insert a catheter into its cavity.

A saline solution is supplied through the tube to the organs. The doctor uses a special sensor to monitor the behavior of the fallopian tubes. If they are blocked by adhesions, then the solution will not pass through them.

Metrosalpingography

MSG is one of the modern diagnostic procedures that allows you to assess the patency of the fallopian tubes. During its implementation, it is possible not only to detect adhesions, but also to remove them. They are simply broken up with a solution that is supplied to the appendages under pressure.

Preparation for the procedure consists of submitting a vaginal smear for analysis. A clinical blood test will also be required. MSH is monitored using an X-ray machine. The catheter is inserted into the uterine cavity and brought as close as possible to the appendages. This will reduce the effect of the solution on the uterine cavity itself. Once the tubes are full, the doctor will take a series of x-rays.

Laparoscopy

This is how laparoscopy for tubal patency is performed. The advantage of this research method is that if adhesions are detected, they will be immediately removed.

This study is carried out using a special device - a laparoscope. To perform the procedure, the woman is admitted to the hospital. It is performed under general anesthesia. Adhesions detected during laparoscopy can be immediately removed.

Before undergoing a minimally invasive technique, a woman needs to give blood, urine and a smear test. On the morning of the operation, the patient is given an enema. 12 hours before its implementation, you cannot eat food, water is limited.

The surgeon makes several punctures in the peritoneum through which the equipment is inserted. With its help, he detects adhesions and removes them.

Fertiloscopy

This diagnostic procedure is an alternative to laparoscopy. During this procedure, the doctor makes an incision in the back wall of the vagina. Optical instruments are inserted through it. The intestinal loops are lifted by injecting saline into the peritoneum.

Preparation for fertiloscopy is similar to laparoscopy. However, this procedure avoids scars on the abdomen. Fertiloscopy is performed under general anesthesia. It is not often used in public medical institutions, but this diagnostic method is preferable to laparoscopy.

Perturbation

With the help of perturbation, it is possible to determine the presence of adhesions in the uterine appendages, as well as assess their tone. A catheter is inserted into the uterine cavity, through which air is supplied. It can be carbon dioxide or oxygen. The gas pressure remains within 200 mm. rt. Art. When it is maintained at 90mm. rt. Art., the pipes are passable. This fact can be assessed using radiography and listening to characteristic noises. If air passes through the appendages under a pressure of 60 mm. rt. Art., then the tone of the pipes is reduced. Provided that gas does not enter the abdominal cavity, the patient’s pipes are completely blocked by adhesions.

Perturbation allows not only to detect adhesions, but also to remove them. To do this, the gas pressure is increased to the required levels.

MRI

Diagnosis of fallopian tube patency using an MRI machine is not the most accurate research method.

MRI is one of the informative and painless methods for detecting adhesions in the uterine appendages. Preparing for the procedure is not difficult. The woman will need to go to the doctor with an empty bowel. The day before the MRI, avoid eating foods that increase gas formation. During the procedure, the patient will have to remain motionless. Her body will be influenced by magnetic fields. MRI allows you to determine whether there are adhesions in the appendages. The main disadvantage of such a study is that information about the performance of the ovaries, as well as the tone of the fallopian tubes, will not be obtained.

Most often, MRI is prescribed to patients with suspected tumor growth.

Which method should you prefer?

Each of the listed methods has certain advantages and disadvantages. Without knowing the clinical history of a particular patient, it is impossible to determine which method is preferable for her.

Diagnostic methods that do not imply violation of tissue integrity are considered safe and non-traumatic. During their implementation, no anesthesia is required. However, their significant disadvantage is that the doctor is not able to immediately remove detected adhesions. To do this, another procedure will be required.

Most women are afraid of radiographic examination methods. However, it is not advisable to worry about this, since the radiation dose will be minimal. It will not be able to harm the body and negatively affect the state of reproductive function. To decide which method is right for a particular woman, you need to consult a gynecologist.

Be sure to watch this informative video from an experienced obstetrician-gynecologist about tubal patency:

Is it possible to check the patency of pipes at home?

It is impossible to independently detect tubal obstruction at home. Although, based on some signs, a woman may suspect the presence of adhesions in the appendages. Factors such as:

• Pathological vaginal discharge, pain in the lower abdomen and other symptoms that may indicate an inflammatory process in the genitals.
• Pain during intimacy.
• Disruption of the menstrual cycle, which often occurs against the background of inflammatory diseases of the reproductive system.
• Previous abortions and other operations on the pelvic organs.

These symptoms will be supplemented by one main sign -. It is indicated by unsuccessful attempts to conceive, which are made by a couple throughout the year.

Write in the comments: did you undergo a patency test, what method was used to do it, was it painful to do the diagnosis, and did you manage to get pregnant after that? Your experience will help other readers. Don't forget to rate the article. Thank you for being with us. Be healthy!