After a sample survey of the reproductive health of Russian women conducted in 2011, an analysis of the results showed that 5% of women suffer from infertility. In 30% of cases it is affected by the patency of the fallopian tubes. The figure is impressive, and every woman would not want to be among those who receive an unpleasant diagnosis.

How does the verification take place? What tests need to be taken to identify pathology? Is it possible to identify and treat it at home using folk remedies? How much does it hurt? The answer to these questions should be sought in the gynecologist's office. Only after his appointments can we hope that the problem with pregnancy will be successfully resolved.

The functioning of the fallopian tubes is influenced by two main factors: the condition of their internal mucous membrane and mechanical patency. If the villi cannot cope with the movement of the egg through the tubes, it is necessary to establish the cause of damage to the mucosa. It may turn out to be:

• inflammation of the appendages;
• adhesive process;
• endometriosis.

They also become the culprits for disrupting the capacity of the fallopian tubes, which results in their narrowing or complete blocking. Infectious diseases are additional sources of the problem. In rare cases, obstruction is associated with congenital structural features of the fallopian tubes or their absence.

The insidiousness of obstruction is that it does not manifest itself in any way. If a woman was in pain or experiencing discomfort, then it would be much easier to find out about the problem. They begin to find out the circumstances when they are looking for the causes of infertility. The woman will undergo a procedure to determine patency, which is preceded by tests. It is impossible to get by with folk remedies in this situation.

How can you determine patency?

How complex the procedure is can be judged by the internal diameter of the fallopian tubes. It does not exceed 10 mm, and its minimum value is only 0.1 mm. Doctors suggest solving the problem by conducting an analysis using:

1. Hysterosalpingography (HSG).
2. Hydrosonography.
3. Diagnostic laparoscopy.
4. Hydrotubation.
5. Pertubations.
6. Fertiloscopy.

There are many ways, but most often they do HSG. In addition to establishing patency, it can provide a picture of the condition of the uterine cavity. As with hydrosonography, during HSG there is no surgical intervention, which means you do not need to use anesthesia and do not expose the body to undue stress.

The information that the procedure is difficult to tolerate and that during it the patients are not just in pain, but unbearably painful, is partially true. Whether a woman will have to suffer or not depends largely on the doctor’s qualifications. Therefore, to avoid pain, you need to carefully choose a medical institution and a doctor. The analysis can be carried out in a private medical institution at its prices or free of charge in a public one. Which one to choose is up to the patient to choose, but it won’t hurt in either case.

GHA is the most informative and safe technique. The procedure involves receiving a small dose of radiation, similar to a regular X-ray. This small minus does not play a significant role when it is necessary to check patency.

Hysterosalpingography is done if necessary:

1. Determine the cause of infertility or miscarriage;
2. Get comprehensive data on cross-country ability;
3. Confirm or exclude suspicion of the presence of diseases such as endometriosis, fibroids, polyps, synechia, tuberculosis of the fallopian tubes, ovaries, uterus;
4. Prepare for IVF.

Complications after HSG usually do not occur, since it is done with sterile instruments. Minor bleeding for 2-3 days is considered normal. If they become protracted, have an unpleasant odor, or the temperature rises after the test, a visit to the doctor cannot be postponed. It is possible that an infection has occurred. Waiting for everything to get better and being treated with folk remedies is dangerous. You can worsen the condition, after which it will take a long time to restore your health.

The first step is getting tested

Despite the fact that HSG does not relate to surgical operations, before it the doctor must issue a referral for tests and examinations. Some of them can be submitted in advance. Blood tests for the Wasserman reaction, AIDS, hepatitis type B and C, as well as ultrasound OMT remain valid for 1 month. A cytology smear has an even longer validity period - 3 months.

A smear for flora and a clinical blood test are taken immediately before the HSG. They are valid for only 7 days. Blood type and Rh factor are determined once in a lifetime, since these indicators do not change.

In private clinics, special attention is paid to ensuring that the patient is not in pain. For this purpose, sedation is performed. If sedatives are to be used, an electrocardiogram is additionally performed.

When no inflammatory processes or infectious diseases are identified, and the existing deviations are within normal limits, after the examination you can go to the doctor. At the appointment, the date of the manipulation is determined. The doctor will tell you what the preparation is and give the necessary recommendations.

Preparing for the study

The timing does not depend on when your last period was. Any day of the cycle is suitable for the study, except for the period of menstruation. Preference is given to the first two weeks after it, since during this period, due to the small thickness of the uterine mucosa, the catheter insertion procedure is easier. To make sure it doesn't hurt, you can take a painkiller tablet.

After all the tests have been completed and a date for the study has been set, they stop using vaginal suppositories, sprays, and intimate hygiene products. In order to exclude pregnancy, contraceptives are used before and after HSG or they refuse to have sex.

