Examination of tubal patency is one of the basic tests in infertility, without which further treatment is generally not possible. Problems with the fallopian tubes or tubal infertility are considered to be responsible for about 30% of all cases of infertility.
The most common reasons for the appearance of the tubal infertility are previous infections and inflammations (which may or may not have been symptomatic), usually caused by Chlamydia, and other microorganisms.
Certain problems with fallopian tubes, even if they are discovered during the examination, can be treated surgically, while certain types of tubal blockage can be such that the success of surgery is very small, in which case in vitro fertilization is immediately suggested.
There are many options at our disposal for testing the fallopian tubes that differ in precision, comfort, invasiveness and affordability to patients.
Hysterosalpingography - HSG
HSG examination (hysterosalpingography) or the classic "blowing the fallopian tubes open" has for a long time been the only option available whereupon, controlled by X-rays, a contrast is injected into the uterus under increased pressure, and the X-ray shows the interior and shape of the uterus. This method also shows how contrast matter flows through the tubes and how it is discharged into the abdominal cavity
Benefits of HSG are that it is readily available in all the cities in the country; it has long been used in practice, and it gives us information about the state of the uterus and of the fallopian tubes. It is still prominently positioned in practice, but its disadvantages are a relatively high percentage of false positive and false negative results, pain (if not performed under anaesthesia) and exposure of the patient to radiation.
Endoscopic examination of tubal patency
This procedure is the gold standard, i.e. it is the most accurate method since endoscopic procedures have been in use - the introduction of a camera into the abdomen - with a direct visualization of the fallopian tubes; examining not only their mobility, but also their appearance and quality of the walls and mucous membranes. Damage to these can prevent pregnancy, even when Fallopian tubes are passable, and in addition to this, these procedures offer the possibility of surgical treatment during the same procedure.
Coloured contrast is passed through the uterus (blowing again, which has its therapeutic effects), and the camera detects the passage onto the other side.
This procedure can be performed via the transvaginal laparoscopy (TVL), which is the procedure we absolutely advise and which is a standard in situations where there is no suspicion of a larger problem based on previous results. This is suggested because TVL is less invasive than classical laparoscopy, it requires only one comfortable spot at the bottom of the vagina and provides complete diagnostics, but it is insufficient for more serious surgeries on fallopian tubes.
Classic laparoscopy today, as a rule, in order to test tubal patency, is used only when we have doubts, or confirmation of a certain problem on the fallopian tubes that requires surgical treatment. Although it is the most precise method, classical laparoscopy is, however, more invasive than TVL, and that is why TVL is used for the standard diagnostics.
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