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

Abstract

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.