Some dietary changes should be considered. It is undesirable to consume foods that increase gas formation. These include carbonated mineral water and drinks, dairy products, legumes, cabbage, carrots, bread, and all types of baked goods. On the eve of hysterosalpingography, a cleansing enema is performed.

Some contraindications

The tests preceding the study are aimed at identifying inflammatory processes and infections. Their presence in the body is indicated by an increased number of leukocytes, ESR. Deviation from the norm is observed with sore throat, ARVI, influenza, furunculosis, thrombophlebitis. In this case, hysterosalpingography is performed only after complete recovery.

Severe diseases affecting the cardiovascular system, kidneys, and liver serve as an obstacle to hysterosalpingography. The study cannot be carried out in case of acute inflammation in the uterus and appendages, cervicitis, colpitis, bartholinitis.

It is necessary to check for a possible allergic reaction to iodine, which is part of the contrast agents administered during the procedure. If it is positive, then HSG is strictly contraindicated, and another technique should be chosen.

A pregnancy test is required. Hysterosalpingography, like x-rays and fluorography, has an undesirable effect on the fetus, therefore, when the fact of pregnancy is established, the study is canceled.

Stages of implementation

First, pain relief is performed using one of the methods agreed upon with the doctor. 15 minutes before HSG, sedatives are taken or lidocaine is administered. Then they proceed directly to the study, for which a soft catheter is inserted into the uterine cavity. Through it, a contrast agent is supplied in small doses using a syringe. Urografin is the most widely used, but verografin, ultravist, and triomblast have also proven themselves well.

The solution fills the uterine cavity, gradually moving along the fallopian tubes. If the patency is not impaired, then it pours into the abdominal cavity and naturally leaves the body within 3-7 days.

Take several pictures. They show whether urografin has reached the peritoneum. After this, the catheter is removed. All manipulations take about 30 minutes. At the end, the woman rests for half an hour and leaves the medical institution. The vast majority of women note that they were not in pain, and the sensations they experienced were comparable to the discomfort before menstruation. The local anesthesia used completely copes with the task, so there is no need for general anesthesia.

The relationship between hysterosalpingography and conception

The purpose of an HSG is to exclude tubal patency from the list of possible causes of infertility. If it is not broken, then the problem lies in something else, and the task of doctors is to establish the factor that prevents pregnancy.

Hysterosalpingography helps eliminate small adhesions and remove menstrual blood clots from the fallopian tubes. At the same time, motility improves and favorable conditions are created for the advancement of sperm. The results of clinical observations indicate that many women become pregnant very quickly after hysterosalpingography.

Doctors advise using contraception in the cycle when HSG is performed to prevent the influence of X-ray radiation on the fetus. In the future, there are no contraindications, and the woman can fully count on the birth of a healthy child.

Hysterosalpingography is one of the simple tests that opens the way to conception. You may have to experience several unpleasant moments during it, but you must definitely take advantage of them so as not to miss the chance to become a mother.

Tubal factor infertility is the medical term for obstruction of the fallopian tubes. This pathology occupies one of the leading places in reproductive function disorders: it accounts for up to 30% of all cases. Checking the patency of the fallopian tubes is a way to assess the possibility of pregnancy naturally.

Causes of tubal obstruction

Tubal factor infertility occurs when:

• inflammatory diseases of the pelvic organs;
• operations on the internal genital organs;
• sexually transmitted infections (chlamydia);
• operations on the intestines, including removal of the appendix.

Normally, the sperm penetrates the egg in the fallopian tube and the embryo moves along it towards the uterus during the first week of pregnancy. The movement occurs due to rhythmic contractions (peristalsis) and the cilia of the epithelium that line the tube. Even a slight narrowing of the lumen can interfere with the process of migration of a fertilized egg and leads to infertility or the development of an ectopic (tubal) pregnancy, which threatens the woman’s life.

The patency of the fallopian tubes is examined in the absence of pregnancy within one year of marriage without contraception.

Pertubation (blowing of the fallopian tubes)

The method is based on the introduction of air into the uterine cavity. Before the procedure, you need to do a cleansing enema and empty your bladder.

Pertubation is performed on an outpatient basis. The woman is placed on a chair and gas under pressure is supplied into the uterine cavity through a probe. The gynecologist evaluates the result based on clinical signs. If there is obstruction, gas does not leave the uterus into the abdominal cavity, its pressure increases and the procedure is stopped. The method has a large error, because there is no way to reliably determine the passage of gas through the fallopian tube, and is currently practically not used.

After purging, the woman is observed for an hour and sent home. Bloody discharge appears immediately or in the coming days if damage to the cervix has occurred. Pregnancy should be planned in the current cycle; the likelihood of its occurrence increases due to the expansion of the tube lumen by gas during the procedure.

