gynecology and obstetrics
Tubal Dysfunction and Pelvic Abnormalities
Diagnosis of Tubal Dysfunction and Pelvic Abnormalities
Tests for cervical gonorrhea or chlamydia, if cervicitis or PID are suspected Hysterosalpingography or sonohysterography Hysteroscopy to further evaluate abnormalities Rarely laparoscopy If pelvic infection is suspected, tests should be done for gonorrhea or chlamydia. Also, screening for sexually transmitted infections is typically done as part of routine preconception care. All infertility evaluations include assessment of the fallopian tubes. Most often,hysterosalpingography(fluoroscopic imaging of the uterus and fallopian tubes after injection of a radiopaque agent into the uterus) is done 2 to 5 days after cessation of menstrual flow. Hysterosalpingography rarely indicates tubal patency falsely but indicates tubal obstruction falsely in about 15% of cases. This test can also detect some pelvic and intrauterine abnormalities. For unexplained reasons, fertility in women appears to be enhanced after hysterosalpingography if the test result is normal. Thus, if hysterosalpingography results are normal, additional diagnostic tests of tubal function can be delayed for several cycles in young women. Sonohysterography(injection of isotonic fluid through the cervix into the uterus during ultrasonography) is done to detect or further evaluate intrauterine and tubal abnormalities; it has replaced hysterosalpingography in many specialized infertility centers. Hysteroscopymay be done to further evaluate intrauterine lesions. Rarely,laparoscopyis done to further evaluate tubal lesions. Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy. 