X-ray of the fallopian tubes for patency

The fallopian tubes play an important role in the female reproductive system, connecting the uterus to the ovaries. It is in them that the egg meets the sperm, is fertilized, and moves into the uterine cavity to attach to the wall and begin to grow. This is how the mystery of the origin of life occurs. It happens that a woman cannot get pregnant. To find out the reason, it is necessary to conduct an examination, including an X-ray of the fallopian tubes.

Indications for the procedure

The uterine or fallopian (named after the physician Gabriel Fallopius, who first described their structure) tubes provide nutrition to the embryo in the first days of its existence, and also, thanks to the cilia of the epithelium lining the walls and their flickering movements, move it into the uterine cavity. Its length is on average 11-12 cm. The fallopian tube is divided into 4 main segments:

1. infundibulum, the terminal end of which is the opening of the fallopian tube;
2. ampullary region;
3. isthmic part; and
4. intramural or interstitial part, which is located in the wall of the uterus. [ 1 ]

If the desired pregnancy does not occur for a long time, there is a suspicion of obstruction of the fallopian tubes. The prevalence of obstruction of the fallopian tubes is 19.1% in the primary infertility group and 28.7% in the secondary infertility group. [ 2 ] A diagnostic procedure called hysterosalpingography (HSG) helps to identify it.

A hysterosalpingogram (HSG) is an imaging test used to evaluate the patency of the fallopian tubes in women with primary and secondary infertility. Tubal abnormalities can be a cause of primary and secondary infertility. Based on several research studies, women with secondary infertility were more likely to have tubal obstruction on HSG than women with primary infertility. [ 3 ], [ 4 ]

Among the risk factors for infertility, previous pelvic surgery was significantly higher in a controlled study by Romero Ramas et al. The prevalence of previous chlamydial infection was very high in women with secondary infertility.[ 5 ],[ 6 ]

In fact, hysterosalpingography is an X-ray with the use of a contrast agent. It allows to detect adhesions, fibroids, other neoplasms pressing from the outside and squeezing the tube, or internal blockages due to tubal infections, congenital underdevelopment and other reasons. [ 7 ], [ 8 ]

Indications for X-ray examination of the fallopian tubes also include:

• stimulation of ovulation, when medications are used to increase the secretion of hormones necessary for the release of an egg from the ovary;
• in vitro fertilization (IVF) procedure. [ 9 ]

Preparation

X-ray examination of female reproductive organs is performed in the first 2 weeks after the end of menstruation. A week before the procedure, it is necessary to stop using vaginal ointments, suppositories, and intimate hygiene products. In the last 2 days, refrain from sexual intercourse.

Technique salpingographs

Immediately before the image, the doctor examines the patient and inserts a cannula into the cervix - a small-diameter tube through which a contrast agent is poured into the uterus from a syringe (iodine-containing drugs are used for this: Ultravist, Triombrast, Verografin), which is necessary to delay the X-rays. The places where the liquid has penetrated are colored bright white on the image, dark spots indicate obstruction.

Usually women complain of minor pain in the lower abdomen and discomfort. To avoid this, local anesthesia is used, the anesthetic is injected directly into the uterine cavity.

Next, several pictures are taken, after which the tube is removed. [ 10 ]

Contraindications to the procedure

Hysterosalpingography is not performed during pregnancy, in case of complete obstruction of the fallopian tube, in case of internal infections, for the detection of which a bacteriological smear from the vagina is examined before the procedure. It is also contraindicated for women with an allergic reaction to the contrast agent. [ 11 ], [ 12 ]

Complications after the procedure

Half an hour after the procedure, the patient returns to her normal state. The contrast fluid is absorbed into the blood and is naturally eliminated from the body, without any negative impact or consequences on the patient's well-being. Occasionally, bloody or watery discharge appears, which passes after 1-2 days, mild pain may last for several hours. A slight delay in menstruation is possible.

Fluoroscopy of the fallopian tubes is associated with minimal complications, but they can still occur due to a violation of sterility of the instruments or failure to observe hygiene rules in the following days. Nausea, pain, heavy bleeding, fever are symptoms that give reason to immediately consult a doctor. Other complications: venous intravasation [ 13 ], uterine perforation, infections, allergic reactions and urticaria [ 14 ], fainting, hemorrhage and shock, pulmonary embolism or retinal embolism [ 15 ], a case of hyperthyroidism has been described [ 16 ].

Care after the procedure

There is no need for special care after the examination, however, you should still follow some rules:

• avoid sexual intercourse for several days;
• do not take a bath, but only a shower;
• do not visit saunas and baths;
• Do not use tampons, but only pads.

Reviews

Which is better, ultrasound (echohysterosalpingography) [ 17 ] or x-ray of the fallopian tubes? According to the study, the sensitivity of hysterosalpingography and sonohysterography is 58.2% and 81.8%, respectively. The specificity of hysterosalpingography and sonohysterography is 25.6% and 93.8%. Hysterosalpingography has an overall accuracy of 50.3%, while sonohysterography has a significantly higher accuracy of 75.5%. [ 18 ]

Some note that after the contrast agent enters the tubes, the likelihood of becoming pregnant increases, since they are washed, cleared of mucus, and small adhesions are eliminated. [ 19 ], [ 20 ]

The desire of women to become mothers is a natural need, laid down by nature itself. Often they are capable of any trials, if only to give birth to a child. X-ray of the fallopian tubes, according to reviews, is not the worst of them. Although each has its own pain threshold, but with the help of painkillers the procedure is not perceived as difficult and lasts no more than a quarter of an hour.