Ultrasound hysterosalpingoscopy (USGSS)

Method using ultrasound.

Preparing for the study:

UZGSS is carried out 6-12 days after menstruation. The procedure takes 10-15 minutes and is performed at an outpatient appointment with a gynecologist. Local anesthesia - irrigation or injection of lidocaine into the cervical area.

The woman is placed on a chair, a speculum is inserted into the vagina (as during a gynecological examination) and a thin probe is passed through the cervix into the uterus. A small amount of sterile liquid (usually saline) is injected through the probe. Ultrasound waves do not penetrate the air space, so to visualize the lumen of the fallopian tubes, they are filled with a solution.

All stages of the process are monitored using an ultrasound probe through the anterior abdominal wall (stomach). Can assess the patency of the pipe, its internal relief, and the presence of peristaltic movements. In some cases, if the lumen was blocked by a mucus plug, the fluid washes it out and the chances of pregnancy increase sharply.

Immediately after ultrasound examination and for several days, bloody discharge from the vagina is possible - the reaction of the uterus to the introduction of fluid into its cavity. There is no need to delay conception for subsequent cycles, since the procedure does not have a negative effect on the woman’s body and her reproductive cells.

Hysterosalpingography (metrosalpingography)

This is an examination using x-rays.

Preparation:

• vaginal smear;
• blood tests for HIV, hepatitis B and C, syphilis;
• fluorography;
• negative pregnancy test;
• a few hours before the procedure you can take no-shpa and baralgin.

Just as with USGSS, a liquid - a radiopaque substance - is injected into the uterus. The contrast enters the fallopian tubes and in the pictures you can track how it passes through them, whether there are areas of narrowing or complete obstruction.

The contrast agent is chosen by the doctor; it can be water- or fat-soluble. Water-soluble penetrates better into the folds of the mucous membrane, so you can get more detailed pictures of the pipe relief. In addition, it is quickly eliminated and does not cause pain when absorbed.

The oily contrast is thick and does not cover the mucous membranes well, but has an undeniable advantage - after it, pregnancy occurs much easier. It lingers in the tube for up to a day and can cause abdominal pain as it dissolves.

After the contrast is administered, several x-rays are taken. Hysterosalpingography lasts no more than half an hour, after which the woman goes home.

The radiation dose during hysterosalpingography is minimal, so you can conceive a child already in the current cycle.

Chromosalpingography

This is a surgical (laparoscopic) examination of the patency of the fallopian tubes.

Preparation for the procedure:

• general and biochemical blood test;
• blood clotting test (coagulogram);
• analysis for HIV, hepatitis B and C, syphilis;
• fluorography;
• vaginal smear;
• exclusion of pregnancy in the current cycle;
• the day before - only liquid food, in the evening - a cleansing enema;
• On the day of laparoscopy, you should not consume food, liquids, or tablets.

The procedure is performed at any time during the cycle, except menstruation, in the operating room under general anesthesia. The gynecologist-surgeon makes a puncture with a thin tube - a trocar in the navel area. Through it, a laparoscope is inserted into the abdominal cavity - a device with a video camera, the image from which is displayed on the monitor. At the same time, a solution of indigo carmine (“blue”), a harmless dye, is supplied through the uterus into the tubes. Normally, it should pour into the abdominal cavity, which will be visible on the monitor.

Video: Normal patency of the fallopian tubes during chromosalpingography

The trocar can also be inserted through the vagina; such a study is called fertiloscopy. In any case, the surgeon has the opportunity to immediately begin surgical treatment. To do this, he cuts the anterior abdominal wall in several more places and inserts manipulators through the holes. So, you can immediately perform the operation and restore the patency of the fallopian tubes.

After the operation, the woman requires hospitalization for up to one week. During this period, she is given antibiotics, painkillers and other drugs if necessary. Immediately after the operation, there may be slight mucous-blood discharge from the genital tract; menstruation usually begins on time. It is better to postpone conceiving a child at least until the next cycle.

All types of examinations are prescribed only by the attending physician, taking into account the clinical picture of infertility.

HSG (hysterosalpingography) of the fallopian tubes is one of the types of gynecological diagnostic tests. The technique provides the doctor with reliable data on the condition of the reproductive organs.

According to the method of conducting the study, it is divided into X-ray and ultrasound. Modern ultrasound HSG is considered a more effective and safer procedure for women’s health than the standard x-ray type of examination.

What is HSG in gynecology?

The procedure involves an x-ray of the uterus and fallopian tubes. The purpose of the study is to determine their patency and diagnose the physiological state of the uterus in women. In most cases, the procedure is prescribed for an established diagnosis of infertility and recurrent miscarriage.

