Hysterosalpingography (fallopian tube patency test)

According to the American Society for Reproductive Medicine (ASRM), fallopian tube diseases account for approximately 25–35% of cases of female infertility. After all, the success of conception directly depends on whether the egg can pass through the fallopian tube toward the sperm.

That is why checking the patency of the fallopian tubes (echohysterosalpingography) is one of the main examinations performed when diagnosing the causes of female infertility.

The fallopian tubes can be checked for patency in several ways. The choice depends on the results of previous examinations, past diseases, and other characteristics of the woman's health.

The main methods:

• Echohysterosalpingography (ECHO-HSG). During the procedure, a sterile solution or a special contrast agent is introduced into the uterine cavity through a thin catheter. Using ultrasound, the doctor observes how the fluid passes through the fallopian tubes. If it freely enters the abdominal cavity, this indicates that they are patent. The procedure is also called echosalpingography.
• X-ray hysterosalpingography (HSG). A contrast agent is introduced into the uterine cavity, after which X-ray images are taken. They make it possible to see the shape of the uterus, the contours of the tubes, and determine whether there are any obstacles to the passage of the contrast agent.
• Laparoscopy with chromopertubation. This is a surgical examination performed under anesthesia. A camera is inserted through small punctures in the abdomen, and a special dye is introduced through the cervix. The doctor observes whether it passes through the tubes and can also detect adhesions, endometriosis, and other changes. This procedure is performed for specific medical indications.

ECHO-HSG or X-ray HSG is most often prescribed for the initial evaluation. According to the European Society of Human Reproduction and Embryology (ESHRE), both methods make it possible to assess fallopian tube patency with high accuracy.

If polyps, adhesions, or other changes inside the uterus are suspected during the examination, diagnostic hysteroscopy may additionally be recommended. It makes it possible to examine the uterine cavity using a thin camera.

Doctors at Oxford Medical emphasize that the presence of these risk factors does not necessarily indicate fallopian tube obstruction. An appropriate examination is required to confirm or rule out this disorder.

Echohysterosalpingography is a relatively safe procedure, but in some cases it needs to be postponed. The main contraindications are:

• pregnancy or suspected pregnancy;
• acute inflammatory diseases of the pelvic organs, in particular salpingitis;
• infectious diseases of the vagina and cervix;
• uterine bleeding of unclear origin;
• allergy to components of the agents used during the procedure.

Before such an ultrasound examination of the fallopian tubes, the gynecologist checks for contraindications. If an infection or inflammatory process is detected, the examination is postponed until treatment is completed.

Diagnosis of fallopian tube patency does not require any special complicated preparation. The examination is usually performed in the first half of the menstrual cycle, after menstruation has ended but before ovulation. This is important to exclude the possibility of pregnancy and obtain accurate results.

Before ultrasound examination of fallopian tube patency, it is recommended to:

• use condoms or abstain from sexual intercourse from the beginning of the menstrual cycle until the day of the examination;
• undergo a gynecological examination and have the prescribed tests performed, including tests for sexually transmitted infections;
• inform the doctor about allergic reactions to medications, antiseptics, and contrast agents;
• on the doctor's recommendation, take a pain-relieving medication 30–60 minutes before the procedure to reduce possible discomfort.

Doctors at Oxford Medical note: if unusual discharge, lower abdominal pain, or an elevated temperature appears before the examination, the gynecologist should be informed about it. If necessary, the procedure may be postponed.

ECHO-HSG is performed in a gynecological office. The procedure does not require hospitalization. It usually takes from 15 to 30 minutes.

The examination of the fallopian tubes takes place in several stages:

• The patient is positioned in a gynecological chair. The doctor performs an examination and treats the cervix with an antiseptic.
• A thin flexible catheter is inserted through the cervix, through which a sterile solution or a special contrast agent is slowly introduced.
• Using transvaginal ultrasound, the doctor observes how the fluid passes through the fallopian tubes and whether it enters the abdominal cavity.
• After the examination is completed, the catheter is carefully removed. The doctor evaluates the obtained results and explains them to the patient.

During the introduction of the fluid, the woman may feel a pulling pain in the lower abdomen, similar to menstrual pain. It is usually short-lived and passes after the procedure is completed.

Doctors at Oxford Medical explain that the free passage of fluid through both fallopian tubes indicates their patency. If the fluid does not pass or its movement is restricted, this may indicate obstruction. However, sometimes the cause is a temporary spasm of the tube, so an additional examination may be required to clarify the result.

After ECHO-HSG, a woman can usually return home immediately and resume her usual activities. If she feels well, prolonged rest or special restrictions are not required.

During the first 1–2 days after the procedure, the following may occur:

• mild pulling pain in the lower abdomen, similar to menstrual pain;
• slight bloody discharge;
• watery discharge due to the release of residual introduced fluid.

These symptoms usually resolve on their own. If pain is bothersome, a pain-relieving medication can be taken. Sexual activity can be resumed after the discomfort disappears, unless the gynecologist has advised other restrictions.

Complications after ECHO-HSG occur rarely. However, severe or increasing pain in the lower abdomen, heavy bleeding, fever, or discharge with an unpleasant odor are reasons to consult a doctor as soon as possible. Such symptoms may indicate the development of an infection or other complications.

The cost of ECHO-HSG at the Oxford Medical clinic can be viewed here. At Oxford Medical, echohysterosalpingoscopy is performed by experienced gynecologists using modern ultrasound equipment. The doctor explains each stage of the procedure, carefully monitors the patient's well-being, and after the examination explains the obtained results.

To make an appointment for a fallopian tube patency examination in Kyiv, call the Oxford Medical contact center or use the online appointment form on the website.