Evidence-based management of tubal disease and infertility

There is a multitude of tests available for the investigation of tubal disease. This review gives an overview of the use of hysterosalpingography (HSG), the laparoscopy and dye test, hystero-contrast-sonography (HyCoSy), falloposcopy and fertiloscopy in the evaluation of the fallopian tubes. The current sensible approach would be to offer HSG for women with a low risk of tubal disease as HSG is a valid and accurate test used to diagnose tubal patency in subfertile couples. In women with suspected underlying gynaecological pathology such as endometriosis or pelvic inflammatory disease, and/or in the presence of tubal blockage on HSG, one should proceed with the laparoscopy and dye test to confirm or refute the diagnosis. The National Institute for Clinical Excellence also recommends the use of HyCoSy where the service is available as this is as effective as HSG in diagnosing tubal disease in low-risk women.