Ultrasound hysterosalpingography

Modern medical equipment makes it possible to conduct research without the use of x-rays. Ultrasound hydrosonography is performed using a sterile saline solution, which is injected into the uterine cavity using a soft hysterosalpingography catheter.

The saline solution enters the uterine cavity and fills the fallopian tubes. The doctor evaluates this process and monitors it using a transvaginal ultrasound sensor. Ultrasound helps determine whether liquid flows freely in pipes. In the presence of obstacles and impaired patency, the liquid will not spread correctly.

Advantages of ultrasound HSG:

• painless and physiological;
• absence of harmful effects of X-ray irradiation on ovarian follicles;
• lasts about half an hour, which allows you to best assess the condition of the fallopian tubes;
• does not cause individual reactions or allergies.

Indications and contraindications for diagnostics

Indications for the procedure are the following pathologies:

• suspicion of infertility;
• endometriosis and endometrial hyperplasia;
• physiological malformations of the vagina, cervix, uterus itself and appendages;
• isthmicocervical insufficiency.

Contraindications:

• the presence of an acute infectious process;
• heart failure;
• thrombophlebitis;
• renal and liver failure;
• hyperthyroidism, impaired thyroid function;
• inflammatory process in the uterus and appendages;
• acute inflammation of the vagina and vulva (colpitis, vulvovaginitis);
• unfavorable blood test (increased leukocytosis, increased erythrocyte sedimentation rate);
• unfavorable urine test;
• individual iodine intolerance;

An absolute contraindication is the period of pregnancy and lactation.

On what day of the cycle is hysterosalpingography performed?

The exact length of time for the procedure depends on the purpose of the study. To confirm the diagnosis of endometriosis, the procedure is prescribed on days 7-8 of the cycle. To determine the degree of patency of the fallopian tubes, an examination is scheduled for the second phase of the cycle. HSG can be performed at any phase of the cycle to detect the presence of uterine fibroids.

The most optimal time to conduct the study is the first two weeks after menstruation. During this period, the endometrium is still thin enough to provide free access to the mouths of the fallopian tubes.

Preparation for tubal HSG

The HSG method is safe and low-traumatic, but it is an invasive procedure and therefore requires special preparation. Preparation for hysterosalpingography includes the following steps:

• it is necessary to undergo a general gynecological examination and undergo tests for hysterosalpingography: a bacteriological smear from the vaginal mucosa is necessary to ensure the absence of sexually transmitted infections;
• to diagnose other infectious diseases it is necessary to take blood tests;
• during the week before the examination, you should not use vaginal suppositories and suppositories, sprays, douching solutions and intimate hygiene products;
• you should abstain from sexual contact for two days before the study;
• sometimes the doctor prescribes allergy tests for the contrast agent used in x-ray examination;
• if the procedure is performed in the second phase of the cycle, a pregnancy test is performed.

Diagnostic technique

Before the procedure, the woman must undergo a routine gynecological examination with speculum.

The procedure does not take too much time. After examination, a special tube (soft catheter) is inserted into the cervix. Through this tube, the doctor uses a syringe to inject a contrast agent for X-ray examination into the uterine cavity. After some time, when the contrast fluid penetrates the tubes, the doctor takes x-rays showing the condition of the fallopian tubes.

The research liquid is absolutely safe for health. It is eliminated from the patient’s body without a trace, absorbed into the blood, without requiring any additional procedures to clean the uterus.

Is it painful to have a tubal HSG procedure?

Many women are interested in whether the examination will be painful. The procedure is considered a painless, minimally invasive diagnostic method, so no anesthesia or local anesthesia is required before the procedure. In some cases, local anesthesia with lidocaine is used if the patient does not have individual intolerance to the anesthetic.

During the procedure, you may experience unpleasant sensations reminiscent of menstrual pain in the lower abdomen. An hour after the end of the examination they disappear.

Video: "How is hysterosalpingography done and what are the advantages of diagnosis?"

Results of the procedure

X-rays show the contrast agent moving through the fallopian tubes. If fluid fills the tubes and enters the abdominal cavity, the doctor makes sure that the fallopian tubes are patent. If the liquid has not completely penetrated the pipes and stopped at a certain level, the specialist confirms the presence of obstruction and prescribes further treatment.

If the study was carried out correctly, it is quite informative and allows not only to confirm or refute the presence of obstruction, but also to identify various intrauterine pathologies.

Consequences and complications of tubal HSG

Complications and consequences after the procedure are rare. One of the possible complications is an individual allergic reaction to the contrast liquid used for the procedure. If the examination technology is violated, inflammation of the appendages may begin.

As for X-ray radiation, its doses during examination are so small that they do not cause any harm to women’s health.

