What is Tubal Patency Testing?

Tubal patency testing is a procedure that checks whether a woman’s fallopian tubes are open (patent) or blocked. It can also detect if the tubes are abnormally shaped or swollen (a condition called hydrosalpinx). Healthy, open fallopian tubes are important for natural pregnancy because they allow the egg to move from the ovary to the uterus and let sperm reach the egg for fertilization.

Who Should Consider This Test?

In the United States, around 15-17% of women dealing with infertility have problems related to blocked or damaged fallopian tubes, and 10% of women pursuing in-vitro fertilization are doing so because of this condition. Blocked fallopian tubes are twice as common among Black women, highlighting the importance of timely testing and care.

Doctors may recommend tubal patency testing if:

  • You’ve been trying to conceive for 6 to 12 months without success
  • You have a history of conditions like endometriosis, ectopic pregnancy, or pelvic infections
  • You’ve had a sexually transmitted infection (STI), such as chlamydia or gonorrhea

In fact, up to 70% of women with blocked fallopian tubes have previously had an undiagnosed or untreated Chlamydia trachomatis infection.

Because tubal patency tests are more invasive than most other fertility tests, it’s often recommended to first check your partner’s sperm through a semen analysis. This test is simple, low-cost, and can help determine whether additional treatments, e.g. in-vitro fertilisation (IVF) might be needed based on sperm quality or quantity.

What are common methods of tubal patency resting?

 

  1. Hysterosalpingogram (HSG)
    An HSG is an X-ray procedure used to check whether your fallopian tubes are open and to look at the shape of your uterus. During an HSG, a contrast dye is injected into your uterus through a thin catheter. X-ray imaging tracks the dye as it flows through the uterus and fallopian tubes. If the tubes are open, the dye spills out into the abdominal cavity.
  2. Hysterosalpingo-foam sonography (HyFoSy)
    A HyFoSy is a newer, ultrasound-based alternative to the traditional X-ray HSG. Instead of dye, it uses a special foam that can be visualized with ultrasound. It offers a radiation-free way to evaluate tubal patency and the uterine cavity, goes with fewer side effects, and has recently been recommended by many fertility experts as the ideal testing method for tubal patency.
  3. Saline Infusion Sonohysterogram (SHG or SIS)
    An SHG uses ultrasound to evaluate the inside of the uterus. It does not assess the fallopian tubes as clearly as an HSG but is very effective at identifying uterine abnormalities like polyps or fibroids. During an SHG or SIS, a sterile saline solution is introduced into the uterus using a small catheter. As the fluid fills the uterus, a transvaginal ultrasound is performed to examine the uterine cavity.
  4. Laparoscopy with Chromopertubation
    A laparoscopy with chromopertubation is a surgical procedure performed under general anesthesia during which dye is injected into the uterus while a camera views the tubes from outside. It is typically performed if other tests are inconclusive or when endometriosis or pelvic adhesions are suspected.

Comparing Side Effects & Comfort of Tubal Patency Testing Methods

 

Aspect Traditional HSG (X-ray + dye) SHG (saline + ultrasound) HyFoSy (foam + ultrasound)
Discomfort/cramping Moderate to significant in some; can feel like period cramps or stronger Mild to moderate, usually brief Mild for most patients
Use of radiation Yes (low dose X-ray) No No
Contrast medium Iodine-based dye (may cause allergic reaction in rare cases) Sterile saline Sterile gel-based foam
Tubal evaluation Yes (primary purpose) Not reliably Yes
Uterine cavity evaluation Yes (limited detail) Excellent Good to excellent
Recovery Mild spotting, moderate to heavy cramping for a day or two Mild spotting or discomfort for a few hours Typically minimal side effects

What to Expect During Tubal Patency Testing

Tubal patency testing is usually scheduled between day 5 and day 11 of your menstrual cycle—after your period ends but before you ovulate. This timing helps ensure you’re not pregnant during the test.

The test typically takes about 15 to 30 minutes. You may experience some cramping, especially if you’re having a traditional HSG (hysterosalpingogram). To help reduce discomfort, you can take over-the-counter pain medication (like ibuprofen) about 30 to 60 minutes before the procedure.

If there’s any concern about possible infection, your doctor might prescribe antibiotics to reduce the risk of complications.

After the Test

It’s common to have light spotting and mild cramping afterward. If you’re undergoing the HyFoSy, you likely will not need any pain medication whatsoever. Please contact your doctor right away if you experience heavy bleeding, severe or prolonged cramping, or develop a fever.

If you’re having the test done at a fertility clinic, your results are often available immediately. In other settings, it may take a few days. Your results will show whether:

  • Both fallopian tubes are open (patent)
  • One tube is open and the other blocked
  • Both tubes are blocked or show signs of damage

Depending on your test results and any other fertility factors, your reproductive endocrinologist will recommend next steps. These may include continuing to try naturally (if at least one tube is open and you’re ovulating regularly), or exploring assisted reproductive options like IUI or IVF.

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Sources

  • Kawwass JF et al: Tubal factor infertility and perinatal risk after assisted reproductive technology. Obstet Gynecol. 2013 Jun;121(6):1263-1271.
  • Exalto N, Emanuel MH. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. Biomed Res Int. 2019 Jul 8;2019:4827376.
  • Anyalechi GE et al: Self-Reported Infertility and Associated Pelvic Inflammatory Disease Among Women of Reproductive Age-National Health and Nutrition Examination Survey, United States, 2013-2016. Sex Transm Dis. 2019 Jul;46(7):446-451.
  • Anyalechi GE et al:  Tubal Factor Infertility, In Vitro Fertilization, and Racial Disparities: A Retrospective Cohort in Two US Clinics. Sex Transm Dis. 2021 Oct 1;48(10):748-753.