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

Obstruction of the fallopian tubes is a pathology that does not allow you to get pregnant. To identify the cause of infertility, doctors perform various tests, including checking the patency of the fallopian tubes. There are several research methods that differ in the technique of execution. Where to make them better, the doctor will tell.

In what cases is it prescribed to check the patency of the fallopian tubes?

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

When the patency of the fallopian tubes is broken, the egg cannot reach the uterus, which is why it dies. Such a violation of the canal can provoke the fixation of the fetal egg on the wall of the tube - an ectopic pregnancy. Several factors can cause obstruction:

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

A fallopian tube test is ordered when a couple has been unable to conceive for more than 6 months. Usually, before that, they take blood for hormone tests and do an ultrasound of the pelvic organs to make sure there are no problems with the maturation of the egg. In case of unsuccessful attempts to become pregnant, it is necessary to check the condition of the uterus and fallopian tubes. An examination is also prescribed in such cases:

• a history of ectopic pregnancy;
• had several miscarriages;
• in preparation for artificial insemination.

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

Various methods allow you to learn about the condition of the pipes: hysterosalpingography, hydrosonography, laparoscopy, fertiloscopy, perturbation. These procedures differ significantly in technique. The doctor prescribes one of the types, taking into account contraindications. It should also be borne in mind that not all institutions have the necessary equipment and tools to conduct 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 entry of a special fluid 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.

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

If an x-ray is prescribed to detect patency of the fallopian tubes, it is necessary not to use birth control pills or suppositories for a week. A couple of days before the test, it is forbidden to eat foods 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;
• tumor or ovarian cyst;
• hyperthyroidism;
• thrombophlebitis;
• allergy to iodine (part of the injected fluid).

HSG is painless. A woman may experience slight discomfort or pulling sensations in the abdomen. If the patient is sensitive to pain, the doctor recommends taking an anesthetic before the x-ray.

The advantage of the method is informativeness. The fallopian tubes are clearly visible on the pictures, they cannot be confused with other organs. With the result of the x-ray, you can contact another specialist or leave it for comparison with the changes after the treatment.

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

Hydrosonography (ultrasound method)

Hydrosonography (echohydrosalpingography) is a type of ultrasound. With USGSS, the uterine cavity is filled with saline, which moves into the tubes. The ultrasound sensor captures 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 which day of the cycle it is better to conduct an ECHO, the doctor determines based on the duration of the woman's menstruation and the duration of the cycle - for 5-10 days. The neck during this period is quite relaxed. At the preparatory stage, analyzes are carried out to confirm the absence of pathological processes. Ultrasound examination is excluded when inflammation is detected. The microflora is also checked to make sure that there are no viruses.

ECHO-HSG is safe and does not cause pain. Mild discomfort is possible. The reliability of hydro-ultrasound is somewhat lower than that of hysterosalpingography. This is due to the complexity of image recognition. It should be viewed on the monitor by a qualified specialist who can correctly diagnose.

Surgical intervention - laparoscopy

Laparoscopy involves surgical intervention, so it is rarely used only for diagnosis. Usually it is prescribed in conjunction with treatment, during which surgery is indicated. During laparoscopy, punctures are made in the peritoneum. The doctor introduces optical devices through them. Focusing on the video, he can examine in detail the degree of patency.

The condition of the patient is preliminarily 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 the diagnosis to carry out an operation to eliminate the pathology. Like any surgery, it can be dangerous. The disadvantage of surgical methods is the need for hospitalization. In the absence of complications, the discharge occurs every other day. Some time shows sexual rest. Sometimes there are failures of the menstrual cycle. At least a month later, when the body recovers, you can begin to conceive.

Fertiloscopy and its distinctive features

Fertiloscopy is one of the modern types of examination of the genital organs. The posterior fornix of the vagina is punctured, and a special fluid is injected into the cavity. It promotes the "emergence" of intestinal loops. In this case, the ovaries and tubes are straightened. A hysteroscope is inserted into the opening of the vagina, with the help of which the condition of the tubes is checked.