Some experts note that pregnancy after HSG of the fallopian tubes occurs more easily, and the procedure increases female fertility, facilitating the rapid conception of a child.

Recovery after HSG

The patient may experience minor vaginal bleeding for a couple of days after the procedure. Discharge is associated with trauma to the cervix and is most often observed in women suffering from cervical erosion.

Minor pain in the lower abdomen passes quickly enough, without requiring additional pain relief.

Estimated cost of hysterosalpingography

It is best to find out how much HSG of the fallopian tubes costs directly at the medical institution where hysterosalpingography is performed. On average, the cost of the procedure varies between 4000-8000 rubles (150-250 dollars), depending on the clinic.

Today, X-ray HSG of the fallopian tubes is considered an outdated technique, which is increasingly being replaced by high-tech ultrasound and computer. In combination with other diagnostic methods, the procedure allows you to quickly and effectively diagnose and determine the physiological state of a woman’s reproductive organs.

When examining a woman for possible infertility, in addition to other studies and tests, a determination of the patency of the uterine tubes is required. This test is necessary because, among other reasons for lack of pregnancy related to the woman’s health, tubal obstruction accounts for about a third of all cases.

The obstruction of the fallopian tubes itself, depending on the factors that caused it, can be functional and/or anatomical. A carefully collected gynecological history will help to suspect one or the other type before performing the study. Consequently, of the several existing modern methods for assessing patency, the doctor will prescribe the most optimal one for a particular patient.

Functional. This type is caused by a violation of the hormonal regulation of female reproductive function. As a result, either the contractility of the smooth muscle layer of the tubes decreases, or a change in the functional epithelium lining them. In both cases, the advancement of a mature egg is impossible (difficult) and, even if fertilization occurs, it either dies or penetrates into the mucous membrane of the fallopian tube. The latter option leads to a situation of emergency gynecological surgery - ectopic (tubal) pregnancy.

Anatomical causes may be due to the tube itself and/or peritoneal factors.
Its structure directly depends on the fallopian tube. There are several types of developmental anomalies that prevent pregnancy: duplication on one or both sides; underdevelopment or absence on one side; splitting of the tube lumen, the presence of additional blind passages; pronounced (more than 5 mm in length) asymmetry of pipes.

Acquired causes of obstruction include adhesions inside the tubes, which are formed as a result of inflammation of the uterine appendages (salpingitis, salpingoophoritis). Inflammations can be induced by common flora (for example, staphylococcus) or infectious agents that are predominantly sexually transmitted (for example, chlamydia).

Separately, in the group of acquired factors of anatomical causes of uterine tube obstruction, mention should be made of the consequences of external genital endometriosis. As a result of this disease, there is a persistent replacement of the mucous epithelium of the tubes with cells characteristic of the epithelium of the uterus.

How is the patency test performed?

Peritoneal factors are adhesions or atypical formations of the small pelvis that narrow the lumen of the tube from the outside or change its topography. Peritoneal adhesions can form as a result of inflammatory processes of the pelvic organs, as a result of previously performed surgical procedures. Including on the abdominal organs. At the same time, they can not only block the lumen, but also displace the tube (or a section of it) along with the ovary. This, in turn, makes the normal advancement of the egg difficult or impossible.

Types of studies to determine the patency of the fallopian tubes:

Modern gynecology has four main methods: echohysteroscopy (hydrosonography), hysterosalpingography, fertiloscopy and diagnostic laparoscopy. Each of them has its own advantages and disadvantages. For each, there are certain indications and contraindications, appropriate preparation is carried out, and the necessary regimen is prescribed after the study. In some cases, several methods for determining the patency of the uterine tubes can be combined.

Another name – hydrosonography – more accurately defines the essence of the technique. This is an ultrasound examination of the uterine cavity, fallopian tubes and ovaries using a contrast agent. Allows you to more accurately assess the structure of the uterus and the “purity” of its cavity (absence of polyps, nodes), the configuration and patency of the uterine tubes or the level and degree of their occlusion (blockage), ECHO picture of the ovaries.

The study is prescribed in the first phase of the menstrual cycle, usually on the 5th – 9th day, possibly up to the 13th day (with a 28-day cycle). Preparation includes an analysis of the vaginal microflora (smear), serological tests (blood from a vein) for sexually transmitted and other sexually transmitted infections. In the morning, on the day of the examination, it is recommended to do a cleansing enema, perform hygiene of the groin area and external genitalia. The examination itself is carried out with moderate fullness of the bladder. A transvaginal sensor is used. The procedure lasts about 15 minutes. No anesthesia is required. It is possible to use mild sedatives (sedatives) to prevent spasms of smooth muscles, in particular the uterine tubes. Ordinary sterile saline solution (0.9% sodium chloride) is widely used as a contrast agent. It is possible to use a special contrast “Echovist”. According to indications, anti-inflammatory and/or antibacterial drugs can be added to the saline solution. The volume of injected contrast is 20-40 ml.

