Hydrosonography (echohydrosalpingography) is a study of the functional state of the fallopian tubes using ultrasound imaging. Through a thin catheter, sterile saline is injected into the uterine cavity, which enters the fallopian tubes. In real time, the diagnostician tracks the movement of the fluid. On the monitor of the ultrasound device, the lumen of the fallopian tubes is visualized throughout their entire length and the presence of obstacles to the passage of the solution. By means of hydrosonography, tubal and peritubar adhesions, hydro- or sactosalpinxes, and other pathologies can be diagnosed. When combining the procedure with echohysteroscopy, the cost of the study increases.
Hydrosonography is necessary if it is not possible to conceive a child within 12 months. At the same time, a married couple lives a regular sexual life without contraception and male infertility is excluded.
In the anamnesis of women with suspected obstruction of the fallopian tubes, there may be indications of:
- transferred inflammatory diseases of the reproductive system (first of all, salpingitis, adnexitis);
- ectopic pregnancy;
- severe purulent-inflammatory processes (complicated appendicitis, peritonitis, etc.);
- surgical interventions on the appendages and uterus.
Hydrosonography is prescribed before the planned intrauterine insemination, induction and stimulation of ovulation, IVF protocols. Ultrasound sonosalpingoscopy is chosen if the patient is allergic to iodine-containing drugs and X-ray examination by hysterosalpingography is contraindicated. The optimal time for the procedure is the first half of the menstrual cycle (8-10 days).
Contraindications to hydrosonography are:
- acute inflammation of the genital organs (colpitis, cervicitis, endometritis, salpingoophoritis);
- low degree of purity of the vagina;
- pregnancy at any time;
- malignant tumors of the female genital organs of various localization.
To exclude contraindications, a gynecological examination is performed before diagnosis. It includes an examination on a chair, ultrasound of the pelvic organs, a smear on flora and a smear on oncocytology. The list of tests and studies can be expanded by a gynecologist.
How to check the patency of the fallopian tubes
The patency of the fallopian tubes is checked on an outpatient basis, in a gynecological office equipped with an ultrasound scanner. The patient lies down on the gynecological chair. After the introduction of vaginal mirrors and treatment of the cervix, the doctor inserts a disposable intrauterine catheter into the uterine cavity. At its inner end there is a special balloon, which, when inflated, fixes the catheter in the uterus. The correct position of the catheter is monitored by ultrasound. A physiological or other inert solution is injected through the outer end of the catheter using a syringe. This “contrasting” ensures the expansion of the uterus and amplification of the echo signal from the walls of the organ.
As the solution is supplied, a series of ultrasound images (sonograms) are performed, recording the sequential filling of the uterine cavity, fallopian tubes, the appearance of free fluid in the pelvic cavity.
- If the fluid freely exits the ampullary part of the fallopian tubes, this indicates the absence of pathology.
- If the contrast does not completely fill the tube and does not go beyond it, an obstruction is diagnosed.
Echohydrotubation allows you to indirectly judge the causes of obstruction of the fallopian tubes. So, with chronic salpingitis, the contours of the pipe are uneven, deformed, the walls have a “pitted” appearance. The expansion of the lumen of the pipe and the thinning of its wall indicates the presence of a hydrosalpinx.
Anesthesia for hydrosonography
Ultrasound examination of the patency of the fallopian tubes does not require anesthesia. Before the procedure, it is recommended to take an antispasmodic tablet (sometimes an intramuscular injection is performed) to avoid cervical canal spasm.
With ultrasound salpingography, the patient may experience discomfort or minor aching-pulling painful sensations. Usually they are stopped independently 20-30 minutes after the end of the study. In the next 2-3 days, spotting bloody discharge from the genital tract may appear. During this period, the patient is advised to refrain from sexual intercourse, taking baths, visiting baths and saunas.
Pregnancy planning with normal echograms and ascertaining sufficient patency of the fallopian tubes is possible in the same cycle when the study was carried out. If functional insufficiency and physical obstruction have been identified, a course of treatment is prescribed.