Fallopian Tubes and testing for its patency

Fallopian tubes arise from the womb (uterus) and curve around the ovaries on either side. The ends of the tubes sweep over the ovaries and collect the eggs once the follicles rupture. This egg is then swept along the inside of the tube, towards the womb, by fine hairs (called cilia). At a point called the ampulla of the tube, the egg is met by the sperms, rising up the womb and swimming into the tubes. This is where the fertilization occurs. The fertilized egg or embryo stays in the tube for another 4 days, matures, grows and then enters the womb and attaches it self to the wall of the womb and grows there. Voila !!! pregnancy is thus positive.

The fallopian tubes are very sensitive structures which can be easily damaged. The tubes can get blocked, damaged by infection, kinked due to adhesions or simply, the small hairs inside could be damaged. This prevents the egg from meeting the sperms, thus creating Infertility.

Tubal testing can be done by HSG (Hysterosalpingogram) or Laparoscopy. The former has the advantage of being cheap, quick and not requiring hospitalisation but has the disadvantage of being painful and sometimes giving inaccurate and sometimes limited information. Laparoscopy on the other hand gives a complete picture and tells us not only if the tubes are open or closed but also whether the tubes are healthy or not. A condition called Endometriosis can be best diagnosed by laparoscoy. Any small defects can be corrected in the same sitting. If Polycystic ovaries are present, ovarian drilling can be done. However laparoscopy can be an expensive procedure and requires hospitalisation and is not covered by insurance.
The decision whether to do HSG or Laparoscopy and when cannot be a black and white answer. It depends on several factors like age, duration of infertility, other associated problems, economic factors and also sometimes on the patience levels of the couple. An HSG is good as an initial investigation for a couple who is just starting treatment and for a couple who is willing to be patient as treatment progresses systematically. Another useful test to do is testing for Chlamydia as it is the most common infection which is silent but causes blocked tubes. If the results are positive, one should go in for a Laparoscopy rather than HSG.