There are multiple tests to evaluate tubal conditions, though each diagnostic test has its own limitations.
Hysterosalpingogram (HSG) is a contrast study using x-rays that provides visualisation of the uterine cavity and fallopian tubes with few complications. A water soluble contrast medium is used to inject through the uterine cavity using a cannula through the cervical canal, whilst imaging the pelvis to get a dynamic view of the passage of dye.
HSG has a sensitivity and specificity of 53 and 87%, respectively, for any tubal pathology and 46 and 95%, respectively, for bilateral tubal pathology compared with laparoscopy (Broeze et al 2010 and Lim et al 2011).
The procedure should be performed optimally within 10 days of a menstrual period, preferable after the period of active bleeding, when the risk of a pregnancy is reliably excluded. A chlamydia infection should be excluded prior to the test. Tubal flushing resulting from HSG increases the chance of spontaneous conception only if oil based dye is used. Oil based dye increases the risk of anaphylaxis and lipoid granuloma. Usually water soluble dye is used in testing.
Broeze KA, Opmeer BC, Van Geloven N, Coppus SFPJ, Collins JA, DenHartog JE, et al. Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis. Hum Reprod 2011;17:292–300.
Lim CP, Hasafa Z, Bhattacharya S, Maheshwari A. Should a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup? Hum Reprod 2011;26:967–71.