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Laparoscopy and dye test (hydrotubation)

If you are considering having a laparoscopy and dye test or have a test planned, it is important to know all you can about it. This includes:

 

  • why you need this test

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You are having problems with becoming pregnant. This may be because your Fallopian tubes are blocked. During this test we inject dye through your cervix and into your uterus. If we see dye passing through the ends of your Fallopian tubes we know they are not blocked.

 

What are the uterus, Fallopian tubes and ovaries?

To explain where your uterus, Fallopian tubes and ovaries are and what they do, the best place to begin is the vagina. Your vagina is a tube about five inches long. It runs from just in front of your rectum up into your pelvis. It is just behind your bladder. You can feel your bladder in your lower abdomen when it is full of urine.

Laparoscopy and dye test (hydrotubation)

 

At the top of your vagina is your uterus. It is about the size of your clenched fist. It is made of special thick muscle, but it is hollow inside with a special lining called the endometrium. The lowest part of your uterus, which juts into your vagina, is ‘the neck of the womb’, also called your cervix. Cervical smears are taken from the surface of your cervix.

 

The rest of your uterus is called the body. It thins out at the top to form two hollow tubes called the Fallopian tubes. You have a Fallopian tube on each side. These run sideways to end near your left or right ovary. Your ovaries are slightly smaller than a golf ball. They lie deep in your pelvis just below your waist. Your ovaries make hormones and contain tiny eggs, which are too small to see with the naked eye.

 

What do the uterus, Fallopian tubes and ovaries do?

The uterus is where a baby normally develops during pregnancy. About once a month an egg in one of the ovaries grows and breaks free from the ovary. It moves into the Fallopian tube and travels down the tube towards the uterus. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus.

 

Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.

Laparoscopy and dye test (hydrotubation) 2

 

After the age of about 45 years the ovaries stop making some of the female hormones. Eggs are not released each month. The endometrium is no longer shed. The periods stop. This is called the change or the menopause. The changes in hormones often cause hot flushes and dizzy spells. Sometimes the periods become very heavy during this time.

 

What has gone wrong?

Your Fallopian tubes may be blocked because of a past infection or by scarring, called adhesions, inside your pelvis. You may have a different condition inside your pelvis that is making it difficult for you to become pregnant.

 

The aims

We use this test to find out if your Fallopian tubes are blocked and, if so, why. As part of the test we do a diagnostic operation with keyhole instruments, called a laparoscopy. This lets us examine inside your pelvis with a telescope, called a laparoscope. We pass this through a small cut in your abdomen. This may reveal a different cause for your pregnancy difficulties. The dye test part of the operation is called hydrotubation.

 

The benefits

If we find a clear cause for your pregnancy difficulties, such as blocked tubes, you can start the best treatment. If there are other causes, a laparoscopy is a very good way of detecting them.

 

It may be possible to unblock your tubes using keyhole instruments during this operation. This may be just dividing a few adhesions that are causing the blockage.

 

Using keyhole techniques is less painful than doing open operations, recovery is quicker and you avoid having a large scar.

 

Are there any alternatives?

Ultrasound scans or x-rays may also give us some information about your tubes, but they are not usually as informative as a laparoscopy. A laparoscopy is usually better for finding the cause of any blockage and for seeing the condition of your pelvic organs.

 

Some specialists use culdoscopy. For this, instead of passing a telescope through your abdomen and into your pelvis we pass it through the wall of your vagina. It lets us see the outside of your uterus, Fallopian tubes and ovaries, and with the dye test we can see if your Fallopian tubes are blocked. The advantages of culdoscopy are that it leaves no visible scars on your abdomen and can be done using local anaesthetic. The disadvantages are that the view is not usually as good as from a laparoscopy and it gives a higher risk of infection. Also we cannot usually operate to remove a blockage during a culdoscopy. With a laparoscopy under general anaesthesia, if you require treatment, we may be able to do it straight away using the laparoscope. You may have a culdoscopy first then a laparoscopy at a later date if you need treatment.

 

Discuss the options with your gynaecologist.

 

What if you do nothing?

If you do nothing, your difficulties in becoming pregnant will probably continue. If we do not know the cause of your problems we cannot treat you.

 

Author: Dr David Hutchon F.R.C.O.G. Consultant Gynaecologist.

© Dumas Ltd 2006

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