Assessment of uterine tubal and peritoneal factors

Tubal patency and peritoneal factors such as endometriosis may be assessed by:

• laparoscopy - premenstrual examination of the tubes by laparoscopy combined is the method of choice for investigating tubal patency. A dilute solution of sterile methylene blue is injected through a tightly fitting cannula in the cervical canal. Tubes which are patent fill with dye. A distal block is indicated by filling of the tubes with dye, but no spillage; a medial block, by lack of dye entering the tubes. The tube, ovaries and peritoneum are inspected for any obvious abnormality. The woman should be warned beforehand to take avoid becoming pregnant during the cycle in which this investigation is performed.
  
  
• hysterosalpingography - this is the instillation of a radiopaque dye through the cervix under radiographic control. It allows for the determination of tubal patency - indicated by free spillage of dye from the distal ends - and the outline of the uterine cavity - distortion may indicate leiomyomata.