Tubal Patency Testing: HSG, Sonosalpingogram and Chromopertubation Explained

We generally say at least 3 to 4 months of contraception should be used, and conception should not happen within that window.

There are now government of India guidelines on this. Strictly by those guidelines it is 50 for the woman and 55 for the man, though this used to be more liberal — we used to see people at 60–65 also getting IVF done, before the ethical question of who will care for the children led to the cutoff being tightened.

After adhesiolysis we give a combination of estrogen throughout the cycle and progesterone added in the last 14 days, and it takes about 3 months for regeneration, confirmed with transvaginal sonography for endometrial thickness before and after. Many patients start to show improvement even after about a month and a half, where the scarring and adhesions are not so severe that they have permanently damaged the endometrium.

A lot of times when an HSG is done without sedation, the patient tenses up so much that there is a tubal spasm, which can appear as a bilateral proximal tubal blockage. One good approach is to give the patient an anti-spasmodic before the procedure, or do it with a little sedation, which removes many of these false positives. But if it still appears to be a genuine proximal blockage in both tubes, it's better to go directly for a diagnostic hysterolaparoscopy with chromopertubation, since that lets you directly visualise the tubes — and most patients also find repeating an HSG very painful.

Success rates of IVF in good centres are now around 60%. Cost depends on the kind of IVF procedure required — sometimes an ICSI procedure, sometimes donor eggs are needed — but it would typically start around 3 to 4 lakh rupees, roughly $3,200 to $4,500 per cycle.

In a hysterosalpingography, a water-soluble dye is pushed through the uterus and out through the tubes while X-rays are taken on a fluoroscopic screen, providing documentary evidence of whether the tubes are open.

A sonosalpingogram uses ultrasound instead of X-ray, with saline pushed through the cervix into the uterus, and fluid collecting in the pouch of Douglas confirms tubal patency.

Where a laparoscopy is already being performed, chromopertubation can be done directly, using a methylene dye that is visualised through the laparoscope to confirm whether the tubes are releasing dye normally.

Blocked tubes are one of the most common reasons patients need IVF, which is why tubal patency testing is considered an essential part of a pre-IVF workup.