Tubal assessment tests

Tubal assessments are fertility tests that can check whether your fallopian tubes are blocked. They’re sometimes called tubal patency tests. 

If you have a blockage in your fallopian tubes, it prevents sperm from meeting and fertilising an egg. Blocked tubes can affect up to a third of couples who are experiencing fertility problems.^1,2

Blockages can be caused by:²

• Infection, including sexually transmitted infections (STIs), such as chlamydia and gonorrhoea
• Injury to your fallopian tubes from a previous surgery
• Endometriosis
• Polyps (growths) in the tubes
• Being born with abnormal tubes 

A blockage can also be caused by something called a hydrosalpinx, which is when fluid collects in a blocked tube. That fluid can flow back into your womb, making it difficult for an embryo to implant.³ A hydrosalpinx can also cause IVF treatment to fail repeatedly.³

Blockages in your fallopian tubes are a very common cause of infertility. That’s why we recommend a tubal assessment as one of the very first fertility tests we carry out. It helps your consultant determine the cause of your fertility problems, so they can work with you and decide the best way forward.

Some studies suggest that tubal assessments can also lead to a short-term increase in your chances of a natural pregnancy. When your fallopian tubes are assessed, they’re flushed, which can help to open them up. However, these studies aren’t definitive and need further research.⁴

Your fertility consultant might recommend one of the following tests:^1,3,5

• A hysterosalpingogram (HSG). This is an X-ray examination that uses a dye to show up your womb and fallopian tubes. It’s a simple test, so if your consultant thinks your fallopian tubes are blocked, they might try this test first. But it only provides limited information.
• A hysterosalpingo-contrast-sonography (HyCoSy), which uses ultrasound to check your womb and fallopian tubes. It’s a good alternative to an HSG.
• A laparoscopy and dye test. This is keyhole surgery that uses a laparoscope (a thin tube with a camera on the end) to look at your fallopian tubes. It’s the best test, but it’s more invasive, so it’s not suitable for everyone. If your consultant is assessing other problems too, like adhesions or endometriosis, they’re more likely to recommend it.

Here's what these tests involve in more detail:

The Hysterosalpingogram (HSG) test

It’s a simple X-ray examination that helps your consultant look at your fallopian tubes more closely, and it happens like this:⁶

1. You’ll lie on a bed or examination couch, with your legs bent (like a smear test). A speculum is inserted into your vagina to hold it open, so your consultant can see your cervix.
2. A dye or contrast agent is injected through a catheter (thin tube) into your womb and up into your fallopian tubes
3. X-ray images are taken as the dye starts to fill your womb and fallopian tubes, and your body absorbs the dye afterwards

The HSG test doesn’t require any anaesthetic or surgery, and you’ll be able to go straight home when it’s done. Afterwards, you’ll probably have some discharge or slight bleeding, and perhaps mild cramps too, but severe problems are rare.⁶

The hysterosalpingo-contrast-sonography (HyCoSy) test

This is a simple test that uses ultrasound to look at your fallopian tubes in more detail. It happens like this:^1,2

1. You’ll need empty your bladder first, then lie down on a bed or examination couch, with your legs bent (similar to a smear test). A speculum is inserted into your vagina to hold it open, so your consultant can see your cervix.
2. Your consultant then gently inserts a transvaginal ultrasound probe in through your vagina
3. A small amount of fluid is passed through a catheter, into your womb and up to your fallopian tubes, which shows up their outline on the ultrasound. Your body harmlessly absorbs the fluid after the test. 

You might have some discomfort during the test (a bit like mild period cramps), and it can help to take some simple painkillers about an hour beforehand. The test itself only takes around 15-20 minutes and you’ll often be told the results there and then. You can go straight home afterwards.

You’ll be given some antibiotics to reduce the risk of any infection associated with the test, and you might have some slight bleeding for a day or two afterwards.

The laparoscopy & dye test

This is a more invasive test that involves keyhole surgery, and you’ll need to be under general anaesthetic when it happens². It involves the following steps:^1,2,7,8

1. Carbon dioxide gas is pumped into your abdomen. This makes it expand so your surgeon can see your pelvic organs more clearly.
2. They’ll make a small incision in your belly button and insert the laparoscope (tiny camera), to see into your pelvis.
3. Dye is injected, through your cervix and into your womb, then your surgeon examines your fallopian tubes to see if they fill with dye. If your tubes are open, dye passes through into your pelvis. During the procedure, your surgeon will also look for signs of other conditions that can affect your fertility, such as endometriosis, fibroids or pelvic infection.
4. During the procedure, it might be possible to treat conditions like endometriosis or adhesions, or to open a blocked tube. If it is, your surgeon might make a second small incision along your bikini line to insert the instruments they need to use.
5. Your laparoscopy and dye test might be performed at the same time as a hysteroscopy, to help give your consultant as much information as possible². This is a test that uses an instrument called a hysteroscope inserted into your vagina to look inside your womb.

Your consultant will help you prepare for your laparoscopy and dye test. You’ll need to stop eating and drinking the night before your surgery, and your consultant will also talk to you beforehand about any potential issues. Major complications are rare.

You can usually go home the same day, but you may have to stay overnight, and you might experience some soreness or bleeding afterwards. Your team will be there to advise and support you.