Which test is commonly used to assess tubal patency, and what does a normal result indicate?

• A. Transvaginal ultrasound; a normal result indicates patent tubes.
• B. Sonohysterography; a normal result indicates patent tubes.
• C. Hysterosalpingography (HSG); a normal result indicates patent tubes and no major tubal pathology.
• D. Laparoscopy; a normal result indicates patent tubes.

Answer: (C)

Hysterosalpingography is the standard noninvasive test used to assess tubal patency. In this procedure, a radiopaque dye is introduced through the cervix into the uterine cavity and then into the fallopian tubes. A normal result shows the dye filling the uterus and both tubes, followed by spillage of dye into the peritoneal cavity. This free spill indicates that the tubes are open (patent) and that there is no major tubal blockage or distortion detectable by this test.

This result also suggests no major tubal pathology such as proximal occlusion or hydrosalpinx. Keep in mind, though, that HSG can miss subtle mucosal damage or certain pelvic adhesions, and it doesn’t rule out all infertility factors. In cases with high suspicion of tubal disease or when a more definitive assessment is needed, laparoscopy with chromopertubation may be employed.