Evaluation of Tubal Patency (HyCoSy, Doppler)

Abstract

Tubal pathology is a significant contributor to subfertility, and therefore, assessment of the fallopian tubes forms an important and integral part of the fertility workup. An ideal method of tubal assessment should be sensitive and specific, be relatively safe, widely available and inexpensive. Laparoscopy and dye testing is the gold standard method of tubal assessment. However, this is associated with operative risks as well as financial implications. Hysterosalpingography was classically the first-line investigation; however, this too has its associated risks such as exposure to radiation. More recently, HyCoSy, which involves ultrasonographic tubal assessment using contrast media, has become more widespread. This involves a transvaginal scan, injection of contrast media through the cervix and observation of bilateral spill from the fimbrial ends of the fallopian tubes. Some investigators have used air as an inexpensive alternative to contrast media. The use of colour flow Doppler, which demonstrates flow of medium through the fallopian tube (as oppose to simply detecting spill from the fimbrial ends), has also been described. In this chapter, we aim to outline the assessment of tubal patency using ultrasound examination.