The main indication for the study is to assess patency. It can also be prescribed for the purpose of dynamic control in the treatment of chronic inflammatory processes (salpingitis, salpingoophoritis) without exacerbation.

During the examination, the doctor, in real time, assesses the rate of filling of the uterine tubes with contrast. With normal patency, the contrast agent fills the entire lumen of the tube 10-15 seconds after filling the uterus. The final result of complete tubal patency confirms the presence of contrast on both sides of the uterine contour.
Hydrosonography ends with the evacuation of the contrast agent from the uterine cavity.

Absolute contraindications:

• acute phases of any inflammatory diseases, especially gynecological ones;
• severe dysbacteriosis of the vaginal flora;
• uterine bleeding;
• venereal diseases.

The study is quite easily tolerated, has good information content and reliability of up to 70%. Does not require a special mode after completion. It can be used dynamically due to the complete absence of radiation exposure.

Hysterosalpingography

One of the types of X-ray contrast examination that allows you to study the structure of the uterus, its shape, assess the lumen and patency of its tubes in real time. It is the main method for identifying abnormalities in the development of the uterus and appendages, and intrauterine pathology. It also makes it possible to visualize adhesive formations.
If tubal infertility is suspected, the study is carried out in the first phase of the menstrual cycle, on the 5th – 7th day. During the preparation process, a woman is strictly prohibited from having sexual intercourse after the end of her last menstruation. Examinations include a smear for flora and a blood test for AIDS, hepatitis and syphilis, a general blood and urine test.
A cleansing enema is performed the day before and on the day of the examination. This will allow you to obtain a clear image of the uterus and appendages without layering the intestinal contents, especially gases, which significantly worsen the x-ray picture and the quality of the images. Before performing the procedure, you should perform hygiene of the groin area and external genitalia, and empty your bladder. All items containing X-ray positive materials must be removed.
The duration of the study is about half an hour. During this time, a series of images is taken at various levels of filling the uterine cavity and the lumen of its tubes with contrast, up to the outflow of contrast into the pelvic cavity. Modern clinics use a digital X-ray machine that produces low radiation exposure.
Anesthesia is usually not performed. Intrauterine injection of local anesthetics or administration of sedatives may be used.

For contrast, X-ray positive water-soluble iodine preparations are used. Upon completion of the examination, the remaining contrast agent is absorbed into the blood and excreted unchanged by the kidneys.
Hysterosalpingography is prescribed for suspected obstruction of the fallopian tubes or abnormalities in their development. This study is also used to diagnose diseases of the uterus: fibrous or tumor changes, abnormalities of development and shape, adhesions in its cavity.

During hysterosalpingography, under the control of a fluoroscope, a contrast agent is injected into the uterine cavity through a cannula. As soon as it fills the entire volume of the cavity, a picture is taken. The contrast then enters the fallopian tubes. In digital fluoroscopy, the doctor has access to not only a visual assessment, but also computer processing of the resulting image. This allows you to determine with maximum accuracy the volume and speed of filling cavities, clearly identify the localization of occlusion, if any, and draw conclusions regarding its possible causes.
An absolute contraindication for X-ray contrast examination is an allergic reaction to iodine and hyperthyroidism. The procedure is not performed in case of acute inflammatory processes of any localization, with severe disorders of the liver and kidneys, or heart failure.

The information content of the method reaches 85%. As a rule, hysterosalpingography is tolerated quite easily. In some cases, unpleasant and painful sensations are noted when contrast is administered. After completing the study, the patient remains under medical supervision for another half hour. Attempting pregnancy is prohibited during one cycle.

A minimally invasive method that includes three types of examination: hysteroscopy, transvaginal hydrolaparoscopy and chromosalpigoscopy. Currently, it is the most progressive study for suspected tubal obstruction.
At the first stage, an examination of the uterine cavity is carried out. Transvaginal hydrolaparoscopy allows you to assess the condition of the pelvic organs accessible for examination. Additionally, microsalpingoscopy (examination of the lumen of the fallopian tubes) is possible. A contrast agent introduced into the uterine cavity allows one to evaluate the patency of its tubes by visually observing its distribution.
The optimal timing for performing fertiloscopy is the first phase of the cycle, on the 7th day. Preparation is carried out as for any minor gynecological intervention: blood tests (general with coagulogram, biochemical) and urine tests are required; specialized tests (blood type and Rh factor, tests for HIV, syphilis, hepatitis); vaginal smear for flora, ECG, ultrasound of the pelvic organs and fluorography. Sexual activity during the period is not recommended.
On the eve of the study, the following were prescribed: a light dinner, mild sedatives and a cleansing enema. On the day of the procedure, strictly on an empty stomach, hygiene of the groin area and external genitalia is carried out.
Fertiloscopy is performed in a hospital setting, the examination duration is about 20 minutes. The total time spent in the department is several hours.

