Tubal Patency

Tubal patency testing checks whether the fallopian tubes are open (patent). Methods: (1) HSG (hysterosalpingography) — X-ray with contrast dye through the cervix; most common; (2) HyCoSy/HyFoSy — ultrasound with contrast or foam; no radiation; (3) Laparoscopy + chromopertubation — surgical gold standard; direct visualisation of dye spilling from tubes. Tubal patency testing is a fundamental part of the female fertility workup — bilateral block = IVF is the only option.

Common causes of tubal blockage: (1) Pelvic inflammatory disease (PID) from untreated chlamydia or gonorrhoea — the most common cause globally; (2) Pelvic tuberculosis — a significant and underdiagnosed cause in India; (3) Endometriosis — peri-tubal adhesions or hydrosalpinx; (4) Previous pelvic surgery — adhesions from appendicectomy, myomectomy; (5) Previous ectopic pregnancy — tubal damage from surgery or rupture; (6) Congenital tubal abnormalities (rare).

Yes — with one patent (open) tube, natural conception is possible, as ovulation from either ovary can theoretically result in fertilisation by sperm travelling through the open tube. However, fertility is reduced by approximately 20–40% with unilateral blockage. IUI is still viable if the open tube is functional. The risk of ectopic pregnancy in the damaged tube is eliminated but the remaining tube must be healthy. If the open tube has any pathology, IVF may be recommended.

A hydrosalpinx is a fluid-filled blocked fallopian tube. The fluid is embryotoxic — it leaks into the uterine cavity and reduces IVF implantation rates by approximately 50%. Multiple large RCTs confirm that salpingectomy (surgical removal of the hydrosalpinx) before IVF doubles live birth rates. Cornual occlusion (blocking the tube at the uterine junction laparoscopically or hysteroscopically) is an alternative when salpingectomy is technically difficult. Leaving a hydrosalpinx untreated before IVF is a significant preventable cause of IVF failure.

HSG causes cramping — typically moderate to severe for 2–5 minutes during and immediately after dye injection. Most women compare it to strong period pain. Pre-medication with ibuprofen 400–600mg 1 hour before significantly reduces discomfort. Some centres apply local anaesthetic to the cervix. The procedure itself takes 15–20 minutes. Post-procedure spotting and cramping may persist for a few hours. NSAIDs and rest are recommended for the remainder of the day.