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 assesses 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 suturing. The risk of mechanical damage to blood vessels and other organs is minimal. Fertiloscopy should be carried out by a specialist who will not allow damage to the membranes of the uterus.

Other Methods

There are other ways to determine the patency of the fallopian tubes. One of them is a method that involves blowing, which is called perturbation. An apparatus for supplying carbon dioxide is introduced into the uterine cavity. It is served under a certain pressure. The result is recorded on the device, the task of which is to determine the level of pressure 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 the microflora.

What methods are the safest and most reliable?

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

Operational methods require the preparation of the body and rehabilitation in the postoperative period. Until the stitches heal, exercise and sex are contraindicated. Narcosis is also an 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 should determine the appropriate research method, taking into account the condition of the woman, the presence of contraindications and the capabilities of the medical institution.

Can there be complications 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 conducting the procedure. With HSG and fertiloscopy, it can allow perforation of the uterine wall, leading to bleeding. A complication of pertrubation is tubal rupture. This rarely happens in cases where the doctor deviates from the technology of conducting.

If there are chronic inflammatory pathologies, a recurrence of endometritis or inflammation of the appendages is possible. There are known cases of an allergic reaction to the injected fluid. Patients with bronchial asthma check the tubes with caution.

Is it possible to diagnose at home?

Currently, many women prefer to analyze their condition without visiting the hospital at home, which is helped by ovulation tests, pregnancy tests, etc. Due to the particular 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 is adjacent to the uterus, and the other is 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 conception even if ovulation occurred in the ovary on the opposite side.

A mature egg breaks through the capsule of the dominant follicle and goes beyond 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 to the uterus.

If at this moment viable spermatozoa are 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 fetal egg for it to enter the uterus.

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

Indications for verification

The procedure for checking the patency of the fallopian tubes requires special preparation and, in addition, it is very painful. Therefore, an indication for diagnostic procedures may be the absence of pregnancy, when all other tests are normal and the gynecologist has not identified a single obstacle 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 cannot descend into the uterus. Both have very serious consequences:

• - in this case, it occurs due to mechanical obstacles. The obstruction may be partial, but even then it often happens that sperm can enter the cavity of the fallopian tube, but the egg cannot, because it is much larger and 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 in the wall of the fallopian tube. This is the most formidable complication caused by adhesions and obstruction.

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

Causes of obstruction of the fallopian tubes

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

• Adhesions resulting from STDs.
• Adhesive processes formed after the urethra, uterus or cervical canal.
• Polyps blocking the entrance to the fallopian tube.
• Violation of the functions of microvilli, with the help of which the fetal 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 operations.
• Mechanical damage to the mucous membrane of the tube cavity as a result of surgical interventions.
• Congenital anomalies in the development of the organs of the reproductive system.

Sometimes the cause of the obstruction is difficult to establish 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 endure pregnancy:

Types of obstruction

After analyzing the patency of the fallopian tubes, 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. Unilateral - involves a violation of the functioning of one oviduct. In this case, a woman has a chance of conception if ovulation occurs in the ovary to which a healthy tube adjoins. There are cases when pregnancy was obtained as a result of an egg entering a healthy oviduct from the opposite ovary.
2. Bilateral - involves a violation of the functioning of the oviducts on both sides. In this case, it is impossible to get pregnant on your own, so the only way to become a mother will be to use the IVF or ICSI method.

Degrees of obstruction

Adhesions or compression of the fallopian tube by internal organs can affect the degree of narrowing of its lumen in different ways. 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 an 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 the 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 (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 adjoins the uterus.
• Obstruction of the isthmus - blockage is observed in the narrowed section of the tube closest to the uterus.
• Obstruction of the tortuous section - the accumulation of adhesions is observed in the longest part of the tube.
• Funnel obstruction - adhesions are diagnosed in that part of the tube that is 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. Least of all - in the funnel area.

