Tubal factors account for about 30%-40% of female infertility causes. These include poorly patent fallopian tubes, blocked fallopian tubes, partial or distal adhesions of the fallopian tubes, hydrosalpinx, uplift, and peri-tubal inflammation. The methods of tubal examination include: tubal lavage, hysterosalpingography (HSG) under X-ray, uterine tubal ultrasonography, endoscopy (laparoscopy, hysteroscopy, tuboscopy) and open exploration. The most commonly used of these are HSG and laparoscopic lavage test. The laparoscopic lumpectomy test is the “gold standard” in assessing the patency of the fallopian tubes; HSG can provide the internal structure of the uterine cavity and fallopian tubes, especially in determining the site of tubal obstruction, which is better than laparoscopic lumpectomy, but not as good as laparoscopic lumpectomy in identifying intrapelvic diseases and adhesions. The combined use of both can lead to accurate and comprehensive diagnosis. Because of the potential therapeutic role of HSG, laparoscopy should be performed six months or a year after HSG if it is not a clear indication. Tubal lavage alone has been gradually eliminated because of poor specificity and repeated lavage can also cause upstream spread of infection in the lower genital tract. As mentioned above, tubal screening is recommended for women who have a history of abortion, or a past history of tuberculosis or septic appendicitis, or who have normal ovulatory function and normal male semen but have not conceived for a long time.
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