In case of blocked tubes seen during HSG, i.e. hysterosalpingography, we encounter two possibilities: the tubes are really blocked.. or the tubes are actually not blocked, and they seemed as blocked because of the spasm that occurred due to the pain and excitement felt during the procedure.
A physician experienced in this subject is largely able to say whether the blockage is real or not, by looking at the x-ray image. However, sometimes a definitive interpretation cannot be done, and inside the abdomen is observed by laparoscopy, with intent to allow for a complete evaluation and clarification of the condition.
Since laparoscopy is done under general anesthesia, no pain or spasm occurs and the actual condition of the tubes is clearly revealed. If the coloring agent (usually sterile methylene blue) administered when the patient is under anesthesia passes easily through the tubes, i.e. the tubes are not blocked, the process is ended.
As a second possibility, the coloring agent administered in a way similar to that of the administration of coloring agent during laparoscopy cannot passes through the tubes, i.e tubes are really blocked. In such a case, doctors try to open the tubes by using various instruments during the operation. The tubes are mostly unblocked successfully, depending on the experience of the surgeon; however, nothing about the result can be said for certain in advance.
If the tubes are unblocked during the operation, and if pregnancy does not occur after waiting for minimum 3 months and maximum 6 months, an in vitro fertilization should be considered. If any success cannot be achieved during the operation, i.e. the tubes are extremely adherent to their surroundings, the process is ended and the couple is directed to in vitro fertilization treatment.
Various research studies have suggested that approximately 20% of the blockages seen in the HSG images are actually false blockages associated with a spasm.
If only one of the tubes is blocked, the other factors should be thoroughly evaluated, as well. The sperm condition of the man, the woman's age, and the duration of their desire to have a baby are some of the important factors that affect the treatment decision. The benefit of waiting should be questioned in cases of people older than 35, and desires to have a baby that last for a period of more than 5 years. And in such cases, it would be useful to ensure not to waste time before initiating effective treatments.
If the hysterosalpingography image shows also a fluid accumulation in the tube called hydrosalpinx, besides the blockage, that tube should definitely be removed by laparoscopy or it should be disconnected from the uterus, by considering the fact that the fluid would reduce the success rate for getting pregnant even if an in vitro fertilization treatment is applied.