The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques



Key content

  • The pathogenesis of infertility is multi-factorial; investigative and treatment approaches should therefore be individualised.
  • There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function.
  • There is often a clear need for in vitro fertilisation (IVF) in the management of infertility.
  • This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART).

Learning objectives

  • To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans-vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency.
  • To understand the role of Chlamydia trachomatis serology in tubal patency testing.
  • To evaluate the role of tubal patency test in the hierarchy of investigations for infertility.
  • To understand the role of tubal surgery in modern management of infertility.
  • To understand the importance of medical history taking in infertility.

Ethical issues

  • Counselling patients about benefits and risks of tests, surgery and need for assisted conception.
  • Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF?
  • There may be psychosocial issues or anxiety so a multidisciplinary approach is important.