Introduction:
Infertility and subfertility are some of the leading problems in the field of gynecology. Around 180 million people all over the world are suffering from these problems. Around 48 million couples are affected by these conditions. The prevalence of women's fertility-related issues is 37 percent and slightly higher than men's. Several issues like hormonal imbalance, infectious diseases, improper release of the egg, and structural abnormality can cause women's fertility problems. Thirty percent of these cases are related to fallopian tube-related pathologies. That is why analysis of fallopian tube patency is important.
What Is Fallopian Tube and Its Blockage?
Fallopian tubes are known as uterine ducts and oviducts. These tube-like structures are extended from the uterus to the ovaries. This muscular tube is 3.94 to 5.51 inches long and less than 0.39 inches in diameter. The fallopian's primary function is to help move the egg from the ovary to the uterus. The fertilization takes place in the fallopian tube in the area known as the ampulla. After fertilization, the fertilized egg moves from the fallopian tube to the uterus for implantation.
The movement of the fertilized egg is aided by ciliated epithelium cells (the presence of thread-like structures in the cell) and the contraction of smooth muscles. However, blockage or damage of the fallopian tube prevents normal movement of the egg and disrupts the normal physiologic process of implantation. The reasons behind such factors are:
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Infection: The most common cause of tubal structure damage is infection. Infectious diseases cause pelvic inflammatory disorders responsible for the adhesion of pelvic structures. Infectious diseases like gonorrhea, chlamydia, and genital tuberculosis are responsible for such conditions. Sometimes, it is associated with post-pregnancy sepsis also.
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Endometriosis: Endometriosis is a condition characterized by ovary-like tissue outside the ovary. Such tissues can be present in the fallopian tube and may cause complete tubal blockage.
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Ectopic Pregnancy: In this condition, a fertilized egg is implanted in the fallopian tube. In such situations, the abnormal growth of the implanted fertilized egg damages the tubal structures. As a result, the fallopian tube remains damaged for the rest of its life.
What Is Tubal Patency Test?
The tubal patency test is the diagnostic assessment of fallopian tube damage or blockage. These tests are done under the following conditions:
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Subfertility is a condition in which a couple cannot be convinced for more than one year after having unprotected sex. The reason behind subfertility is accessed through tubal patency tests.
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Patients complain of irregularities in their menstrual cycle, difficulty in bowel movement, difficulty in peeing, and painful menstrual cycles. These symptoms may be associated with endometritis.
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Assessment of damage of the internal structures after diagnosing sexually transmitted infections.
What Are the General Considerations Before Doing Tubal Patency Test?
Most of the tubal patency tests have the same indications and contraindications. Some of the indications are:
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Primary and secondary subfertility.
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Continuous miscarriage.
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Post-operative assessment.
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Sterilization assessment.
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Evaluation is done before new assisted reproductive treatment and surrogacy.
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Congenital anomalies.
What Are the Different Tests?
Different types of invasive and non-invasive tests are performed for the assessment of tubal patency. These are:
Hysterosalpingography
This is the most commonly used radiographic diagnostic method. This method uses a contrast medium to obtain images of the uterus and fallopian tubes.
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Procedure: In this technique, an analgesic or antispasmodic agent is given to the patient one hour before the procedure. Then, the patient is positioned in a lithotomy position (legs are flexed 90 degrees at the hips, and knees will be bent at 70 to 90 degrees). A catheter with a balloon tip is inserted into the cervix. The function of the inflated balloon is uterine retraction. Following this, contrast media is passed into the uterine cavity, and a radiograph is taken.
Saline Infusion Sonohysterography (SIS)
In this technique, the transvaginal sonographic evaluation of the fallopian tube is done after administering 6.67 fluid ounces of intracervical fluid.
Procedure:
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Analgesics and antibiotics are administered one to two hours before the procedure. At first, a balloon catheter is inserted in the uterine cavity and distended using normal saline. After that, a transvaginal probe is inserted, and saline is injected through the catheter slowly. The spill of saline through various uterine structures can be seen in the scan.
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If any occlusion is detected in the procedure or any part is not visualized, additional color Doppler or pulse Doppler examination can be done. In this proceeding, the Doppler gate is placed where occlusion is suspected.
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Another modification of this technique is the application of both air and saline. A combination of both air and saline forms bubbles, which aid in better visualization.
Hysterosalpingoontrast Sonography (HyCoSy)
This technique uses a hyperechogenic contrast medium, which increases the signals' echoing and allows flow detection. Another advantage of this procedure is that the microbubbles produced are more stable.
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Procedure:
The patient is kept in a lithotomy position before the procedure. In the beginning, transvaginal ultrasound is done. Afterward, a plastic catheter attached to a syringe is inserted into the vagina. Immediately before the infusion, the dye is made and injected through the syringe. With the help of the ultrasound, the movement of the fluid is observed. The solution completely dissolves in the body within about 30 minutes.
Hysterosalpingo-Foam Sonography (HyFoSy)
This technique was introduced in 2011. This technique is based on intrauterine injection of air polymer-type foam. The foam is made with 0.17 fluid ounces of sterile water and a gel containing hydroxyethyl cellulose and glycerol. The viscosity of these foams is very high, and they are more stable. As a result, better visualization of the internal structures is possible.
What Are the Contraindications?
Certain things should be kept in consideration while doing tubal patency tests. These tests must be done within the fifth to the eleventh day of the menstrual cycle. There should not be any blood present during this period. Patients should be asked to avoid intercourse from day one of the menstrual cycle to exclude the possibility of disrupting a potential pregnancy. Pregnant women or women suffering from pelvic infection should avoid these tests.
What Are the Complications?
Usual complications are mild abdominal pain, bleeding, nausea, and vomiting. Severe complications like contrast media allergy, perforation, and vaginal bleeding are rare.
Conclusion:
Blockage of the fallopian tube is one of the main reasons for infertility. Tubal patency tests are very helpful in diagnosing fallopian tube pathology. With modern contrast media and three-dimensional technology, proper visualization of the fallopian tube is possible.
