If the partner’s spermiogram is normal or only slightly abnormal, it may be advisable to check for blockages in the fallopian tubes.
There are two principal tests designed to check for blockages in the fallopian tubes:
- the HyCoSy (Hystero-Salpingo-ContrastSonography) (e.g. with Echovist®)
- Laparoscopy with dye (injection of dye through the fallopian tubes during a laparoscopy)
HyCoSy (hysterosalpingo-contrast sonography), Echovist® test
The advantage of the contrast examination lies in the fact that this test can be done during an office visit and without anaesthetic. When performed by an experienced professional, this method is well tolerated and feels uncomfortable at worst. No anaesthetic is needed for this procedure.
The examination is performed on the gynaecological examining chair a few days before ovulation is expected. After vaginal disinfection, a plastic catheter (tube) is inserted into the uterine cavity. A sugar solution is injected through this catheter. The advancement of this solution along the fallopian tube is often very clearly visible in the ultrasound image.
However, occasionally, it can only be presumed that the fallopian tubes are patent. This is the case when the contrast medium flows out into the abdominal cavity even though the fallopian tubes are not visible.
Additional information can be gained by injecting a saline solution prior to the contrast examination in order to detect abnormalities in the uterine cavity (this procedure is known as hydrosonography). Depending on the experience of the person performing the examination and the ultrasound equipment used, this examination can be highly informative.
“In positive cases, the predictive value of such an examination is over 90 %.” (Keck, Neulen and Breckwoldt: Endokrinologie, Reproduktionsmedizin, Andrologie, 1999 Thieme Verlag).
Laparoscopy provides the most comprehensive information on the status of the internal genitalia (internal sex organs). It permits the use of a contrast medium or dye to examine the fallopian tubes (chromopertubation). Secondly, the procedure provides important information regarding the presence of adhesions, inflammatory changes and endometriosis. In an appropriately equipped centre, any adhesions found can be incised and lesions from endometriosis can be removed. As it is a surgical intervention, laparoscopy should only be performed if the results of the examination will be of significance for the further treatment provided to the couple. If, for example, the spermiogram is abnormal enough to require IVF or ICSI in any case, such an intervention is not plausible and therefore contraindicated.
HSG was widespread as a test method before the development of the Echovist®, which made it possible to visualise the fallopian tubes with ultrasound. The procedure is similar to that of the HyCoSy described above. However, it involves the use of x-rays and x-ray contrast medium. For this reason, HyCoSy with Echovist® has rapidly gained popularity, at least in Europe, since it is possible to avoid x-ray exposure, which is potentially harmful to the ovaries. HyCoSy is nowadays still commonly used in the USA, Middle East, Latin America and Africa.