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A number of tests are available to judge whether or not the tubes are open.
The simplest and oldest test for tubal patency is the RT or Rubin's test named after its inventor. In this test, gas is passed under pressure into the tubes through the cervix and uterus - either with a special machine (Rubin's apparatus) or with an ordinary syringe. The doctor then listens with a stethoscope placed on the abdomen to determine if he can hear the sound of gas passing through the fallopian tube. Even though this test is now obsolete, because it is so unreliable, a number of doctors still do it.
Blood tests for chlamydial antibodies: Since an infection with chlamydia is the commonest reason for tubal disease in the West, some doctors test the blood for antibodies against chlamydia. Women who have antibodies against chlamydia have been exposed to this infection in the past, and are considered to be at higher risk for tubal damage.
Hysterosalpingogram (Uterotubogram) or HSG is a specialized X-ray of the uterus and tubes. An HSG is done after the menstrual flow just stopped usually on Day 6 or 7 of the period, at which time the lining of the uterus is thin. It is done in an X-ray. The patient is advised to take an antibiotic and a painkiller before the procedure by many doctors. After being positioned on the X-ray table, the doctor places a special instrument into the cervix, called a cervical cannula, which is made of metal. Many doctors now prefer to use a balloon catheter, as this makes the procedure less painful. A radio-opaque dye (a liquid which is opaque to X-rays) is then injected into the uterine cavity. This is done slowly under pressure, and pictures are taken - preferably under an image intensifier. The passage of the dye into the uterine cavity and then into the tubes and from there into the abdomen can be seen, and X-ray pictures taken. These provide a permanent record.
At least 3 films need to be taken to provide a reliable record - including an early film for the uterine cavity and a delayed film to make sure the spill of the dye in the abdomen is free.
A normal HSG defines the inside of the reproductive tract. This appears as a triangle (usually white on a black background), which represents the uterine cavity; and from here the dye enters the tubes that appear as two long thin lines, one on either side of the cavity. When the dye spills into the abdomen from a patent (open) tube, this appears as a smudge in the X-rays.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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