Inflammation of the uterine appendages, symptoms, diagnosis, complications and methods of treatment of 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 the obstruction of the fallopian tubes at home, so you need to consult a doctor who will choose the most appropriate diagnostic method.

Conventional ultrasound will not be able to give a complete picture of pathological changes in the fallopian tubes, so it is necessary to resort to endoscopic methods of verification 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 anesthetized. Let us consider in detail how to check the patency of the fallopian tubes.

Studies with a contrast agent

• Hysterosalpingography (HSG)

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

Preparation for the procedure: make an enema, empty the bladder, epilate the 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 get a relief image of the contours of the uterus. To do this, 3 ml of a contrast agent is injected and a picture is taken.

Then an additional 4 ml of a contrast agent is injected so that the uterus is filled - such a manipulation provokes fluid to flow into the fallopian tubes, and from there, subject to their patency, into the abdominal cavity. After that, a second shot is taken.

Interpretation of results: the fallopian tubes are considered well passable if the contrast medium is poured into the abdominal cavity for 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 (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: it is necessary to make an enema, drink half a liter of liquid and epilate pubic hair.

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

Interpretation of results: with complete patency of the tubes, the solution will freely pour into the abdominal cavity.

Adnexitis acute and chronic. Treatment, prevention and rehabilitation measures after the disease:

Examination by endoscopic method

• Office and surgical hysteroscopy

It involves the introduction of a hysteroscope (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 the 5th-7th day of the menstrual cycle.

Preparation for the procedure: empty the 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 shoot and supply fluid that fills the body of the uterus. The monitor displays not only the image of the inner layer of the uterus, but also the cavity of 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 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 the introduction of anesthesia on the anterior abdominal wall, the doctor makes 3-4 punctures. They are needed in order to introduce a mini-camera and the necessary surgical instruments. To expand the abdominal space, carbon dioxide is supplied through the navel.

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

The 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 an ectopic pregnancy, you should not postpone a visit to the doctor and do not try to treat the adhesive process yourself.

The consequences of checking the patency of the fallopian tubes, usually, do not happen. Only procedures carried out with non-compliance with the rules of antisepsis and asepsis can cause inflammatory processes in the small pelvis.

According to WHO, about 15% of couples experience problems conceiving a child. At the same time, 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 the 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 channels that are located on the right and left in the lower abdomen and connect the uterus and the 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 abdomen, the fallopian tubes meet the ovaries. The fallopian tubes play an important role in the process of conceiving a child: it is through them that sperm cells, as well as a fertilized egg, move. Movement occurs due to the work of special "cilia" covering the inner surface of the channels. If there is a violation of the patency of the fallopian tubes, then at best the spermatozoa cannot reach the egg. In the worst case, an 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 regularly undergo a medical examination, and, if necessary, an examination of the patency of the fallopian tubes.

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

What are the main causes of obstruction of the fallopian tubes? First of all, these are various inflammatory diseases caused by the development of pathogenic microflora. As a result of the inflammatory process, the canal can “stick together”. Of the inflammatory diseases of the fallopian tubes, the following are distinguished: salpingo-oophoritis (adnexitis), salpingitis and hydrosalpinx. With adnexitis, inflammation forms in the uterus, and then the infection moves through the fallopian tube and passes 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, due 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. Also, the cause may be congenital malformations, polyps and tumors of the fallopian tubes. Another dangerous disease that affects the patency of the fallopian tubes is endometriosis, in which a woman's body grows tissues similar to the mucous membrane of the uterine cavity. An examination of the patency of the fallopian tubes can be prescribed if any of the above pathologies is detected, as well as if there are problems with conceiving a child.

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

Study of the patency of the fallopian tubes

Any method of checking the patency of the fallopian tubes, whether it is an ultrasound examination, x-ray diagnostics or surgery, is as follows: 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 the 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 an ultrasound or x-ray is sufficient.

