Diagnostic Techniques for Tubal Patency Assessment

Assessment of tubal patency remains a cornerstone of female fertility evaluation, as tubal obstruction accounts for up to 30–40 per cent of infertility cases worldwide. Historically, hysterosalpingography (HSG) has served as the primary screening tool, offering radiographic visualisation of the uterine cavity and fallopian tubes via iodine-based contrast. Ultrasonographic alternatives have gained favour to minimise radiation exposure, notably hysterosalpingo-contrast sonography (HyCoSy) with water-based agents and its evolution into hysterosalpingo-foam sonography (HyFoSy), which utilises gel or foam to enhance acoustic resolution. Real-time two- and three-dimensional imaging platforms now enable dynamic assessment of contrast flow, tubal wall morphology and distal fimbrial patency. Invasive techniques such as laparoscopy with chromopertubation and transcervical fallopian tube recanalisation provide both diagnostic confirmation and therapeutic intervention in selected cases. Emerging modalities include magnetic resonance-based tubal imaging and molecular markers of peritoneal spill, although these remain largely investigational. Overall, modern practice emphasises a stepwise approach: beginning with office-based, patient-friendly methods and reserving more invasive or specialised procedures for inconclusive or high-risk scenarios. This breadth of techniques facilitates tailored workups that balance diagnostic accuracy, patient comfort and global resource considerations.

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Diagnostic Techniques for Tubal Patency Assessment publication trend

The graph below shows the total number of articles in diagnostic techniques for tubal patency assessment across all publications each year (not limited to Nature Index journals).

Technical terms

Hysterosalpingography (HSG): Radiographic examination of the uterine cavity and fallopian tubes using iodine-based contrast under fluoroscopy to assess tubal patency.

Hysterosalpingo-contrast sonography (HyCoSy): Ultrasonographic evaluation of tubal patency employing water-based contrast while visualising contrast passage in real time.

Hysterosalpingo-foam sonography (HyFoSy): Variation of HyCoSy using foam or gel contrast to enhance acoustic reflectivity and improve patient comfort.

Chromopertubation: Laparoscopic technique in which coloured dye is instilled through the cervix to confirm tubal patency and detect peritoneal spill.

Contrast medium: Substance (water-based or oil-based) introduced into the uterine cavity to visualise tubal architecture and assess patency.

References

1. Impact of oil-based contrast agents in hysterosalpingography on fertility outcomes in endometriosis: a retrospective cohort study. Reproductive Biology and Endocrinology (2024).
2. Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology. European Radiology (2024).
3. Factors Associated with a Post-Procedure Spontaneous Pregnancy after a Hysterosapingo-Foam-Sonography (HyFoSy): Results from a Multicenter Observational Study. Diagnostics (2023).
4. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. BioMed Research International (2019).
5. Hysterosalpingography in the workup of female infertility: indications, technique and diagnostic findings. Insights into Imaging (2012).
6. Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications. BMC Medical Imaging (2013).
7. Combined Real‐Time Three‐Dimensional Hysterosalpingo‐Contrast Sonography with B Mode Hysterosalpingo‐Contrast Sonography in the Evaluation of Fallopian Tube Patency in Patients Undergoing Infertility Investigations. BioMed Research International (2019).
8. Factors Affecting Pregnancy Rate Following Fallopian Tube Recanalization in Women with Proximal Fallopian Tube Obstruction. Journal of Clinical Medicine (2018).