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How to Diagnose Blocked Fallopian Tubes?
1. Physical examination
The signs of infection should be checked, whether there is cervicitis should be checked, the signs of PID should be checked carefully, including the pain of cervical lifting and tenderness in appendix; increased vaginal discharge should not be ignored, and the cultivation of cervical secretion is a good choice.
For patients with the signs of uterosacral tenderness or nodule endometriosis should be checked by rectovaginal examination; If the patient has ever suffered from this disease, the examination of Chlamydia antibody (CAT) should be carried out. Many studies support the relationship between cat and salpingal diseases. The sensitivity and specificity of retrospective analysis are 92% and 70%, respectively.
2. Auxiliary inspection
If the risk of fallopian tube disease is low or there is no other cause of infertility, HSG is preferred. If patient has a high risk or the possibility of the disease, laparoscopic evaluation can be considered. The gold standard for fallopian tube evaluation was laparoscopy and Hydrotubation.
2.1 Hydrotubation
It is to use methylene blue or normal saline to inject into the uterine cavity from the cervix, and then flow into the fallopian tube from the uterine cavity, and judge whether the fallopian tube is unobstructed according to the size of resistance and the condition of liquid backflow during the injection.
Due to the advantages of simple equipment, simple operation and low price, this method was widely used before the 1980s. However, in clinical practice, it is found that this method has a high misdiagnosis rate, so it is not an ideal examination.
2.2 Hysterosalpingography (HSG)
It has been used since the 1920s, and it is a rapid, economic, and less dangerous examination. It injects high specific substances (such as iodine, meglumine diatrizoate, etc.) with a high atomic number into the uterine cavity through the cervix tube and forms obvious artificial contrast with the surrounding tissues under X-ray.


The sensitivity of HSG to tubal occlusion and adhesions is 65%, but pain induced tubal spasm can cause false positive, while pain, infection, and contrast agent invasion into the vascular system are rare complications.
2.3 Salpingoscopy
It is a method of imaging the structure of the lumen of the fallopian tube. It needs to be applied to a hard salpingoscope, which can evaluate the whole length of the fallopian tube and the mucosa and patency of the whole fallopian tube.
During the examination, it is feasible to recanalize the fallopian tube. Therefore, it has a potential therapeutic effect on the obstruction of the proximal fallopian tube. However, the salpingoscope requires high technology and equipment, so it is not widely used at present.
2.4 Laparoscopy
It is to inject methylene blue into the uterine cavity through the uterine catheter and observe the overflow of methylene blue into the pelvic cavity through the umbrella end of the fallopian tube through the laparoscope.
Laparoscopy is a gold standard for the diagnosis of oviduct obstruction, but it needs general anesthesia and surgical treatment. It is not commonly used at present. It is only used in patients with oviduct fluid or abnormal oviduct indicated by angiography.
2.5 Transvaginal hydrolaparoscopy
It is a new technique developed in recent years. It is to use small endoscopy to explore the whole pelvic cavity from the posterior dome path. During the operation, the patient is required to take the position of cystolithotomy.
The advantage of this technique is that it may be used in outpatient service and more minimally invasive; the disadvantage is that the condition of the whole abdominal cavity and the pelvic cavity cannot be evaluated, in addition, there is the possibility of intestinal damage, the incidence is about 0.65%.
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