FOLLOW-UP INVASIVE TESTS
Hysterosalpingogram and Laparoscopy
Tubal disease. Assessment of fallopian tube abnormalities is the next step if the
semen analysis is normal and ovulation is confirmed.
Hysterosalpingogram (HSG). In this imaging procedure, a catheter is placed
inside the uterine cavity, and contrast material is injected. The contrast
material should be seen on x-ray images spilling bilaterally into the peritoneal
cavity. It should be scheduled during the week after the end of menses after
prophylactic antibiotics to prevent causing a recurrent acute salpingitis. No
further testing is performed if the HSG shows normal anatomy. If abnormal
findings are seen, the extent and site of the pathology are noted and
laparoscopy considered.
Chlamydia antibody. A negative IgG Antibody test for chlamydia virtually
rules out infection induced tubal adhesions.
Laparoscopy. If potentially correctible tubal disease is suggested by the
HSG, the next step in management is to visualize the oviducts and attempt
reconstruction if possible (tuboplasty). If tubal damage is so severe surgical
therapy is futile, then IVF should be planned.