- Sono Salpingo Graphy (SSG)
- Laparoscopy (Endoscopy)
- Salpingoscopy (Endoscopy)
It is a radiological procedure in which x-ray films are taken to demonstrate the endometrial cavity & spill of dye from the fimbrial end of both tubes.
HSG should be done postmenstrually because the endometrial thickness during this period of cycle is less & hence sensitivity of the procedure increases. HSG has the advantage of being a cost effective, OPD procedure which is done without anaesthesia. It also pin points the site of tubal block & outlines the endometrial cavity.
SSG uses TVS to confirm the tubal patency by visualizing the spill of fluid from the fimbrial end of fallopian tubes.
It is an endoscopic procedure performed under anaesthesia to check for the patency of and character of fallopian tubes through a dye passed intracervically.
If tubes are unhealthy or blocked, they can opened through minor procedures like cornual cannulation or salpingoovariolysis, neosalpingostomy.
In case of thick walled blocked dilated tubes, it is better to clip/remove the the tubes at time of laparoscopy and opt for IVF
Salpingoscopy is defined as visualization of mucosa of the ampullary portion of the tube by a telescope. In this procedure 1.8 mm telescope is introduced from the fimbrial end of the tube to evaluate the lumen.
Salpingoscopy is an advanced surgical procedure which requires specialized training & skill. It involves the handling of fallopian tubes which is a unique & delicate structure – especially the fimbriae. Here, we would like to state that any surgeon performing Salpingoscopy should have adequate training & experience. Otherwise iatrogenic complications may arise.
We grade the tubes according to brojen’s classification.
These changes have been classified as follows (12)
- Grade 1 Normal fold pattern
- Grade 2 Separation and flattening of major folds
- Grade 3 Peripheral filmy and focal adhesions
- Grade 4 Fibrous adhesions across more than 50% of the lumen
- Grade 5 Fibrosis of the tubal walls with loss of the fold system
Salpingoscopy helps us to decide the further treatment modality. Findings above grade 2 may be better treated by IVF. Salpingoscopy has a role to prevent ectopic pregnancy which still continues to be one of the commonest causes of maternal mortality in first trimester.
Salpingoscopy is a newer technique but we believe that it has good prognostic values & it will soon become an integral part of infertility evaluation in all centers.