X-ray diagnostics (hysterosalpingography)

X-ray diagnostics of patency of the fallopian tubes is called hysterosalpingography, abbreviated as HSG. Before taking an x-ray, the doctor injects a contrast agent into the uterine cavity - a fat- or water-soluble preparation, usually containing iodine or barium. If the tubes are passable, then this will be visible in the picture (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 pass tests for HIV, hepatitis B and C, syphilis, as well as a general smear for flora);
• after the passage of the HSG, it is necessary to protect yourself for 1 menstrual cycle;
• HSG should not be done during pregnancy and in the presence of an allergy to a contrast agent;
• 1-2 days before the examination, it is necessary to avoid sexual intercourse, douching, using intimate hygiene products and any vaginal medicines should not be done for a week.

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

Ultrasound diagnostics (echohisterosalpingography)

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

• there is no radiation that is undesirable for the human body: the study can be done several times, since it is absolutely harmless;
• there is no need to protect yourself after the procedure;
• there are no pain sensations and allergic reactions to saline.

Ultrasound diagnostics of patency of the fallopian tubes cannot be carried out in the presence of inflammatory processes. In general, the whole procedure takes about 15 minutes. The disadvantage of ultrasound is that in some cases, saline 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 an ultrasound study.

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:

• carried out in a hospital with the use of anesthesia;
• to undergo the examination, it is necessary 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 the operation, it is recommended to refuse food and drink;
• recovery occurs within 2-3 days, quite severe pain is possible, which is natural when the sutures heal;
• within a month after the procedure, it is necessary to avoid sexual intercourse, you can not lift weights, drink alcoholic beverages and food that is difficult to digest;

Fertiloscopy:

• performed on an outpatient basis under local anesthesia;
• for the introduction of a laparoscope, a small incision is made on the wall of the vagina;
• it is possible to conduct sapingoscopy - assessment of 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:
• duration of the procedure: 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 fertiloscopy pain at 4.2 out of 10.

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 almost painless and lasts no more than 5 minutes. After the introduction of gas, 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 clean the intestines and bladder. Like HSG, pertrubation is performed before the onset of ovulation.

Contraindications:

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

The average cost of HSG in Moscow: 7500-9000 rubles, hydrosonography - 6000-8000 rubles, pertrubation - 4000-6000 rubles. Prices for laparo- and fertiloscopy can vary from 20-40 thousand to 100 thousand rubles. depending on the complexity of the operation. In general, for the diagnosis of patency of the fallopian tubes, the HSG method is the most informative, accurate and relatively inexpensive. Ultrasound, in turn, is the most painless and safest 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", the appointment 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.

Testing 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 us consider in more detail 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, the egg cannot reach its destination and conception does not occur.

Ways to check the fallopian tubes: preparation, conduct and interpretation of the results

Is it difficult to diagnose the obstruction of the fallopian tubes? 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 second 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 pass a series of tests: a smear to determine the flora, a blood test for HIV, syphilis, hepatitis B and C. Only after that 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 called a cannula. It fills the uterus and moves through the fallopian tubes. The substance is clearly visible on x-rays, and by the way 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 synechia in the uterine cavity, hydrosalpinx and peritubal adhesions (that is, adhesions pressing on the fallopian tube from the outside). The results of this examination are accurate in about 80% of cases, and if the doctor has doubts, he may prescribe an additional study by another method.

Hysterosalpingography can be performed only in the absence of inflammation, therefore, before the examination, tests for HIV, hepatitis B and C, syphilis, and a smear for flora should be taken. Pregnancy is also a contraindication. HSG is performed without anesthesia, it is relatively painless (only some patients report some pulling pain in the lower abdomen during contrast injection). The radiation dose for HSG is very low, but doctors strongly recommend that you do not plan to conceive 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 even after ovulation.

