Specialist Gynaecological investigations

Tubal Patency Assessment

The female reproductive organs consist of the vagina, cervix, uterus, fallopian tubes (tubes) and the ovaries. The ovary produces the eggs which are fertilised in the fallopian tubes. The embryo then travels along the fallopian tube and implants in the cavity of the uterus.

Tubal Patency Assessment is commonly requested when a woman is having difficulties becoming pregnant.

One of the common causes of infertility is blockage of the fallopian tubes.  The patency (openness) of the tubes can be checked by performing a Tubal Patency Assessment with an ultrasound contrast fluid.

How is the test performed?

A fine catheter is inserted into the uterus to allow for the contrast fluid to flow into the tubes.  Vaginal ultrasound examination is used to visualise the contrast as it passes along the tubes and spills out around the ovaries.

A special ultrasound contrast agent is used.  It is a suspension of hydroxyethylcellulose, glycerol and purified water.  It is non allergenic and non toxic.

What happens on the day?

A vaginal ultrasound examination is performed. Our doctors will check for any abnormalities that may be relevant to your fertility or future pregnancies. Sometimes abnormal findings, such as polyps, endometriosis or fibroids, point to problems where surgery may be considered. In this case, your doctor will be contacted to discuss the findings and tubal assessment may be deferred.

Once the ultrasound is completed, the equipment and contrast is prepared. A speculum is passed into the vagina, as in a PAP smear. The cervix is cleansed with antiseptic solution. A thin catheter is then passed through the cervix into the uterine cavity. Once in place, a small balloon at the tip of the catheter is inflated to keep it in place. At this time you may experience a period like discomfort.

The speculum is removed and the ultrasound probe is reinserted into the vagina. As the contrast fluid is injected, ultrasound follows its progress along the tubes.  Our doctor will be able to determine whether the tubes are patent and will inform you straight away.

Rarely, the catheter cannot be inserted into the cervix and the test is abandoned.

When is the best time to do the test?

The best time is between day 5 and 12 of the menstrual cycle – before ovulation. The test will not be performed where there is risk of potential pregnancy e.g. after ovulation.

Is there any special preparation?

No preparation is necessary.  Mild analgesic tablets such as Naprogesic or Panadol about 30 minutes prior to the test can be helpful as period type cramping can occur.
Your partner or support person may attend if you wish.

What happens after the test?

The vaginal ultrasound examination and Tubal Patency Assessment will take about 20 minutes.  It is best if you can stay for 15 to 20 minutes after the test in case of cramping.  Please allow for about an hour at the practice.

You can resume normal activity as soon as you leave the clinic, including returning to work. You may experience some mild crampy, period like discomfort after the test which could last for up to 1 hour. You will be given a sanitary pad to wear for the rest of the day as there will be a small leakage of fluid from the vagina. If you continue to experience significant discomfort or bleeding more than 24 hours after the test you should contact your referring doctor as there is a small chance of infection.

Very occasionally a woman may experience severe pain and faintness. This could be due to tubal spasm or rarely due to cervical shock. Some women have a very sensitive cervix and are prone to cervical shock; if this is known about in advance it is a contra-indication to the test.

What does it cost?

The fee charged is for the ultrasound, contrast agent and catheter.
A Medicare rebate is available for part of this test. Please ask our staff for fees.

Summary

The Tubal Patency Assessment is a safe and effective test to examine patency of the fallopian tubes. Mild period like cramping should be expected. Taking mild analgesic tablets 30 minutes beforehand may reduce your discomfort (if any). Ideally you should have the test performed just after you have finished your period. The doctor performing the test will answer any questions you have and also give you the results of your scan and tubal assessment directly.

Endometriosis scan with bowel preparation

Endometriosis is a common gynaecological condition defined as presence of endometrial like tissue outside the uterus which impairs quality of life. In more severe disease, there may be ovarian cysts and deep infiltration of the pelvic organs. Deep endometriosis may involve the bowel, most commonly rectosigmoid colon.

A detailed history is taken by our doctor of you particular symptoms and any prior surgery and therapies. Using transvaginal and transabdominal ultrasound with bowel preparation allows good views of this area to make a more extensive assessment of the pelvis. This may influence surgical decision making to allow time for complex surgery and sometimes the presence of a bowel surgeon to work with your gynaecologist.

Bowel preparation empties the lower bowel so that clear vaginal  ultrasound images can be obtained. Views of the bowel are often hindered by the presence of gas and faecal material which can obscure both bowel and other pelvic structures.

The ultrasound will be done both transabdominally and transvaginally assessing the whole pelvis with detailed views of uterus, ovaries, rectosigmoid, bladder and surrounding structures. You will be able to see the images and the findings will be discussed with you at the time of your scan.

Patient Information and
Instructions

Saline Infusion

Saline Infusion uses saline to view the endometrial cavity.  The endometrial layers usually lie one on top of the other.  A small amount of saline instilled via a catheter will dilate the cavity slightly to allow good visualisation of the whole cavity.  This may be done for suspected polyps, uterine adhesions or to assess the extent of fibroid distortion of the cavity.

A speculum is passed into the vagina, as in a PAP smear. The cervix is cleansed with antiseptic solution . A thin catheter is then passed through the cervix into the uterine cavity while scanning at the same time. Saline infusion is a short procedure. It is less commonly performed as ultrasound resolution improves.

Cyst Aspiration

Persistent cysts can be drained with a fine needle under ultrasound guidance either trasvaginally or transabdominally depending on their location and size.  The cyst must appear benign for this to be performed. Drainage may relieve painful symptoms. The fluid is sent for cytopathology which can reassure as to the nature of the cyst. The majority of cysts will not recur, however, approximately 30% of drained cysts will slowly reaccumulate.