Local anesthesia is used, usually through spinal anesthesia. If necessary, a transition to intravenous anesthesia is possible.
During hydrolaparoscopy, sterile saline solution is used to aid visualization of the fluid. At the chromosalpingoscopy stage, a methylene blue solution is used. After the procedure, most of the liquids are evacuated. The remaining dye is absorbed into the blood and excreted unchanged by the kidneys.

In addition to assessing the patency of the fallopian tubes, fertiloscopy allows you to assess the condition of the endometrium (at the stage of hysteroscopy). During hydrolaparoscopy, the following are available for inspection: the posterior surface of the uterus and the retrouterine space, fallopian tubes, ovaries and uterosacral ligaments.

Contraindications for the examination are:

• acute respiratory infections,
• exacerbation of herpes,
• inflammatory diseases of the external genitalia

Fertiloscopy is not performed in the second phase of the menstrual cycle, if there is a delay or during menstruation. Suspicion of pelvic adhesions, as well as uterine retroflexion (fixed posterior location), make this study impossible.

The method is highly informative. It allows you to identify almost all causes of tubal obstruction and other possible causes of infertility. If a pathology is detected with the possibility of its elimination, a decision is made to switch to transabdominal laparoscopy with reconstructive operations.

Laparoscopy

Therapeutic and diagnostic laparoscopy of the uterine tubes is the “last resort” in determining their obstruction. This surgical treatment is prescribed when other methods are ineffective or when there is a suspicion of a pelvic adhesive process blocking the lumen of the fallopian tubes.

Preliminary examinations, such as ultrasound of the pelvic organs with hydrosonography or x-ray contrast hysterosalpingography, can identify the localization of occlusion. Also, they are able to give a very clear idea of ​​the presence of adhesions that are pulling the pipes from the outside. But they cannot fix this problem.
During a laparoscopic examination of the pelvic organs, the doctor has the opportunity to visually assess the condition of the ovaries, uterus and its tubes. The equipment used during this procedure allows you to see what these organs look like in great detail. The probe's fiber-optic camera, equipped with a light source, displays the image on a monitor at tenfold magnification.
This allows you not only to discern possible problems associated with obstruction of the uterine tubes, but also to eliminate them with pinpoint accuracy, if possible. At the same time, the diagnosis of obstruction is not limited to visual detection of adhesions. The filling capacity and rate of detection in the pelvic cavity of a coloring substance (methylene blue), introduced during the operation into the uterine cavity and then entering the tubes and periovarian space, are assessed.
In addition, a laparoscopic examination allows you to identify: the presence of inflammation of the pelvic organs, endometriosis, the presence of a tumor and its nature, diagnose other diseases that can cause infertility or unexplained pain in the pelvis and lower abdomen.

During the operation, if there is suspicion, it is possible to take a biopsy (a small piece of tissue for examination under a microscope). The cellular composition of the tissue taken allows us to judge the health of the organ. A normal structure indicates adequate blood supply, nervous and hormonal regulation, and, therefore, the performance of proper functions.
The entire laparoscopy process is recorded on digital media. This makes it possible to “return” to a possible problem area during clinical analysis of a case or for discussion with colleagues from other medical and scientific institutions if a rare atypical case is encountered.

Laparoscopy is a full-fledged and sophisticated surgical aid. Therefore, you need to prepare for it seriously. It is necessary to undergo a full range of examinations for those entering a gynecological surgical hospital. This list includes: blood tests (general, biochemical, coagulogram, group and rhesus, for HIV, syphilis and hepatitis), and urine; ECG with interpretation; Ultrasound of the pelvic organs (possibly with hydrosonography); microbiological and serological study of vaginal microflora; a physician's report on physical health with a fluorogram attached.
This surgical aid can be performed on any day of the cycle. Especially when it comes to emergency situations. However, specifically to determine the patency of the fallopian tubes, preference is given to the first phase, on the 5th – 9th day. At the beginning of the cycle and until diagnosis, it is recommended to abstain from sexual activity.

This involves hospitalization in a hospital for several days. If laparoscopy is limited only to diagnosis (possibly with dissection of adhesions) and proceeds without complications, then the patient is discharged the next day under the supervision of the treating gynecologist. Possible temporary disruption of the menstrual cycle. It is recommended to plan pregnancy no earlier than one cycle after its recovery.