Hydrosonography

This method involves an ultrasound. After a routine gynecological examination, the doctor, under the supervision of a sonologist, injects sterile saline 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 exposure. Therefore, with almost equal information content, ultrasound with contrast is considered safer. The hydrosonography procedure is recommended to be carried out before the 9th day of the menstrual cycle, when the endometrium is the thinnest and the doctor can examine the uterine cavity in as much detail as possible.

The procedure takes 20-40 minutes, requires no special preparation (apart from routine STD and pregnancy tests) and is well tolerated. The injected fluid is rapidly absorbed by the peritoneum. Hydrosonography is often prescribed instead of HSG in cases where a woman is allergic to a contrast agent (usually containing 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 introduces optical instruments through them to assess the condition of the inner surface of the fallopian tubes. One of the varieties of diagnostic laparoscopy - 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 with an endoscope. The fluid allows better visualization of adhesions.

Punctures during diagnostic laparoscopy are very small, they do not leave scars, but the operation, of course, is performed under general anesthesia. Laparoscopy is one of the most accurate methods for diagnosing obstruction of the fallopian tubes. With its help, you can not only detect obstruction, but also find out what caused it - adhesions or spasm. Usually the operation is well tolerated, but just in case, the patient should spend a day in the hospital, and you can return to normal life after 2-3 days. However, for 2-3 weeks you will have to give up trying to conceive.

It is important
The most common cause of obstruction of the fallopian tubes is inflammation caused by infections. Usually the culprit for such problems is chlamydia, which many consider a relatively harmless disease. It is really easy to cure it, but it needs to be done on time, since the chlamydia pathogen spreads quickly and penetrates deep into the tissues 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 registers its pressure. Before the procedure, it is necessary to make a cleansing enema and empty the bladder. Perturbation is not carried out after some 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 the fallopian tubes are equally reliable, but there is a difference between them.

HSG has a certain radiation load on the woman's body, but this method is informative and convenient - after the study, the patient receives pictures that her doctor 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, at the risk of an allergic reaction, it is not HSG that is prescribed, but ultrasound. Hydrosonography is safe, but it is often impossible to record the results of the survey - only the most modern equipment can do this. The examination takes place in real time, and the patient receives only a medical opinion.

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

Perturbation is rarely used today, since the reliability of this method, albeit quite a bit, is lower than that of other diagnostic methods.

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

Tuesday, 04/10/2018

Editorial opinion

Most women with blocked fallopian tubes are unaware of the condition until they decide to become pregnant. Fallopian tube obstruction develops imperceptibly and in most cases is asymptomatic. Nevertheless, it is very dangerous - adhesions in the tubes lead not only to infertility, but also to ectopic pregnancies.

The patency of the fallopian tubes is not always ideal. Obstruction of the fallopian tubes causes infertility in 20-60% of cases. It is possible to detect this violation thanks to modern diagnostic techniques. There are several of them. Depending on the specific clinical case, the doctor chooses one or another method of examination. A woman who is faced with a problem conception should know how experienced doctors check the patency of the fallopian tubes and what is the best procedure for diagnosing patency.

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

Who is a study of the patency of the fallopian tubes

It is necessary to assess the condition of the fallopian tubes for those women who cannot conceive a child for a long time. However, such a study is not prescribed immediately. To begin with, the doctor must make sure that infertility was not caused by other causes, such as hormonal imbalance.

If it is not possible to isolate the factor preventing conception, then the doctor will refer the patient for an examination to assess the patency of the fallopian tubes. The appendages of the uterus 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. Classical ultrasound examination does not detect the growth of connective tissue, so it is difficult to identify adhesions. At the same time, it must be remembered that infertility is not always caused by tubal obstruction. Women from the "risk group" are recommended to undergo a study on this matter. These include:

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

If during the study on the passage of the fallopian tubes, adhesions were found in a woman, then she is diagnosed with “tubal infertility”. The significance is the place 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 the patency of the fallopian tubes, the woman will need to prepare for the study. The procedure is carried out in the hospital. However, not every patient is hospitalized. Most often, a woman is sent home after the examination. Only those patients who underwent either fertiloscopy or laparoscopy are left in the hospital.

