Dear Professor Winston
We have recently been diagnosed with blocked tubes (proximal). We weren’t expecting this as we had a chemical pregnancy in January. It was discovered during a lap and dye. They drilled my polycystic ovaries while they were in there too. We are very keen on selective salpingography but find a lot of negative info online? Can you shed any positive info on this please?
J

Reply…

Dear J

I am rather unconvinced about selective salpingography, though I am very positive about hysterosalpingography (HSG) where dye is put into the uterus and tubal potency tested. Occasionally, for various reasons, dye does not always flow into the tubes during laparoscopy. This isn’t common but it does not necessarily mean that you have some disease where the tubes join the uterus. So an HSG done at a separate time from a laparoscopy can give confirmatory evidence of block, but equally may well show that tubes are normal. Moreover, carefully done HSG may show subtle evidence of tubal damage in cases where the tubes are not completely blocked. We on this website are happy to review any x-rays sent digitally to give our opinion if needed.

Selective salpingography mostly involves putting a fine catheter into the tube where it joins the uterus. This is done from below. through the cervix, without an anaesthetic. Most of the time it is a painless procedure, but a radiologist may try to dilate the blocked portion of the tube with a fine probe or balloon attached to the catheter. There is also another procedure which I have only done under general anaesthesia where a very fine telescope is inserted into the blocked bit of the fallopian tube, also from below. This is called tuboscopy. Both these procedures are not commonly done except by practitioners with a special interest and frankly this is because it is not clear whether they really are of value. Quite good results are claimed by a few centres but I am a bit dubious with a long experience of the treatment of tubal problems. The basic problem is that is possible to dilate the tubes and restore potency so that dye flows through, but the original scarring which caused the block in the first place remains. The fallopian tube is not just a pipe – it is a complex organ responsible for transporting eggs down it so a simplistic way of merely dilating it may not be helpful.

A further treatment which does work is unblocking the tubes where they join the uterus by removing any damaged portion of the tube and then restoring it. This must be done by microsurgery as the tube is very fine at this point – often less than a millimetre in diameter. Also, rather sadly there are very few surgeons trained in this approach nowadays and most women get referred for IVF even though the surgical results, in good hands, are very good.

I hope this is helpful,
Best wishes
Robert Winston

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