OG28.2 | Tubal Patency Assessment — Summary & Reflection

KEY TAKEAWAYS

Tubal patency assessment is a core component of the infertility workup, targeting the 25–35% of female infertility attributable to tubal disease. Three main methods are used: HSG (radiological, outpatient, no anaesthesia, ~85–90% sensitivity for occlusion, false-positive proximal block rate ~15% due to spasm), SSG/HyCoSy (ultrasound, no radiation, combined with pelvic USS), and diagnostic laparoscopy with chromopertubation (gold standard, also detects adhesions, endometriosis, ovarian pathology). Women with positive chlamydia antibody titres or risk factors for pelvic adhesions should be offered laparoscopy directly. Findings may be normal, proximal block (cornual/isthmic), distal block or hydrosalpinx, or peritubal adhesions. Hydrosalpinx reduces IVF implantation by ~50% and must be treated (salpingectomy or clipping) before IVF. Surgical restoration options include tubal cannulation (proximal block, ~75–85% patency), salpingostomy (distal block, lower pregnancy rates, ectopic risk), fimbrioplasty (fimbrial phimosis), and microsurgical anastomosis (sterilisation reversal in selected women).

REFLECT

Return to the opening scenario: the HSG showed a possible left cornual block. You now know this may be spasm — 15% false-positive. Before accepting the diagnosis and referring for IVF, you arrange a laparoscopy with dye test. At laparoscopy, the right tube fills and spills freely; the left tube shows dye entering under pressure, passing through the isthmus, and spilling — confirming the 'block' was spasm on HSG. Both tubes are patent. The clinical path changes completely. Reflect: what would have happened to this couple if you had accepted the HSG report at face value and proceeded directly to IVF, bypassing laparoscopy? What does this teach you about the difference between a test result and a clinical diagnosis? (Kolb: Reflect on the importance of understanding test characteristics — sensitivity, specificity, false-positive rates — before acting on results in clinical practice.)