Each diagnostic procedure has its own advantages and disadvantages. To minimize all possible risks, you must strictly follow the medical 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 gets the opportunity 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 the performance of a series of radiographic images. They are done after a contrast agent is injected into the tubes. Two doctors are involved in the diagnosis - a radiologist and a gynecologist. Before the examination, the woman will need to take tests. It is important to exclude pregnancy, inflammatory processes, uterine bleeding, swelling of the tubes and the presence of an allergy to iodine.

Please note that in the picture one fallopian tube is impassable. 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 can also be prescribed, it depends on the individual characteristics of the patient. After an injection of an anesthetic drug, the woman is laid on the couch. Above it is an x-ray machine. A contrast solution is injected into the uterus. This is done using the thinnest catheter. After filling the organ, the solution enters the pipes. At this time, the doctor takes a picture. If the contrast agent is evenly distributed throughout the tubes, 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.

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

Provided that adhesions in the fallopian tubes were not found, it is impossible to immediately start trying to conceive. You have to wait at least a month. This will prevent the negative effects of x-rays on germ cells.

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

Hydrosonography (echohisterosalpingography)

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 for 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 is reduced to the delivery of 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 for the implementation of the procedure is 10-13 days of the cycle. At this time, the cervix is ​​maximally expanded 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 to assess the patency of the fallopian tubes. During its implementation, you can not only detect adhesions, but also remove them. They are simply broken by a solution that is supplied to the appendages under pressure.

Preparation for the procedure is reduced to the delivery of a smear from the vagina for analysis. You will also need to conduct a clinical blood test. MSH control is carried out 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. When the tubes are full, the doctor will take a series of x-rays.

Laparoscopy

This is how laparoscopy of patency of the fallopian tubes is performed. The advantage of this research method is that if adhesions are found, they will be immediately removed.

This study is carried out using a special device - a laparoscope. To perform the procedure, a woman is placed in a hospital. It is carried out under general anesthesia. Detected adhesions during laparoscopy can be immediately removed.

Before conducting a minimally invasive technique, a woman needs to donate blood, urine and a smear for tests. On the morning of the operation, the patient is given an enema. 12 hours before its implementation, you can not eat food, water is limited.

The surgeon performs 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 it, the doctor makes an incision in the back wall of the vagina. Optical instruments are inserted through it. The bowel 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 hospitals, but this diagnostic method is preferred over laparoscopy.

Perturbation

With the help of perturbation, it is possible to determine the presence of adhesions in the uterine appendages, as well as to 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 kept at 90 mm. rt. Art., 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 tubes 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 values.

MRI

Diagnosis of patency of the fallopian tubes on the 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. Preparation for the procedure is not difficult. The woman will need to come to the doctor with an empty bowel. The day before the MRI, refuse to eat foods that increase gas formation. During the procedure, the patient will have to be motionless. Her body will be affected 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 for patients with suspected malignancy.

Which method to prefer

Each of these 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 violations of tissue integrity are considered safe and non-traumatic. During their implementation, the introduction of anesthesia is not required. However, their significant disadvantage is that the doctor is not able to immediately remove the detected adhesions. To do this, another procedure is required.

Most women are afraid of radiographic research 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 determine which method is suitable for a particular woman, you need to contact a gynecologist.

Be sure to watch this informative video from an experienced obstetrician-gynecologist about the patency of the fallopian tubes:

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

It is impossible to independently identify obstruction of the fallopian tubes at home. Although, according to 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.
• Violation of the menstrual cycle, which often occurs against the background of inflammatory diseases of the organs of the reproductive system.
• Previous abortions and other operations on the pelvic organs.

These symptoms will be supplemented by one main symptom -. It is indicated by unsuccessful attempts at conception, which are made by the couple during the year.

Write in the comments: did you undergo a patency test, what method was done, did it hurt to do the diagnosis, and did you 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!