Fallopian Tube Testing
The fallopian tubes are part of the reproductive organs in a woman and provide the passageway through which the egg is moved from the ovaries to the uterus. They are about four or five inches long (10cm) with outer ends that are shaped like a funnel with fringes and they attach at the other end to the uterus. The fringes are called fimbriae and their function is to catch the mature egg when it is released from the ovary and channel it into the fallopian tube.
The fallopian tube is much more than a pipe. It is muscular and extremely motile, capable of very intricate and coordinated movements. The lining of the tube is filled with tiny hairs called cilia that push the egg along the inside of the tube. At the juncture of the tube and the uterus it acts like a sphincter, contracting and closing, holding the egg back until exactly the right time to release it into the uterus.
Why Fallopian Tube Testing Is Necessary
Tubal disease and abnormalities are responsible for nearly half of the cases of female infertility. Damage to the fallopian tubes can occur as a result of inflammation or infection in the pelvis. Pelvic infection and inflammation is called pelvic inflammatory disease (PID) and is caused by:
· sexually transmitted diseases such as Chlamydia and gonorrhea
· infections following miscarriage, termination of a pregnancy, childbirth, or the insertion of an IUD
· infections following surgery for ovarian cysts or a perforated appendix
Blockages and adhesions (scar tissue) can alter the function of the fallopian tubes ultimately causing infertility. Most women with tubal damage from PID are not aware it has happened until they try to become pregnant.
Fallopian Tube Testing: The Basics
There are a number of ways for a doctor to determine if the fallopian tubes are blocked or open. Diagnostic testing is vitally important to determining the issue and how best to deal with it. The simplest and oldest diagnostic test for blocked fallopian tubes is the Rubin test (RT) in which gas is released into the uterus through the cervix either with a syringe or a special machine called a Rubin apparatus. The doctor listens to the abdomen with a stethoscope to determine if the gas is passing through the fallopian tubes. It is not a reliable test and most doctors do not use it any longer.
Blood tests to check for chlamydial antibodies are another way to determine the possible cause of damage to the fallopian tubes. Chlamydia is the most common reason for tubal disease in the West. If blood antibodies for Chlamydia are found it indicates exposure to the STD at some point, putting the woman at high risk for tubal damage.
Fallopian Tube Testing: Fluoroscopic Guided Procedures
The hysterosalpingogram (HSG) or uterotubogram is the diagnostic test of choice for many gynecologists and infertility experts. It is a highly specialized x-ray called fluoroscopy that uses special contrast material (dye - either water based or oil based) making it possible to see internal organs in motion. During a hysterosalpingogram dye is injected into the uterus and into the fallopian tubes to determine if or where there is a blockage, tear or hole.
Selective salpingography is the use of guided fluoroscopy using an image intensifier and special techniques that are used in coronary angioplasty. Catheters are inserted into each of the fallopian tubes under the guidance of a fluoroscope, allowing better visualization of the tubes and also allowing for treatment of mucus plug blockages.
Sonosalpingography is a simple test that allows a gynecologist to determine whether the tubes are normal by injecting fluid into the tubes by way of the cervix. The test allows the doctor to see on the ultrasound screen if the fluid flows through the tubes and into the pelvic cavity.
Fallopian Tube Testing: Laparoscopy and Tuboscopies
A laparoscopy is considered to be the gold standard of diagnostic tests for fertility and to determine problems with the reproductive organs. It is surgery and requires the woman to have general anesthetic and remain in hospital for several hours. The value of this procedure is that more than tubal integrity can be determined. The doctor is able to see things in a laparoscopy that are not visible on an HSG, like endometriosis and tubal adhesions. Sometimes a doctor will order both an HSG and a laparoscopy to determine causes of infertility.
A tuboscopy can be done at the same time as a laparoscopy. The doctor inserts a fine telescope into the fallopian tube at the fimbrial end and checks the health of the inside of the tube. A more recent diagnostic method has been developed in the US, called a falloposcopy. This procedure involves a fine, flexible fiber optic tube that is guided through the cervix and uterus into each of the fallopian tubes allowing the doctor to see the entire inner lining of the tube - something that has not been available until now.
HSG diagnostic testing along with the other types of testing are necessary to address infertility causes. Learn more about the HSG here.