Tubal Patency Testing Methods

Primary Testing Options

The American College of Radiology recommends hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) as first-line tests for evaluating tubal patency due to their less invasive nature and good diagnostic accuracy 1
HSG allows detection of tubal patency, tubal size, tubal irregularity, and peritubal disease, with 65% sensitivity and 85% specificity for diagnosing tubal patency when compared with laparoscopy 1
HSG can also detect intrauterine synechiae (adhesions), which present as irregular endometrial filling defects, and tubal flushing during HSG has been shown to increase pregnancy rates up to 38% compared to 21% in women who did not undergo HSG 1
HyCoSy involves instilling echogenic contrast into the uterus with real-time ultrasound and has similar accuracy to HSG when compared with laparoscopy for determining tubal patency, with 91% accuracy in diagnosing tubal patency in women with endometriosis 1
HyCoSy can be performed as part of a comprehensive infertility examination in one session when combined with transvaginal ultrasound (TVUS) with 3D imaging 1

Transvaginal ultrasound (TVUS) alone is not effective in documenting tubal patency, though it can detect hydrosalpinx with 86% sensitivity 1
Regular sonohysterography without contrast is not supported for tubal occlusion assessment, though increased fluid in the posterior cul-de-sac may indicate patency 1
Antibiotic prophylaxis should be considered at the discretion of the referring physician, particularly with history of pelvic inflammatory disease or if hydrosalpinx is noted 1
MRI is useful for detecting hydrosalpinges (75.6% accuracy) but is not typically used as a first-line test for tubal patency 1
HSG has limited value in categorizing Müllerian duct anomalies (only 16.7% accuracy) compared to MRI (100% accuracy) 1