The procedure is usually performed under general anesthesia. In certain cases, when long-term intervention is not required, local anesthesia (spinal) may be used. If it is necessary to expand the provision of benefits (removal of space-occupying formations, reconstructive operations, etc.), the patient is transferred to endotracheal or intravenous anesthesia. The same applies to cases when, if the need arises during the operation, the laparoscopic approach is replaced by a direct one.
Diagnostic laparoscopy, excluding the time of anesthesia and recovery from anesthesia (if used), takes about half an hour. During the operation, to obtain good visual access, sterile inert gas is injected into the abdominal cavity. As a result, the patient, after cessation of anesthesia, may experience moderate pain in the chest and arms (due to temporary displacement of the diaphragm). Subcutaneous crepitus (crunching when pressed) can be detected for several days due to residual gas, which is gradually absorbed and excreted from the body.

Absolute contraindications for laparoscopy for the purpose of diagnosing the patency of the uterine tubes in case of infertility are diseases and conditions in which pregnancy itself is contraindicated.

The relative prohibitions for this study boil down to the general reasons for postponing elective surgery:
the second phase of the menstrual cycle, the onset of menstruation or its delay;
the presence of acute, as well as respiratory infections suffered less than four weeks ago;
contraindications from a therapist (exacerbation of chronic processes in internal organs);
contraindications from a gynecologist (acute and exacerbation of chronic inflammatory diseases of the genital organs, including internal ones);
severe dysbacteriosis of the vaginal microflora;
venereal disease;
overweight patient.

WHO SAID THAT IT IS HARD TO CURE INFERTILITY?

• Have you been wanting to conceive a child for a long time?
• Many methods have been tried, but nothing helps...
• Diagnosed with thin endometrium...
• In addition, for some reason the recommended medications are not effective in your case...
• And now you are ready to take advantage of any opportunity that will give you the long-awaited baby!

Testing the patency of the fallopian tubes can be done in various ways.

There are three modern diagnostic methods:

• X-ray hysterosalpingography (HSG);
• ultrasound hysterosalpingoscopy (USGSS or echoHSG);
• diagnostic laparoscopy.

X-ray hysterosalpingography (HSG)

HSG is the most commonly usedas part of a tubal patency test and is an x-ray of the fallopian tubes. In order to take this picture, a woman lies down on a special table in the X-ray room and a special tube is inserted into the cervical canal through which a contrast agent is injected into the uterus. This substance fills the uterine cavity and must enter the tubes, and from them flow into the abdominal cavity.

HSG is performed before ovulation to avoid irradiation of the fertilized egg. Hysterosalpingography does not require anesthesia and usually causes only minor spasms. Taking a small dose of pain medication before the test can help relieve discomfort.

This is a rather unpleasant procedure, but in most cases it allows you to most accurately and without surgery check the patency of the fallopian tubes.

In this case, not only the permeability is assessed, but you can see how the pipe has been changed - it can be expanded, highly tortuous, have adhesions, constrictions, etc. The better the picture of the pipes, the more information it can bring.

Sometimes HSG of the fallopian tubes also has a therapeutic effect- there are cases of pregnancy occurring after HSG. This is due to the fact that during the procedure, a contrast agent is injected into the uterus under slight pressure, and if there were thin internal adhesions in the fallopian tubes, they break and the tubes become passable.

Ultrasound hysterosalpingoscopy

The procedure for checking the patency of pipes using diagnostic laparoscopy

Procedure for checking tubal patency using diagnostic laparoscopy allows not only to assess the permeability, but also the condition of the outer surface of the pipes.

This operation complements the information obtained from HSG. Laparoscopy is usually performed under general anesthesia. During this procedure, a narrow, telescope-like, lighted instrument called a laparoscope is inserted through a small hole in or just below the belly button. Using a laparoscope, the doctor examines the abdominal cavity and examines the ovaries, fallopian tubes, uterus and peritoneal surface. In this case, a colored substance is usually injected through the cervical canal and the doctor observes whether it exits through the tubes into the abdominal cavity, determining their patency. Additionally, one or more incisions may be made above the pubis to introduce other instruments for better examination of the pelvic organs and correction of detected pathologies. As a rule, during laparoscopy, detected adhesions in the fallopian tubes in and around them are removed.

In case of severe tubal obstruction, especially in the presence of hydrosalpinxes, the best option for achieving pregnancy is removal of the tubes during laparoscopy followed by an IVF cycle. IVF with one tube is carried out for a fee in any clinic, but receiving a quota for a free procedure is decided only by a commission, taking into account your medical history.

Hydrosalpinx - filled with fluid due to inflammatory processes and a blocked fallopian tube - reduces the effectiveness of IVF, since the fluid in the tube has an embryotoxic effect (kills the embryo).

Laparoscopy allows you to make an accurate diagnosis, allowing the doctor to provide the most optimal treatment after surgery.