Dr Anuradha Tuli - MD Radiology

3D/4D Scan of a 35 week old Fetus

Transva**nal hysterosonosalpingography :
What is the need to do a fallopian tube patency test ?
The fallopian tubes play a very important role in reproduction . They play an important role in transportation of the s***ms towards the o***y and the ova from the o***y towards the uterine cavity .The fertilization happens in the fallopian tube The embryo thus formed initiates its early cleavage and is propelled towards the uterine cavity at the blastocyst stage , where it implants in the uterine endometrium.
If the fallopian tube is blocked , the s***m and the ova don’t meet and no fertilization happens .
Pregnancy can happen naturally even if a single tube is patent .
At times there is visible hydrosalpinx on a routine transva**nal or transabdominal scan .In these cases before opting for an ART it is good to know if the hydrosalpinx is communicating or not.
In case of a communicating hydrosalpinx the results of IUI(if one tube is patent) or IVF may not be favourable as the fluid in the hydrosalpinx can seep into the uterine cavity and is toxic to the embryo .In such cases the hydrosalpinx is best clipped before attempting an ART.
How is the procedure done ?
• What is the best time to do this procedure ?
This procedure is best performed postperiod . If we do it later in the cycle there are chances of damaging the endometrium in that particular cycle ; also with a thick endometrium we may not be able to evaluate the distensibility of the uterine cavity very well.
The procedure is done in the ultrasound clinic on OPD basis and does not need any special preparation or anaesthesia .




• Is the procedure painful ?
The procedure per say is not painful as only normal saline and air are used as contrast in this study ;which in turn are not irritable to the peritoneum .
Pain may be felt if we encounter a blockage in the fallopian tubes.
A prophylactic premedication with a pain killer ½ before the procedure is advised , to make the patient comfortable.
• Technique :
A very thin HSG catheter is placed in the uterine cavity and a small balloon at its distal end is inflated to secure it in the cavity .
A thin transva**nal probe is then placed in the va**na .
Normal saline and air are instilled into the uterine cavity through the cannula and its flow through the fallopian tubes and spill into the peritoneal cavity from the fimbrial end is observed by the TVS .
The fluid spilled into the POD acts as a window to look for any pelvic or tubal adhesions .
The uterine cavity is then examined for its distensability , structural abnormalities or space occupying lesions like polyps , subserous fibroids etc. Adhesions and uterine wall irregularities can also be identified .
• How long does the procedure take ?
It generally takes around 15 -30 minutes for the procedure to complete.
• Will I be able to go to office after the procedure ?
It is not a very painful procedure , less so if your tubes are patent . Women have walked out of the clinic just like after having a transva**nal scan .
But of course , the post procedure condition varies with different individuals and it is best to take it easy that day .
• Is it ok for me to come alone for the procedure?
A friend or a relative can come along with you to give you moral support .
• How long would it take for me to know the result of the procedure?
TVHSS like and other sonography is a real time procedure and we get to know the result as we are doing it .


• Can we try for a pregnancy in the same cycle as the procedure ?
It is safe to try , as there is no use of ionizing radiation, plus as we do it immediately postperiod ,we are not disturbing the uterine endoemtrium (bed that nature is building up for the embryo to implant ).
• More questions ??????
Please feel free to ask , I shall be only too happy to answer them !

Transva**nal Hysterosonosalpingography ( TVHSS /Sono HSG)

An important step in investigating a subfertile woman :

• High diagnostic accuracy for tubal patency and detection of intrauterine pathologies i.e fibromas, polyps , synechiae etc.an overall sensitivity and specificity of 95%.

• No radiation involved.

• No risk of allergy associated with iodinate contrast.

• Unlike HSG allows simultaneous evaluation of uterine myometrium , ovaries and the surrounding pelvis ,finding which may be of great significance in subfertility such as endometriomas, polycystic ovaries, ovarian and parovarian cysts, adhesions in the pelvis , Mullerian anomalies ,hydrosalpinx if present , weither it is communicating or not communicating.This may avoid prolonged , invasive and unnecessary intervention .

• It is a short , well-tolerated procedure compared to the conventional HSG.

• There is an advantage of infusing more saline in an attempt to remove a temporary block in the fallopian tube , i.e a mucus plug.

• Patient can try conceiving in the same cycle as the procedure , as no radiation is involved.

My take: Should replace conventional HSG.

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