It is performed as part of a type of minimally invasive surgery called laparoscopy.
What Happens During the Procedure
A camera-equipped surgical device is placed into the abdominal cavity through a small incision typically just under the belly button, so that doctors can see internal organs—in this case, the fallopian tubes. Before the laparoscope is placed, a device called a uterine manipulator is placed through the vagina and cervix into the uterus. “A dye can then be injected through this catheter into the uterus and the tubes are observed with the laparoscope camera to see if the dye comes out the other end of the tube,” explains Dr. Michael Zinger, a double board-certified OB-GYN and reproductive endocrinologist with RMA Long Island IVF. If the dye does come out, it means there is no blockage, but if the dye does not come out, it suggests that there is some kind of blockage, such as scarring or endometriosis.
Why Is It Performed?
Chromotubation is usually performed in order to determine the cause of someone’s difficulties getting pregnant during an infertility evaluation. If there is a blockage in the fallopian tube, eggs cannot pass from the ovaries to the uterus, cannot be reached by sperm, and cannot result in pregnancy. If both fallopian tubes are blocked in this way, infertility can be diagnosed.
Treatment
If a blockage is found during a chromotubation procedure, there are a few things that might be able to be done to treat it.
Tube Resection
The surgeon can try to correct the blockage during the same laparoscopic surgery. “It is often possible to resect either endometriosis or adhesions that may be blocking the tubes,” Zinger says. “However, resecting the causes of blocked tubes often does not return fertility,” he says. “There is often damage inside the tube that cannot be repaired. This damage may have occurred from the same cause as the blockage or it may be from the pressure that has built up within the tube during the blockage.” According to Zinger, even when the tube is able to be resected during surgery the surgery may not work in the long run because it is possible for the scarring to return as it heals.
Removal of the Fallopian Tube
If it is obvious to the surgeon performing the chromotubation that the tubes are damaged internally, the surgeon may remove the tube because it will never function normally. Removal of the tubes does not mean that the patient cannot subsequently get pregnant. However, they will have to undergo in-vitro fertilization (IVF) in order to conceive. “IVF bypasses the tubes by allowing the sperm and eggs to meet in a lab dish then placing the resulting embryo directly in the uterus,” Zinger explains.
Risks and Contraindications
Because chromotubation is a procedure performed as part of laparoscopy and because it requires anesthesia, it carries some risks, including:
Blood lossInjury to other organs in the abdomenNerve damageAllergic reactions to the anesthesiaBlood clotsAdhesions
In addition, it can cause some side effects. “In order to separate the organs and be able to see between them, gas is infused into the abdomen during the surgery,” Zinger explains. “This gas is responsible for the most common side effect afterward—shoulder pain— [because] the shoulder is where the body perceives gas pressure at the top of the abdomen.” Chromotubation would be contraindicated if a patient has a known intra-abdominal injury, has had a previous complication from surgery, or has had an allergic reaction to anesthesia.
Other Testing Options
“Because it requires surgery, [chromotubation] has become much less common over the years,” Zinger says. “Most patients now choose nonsurgical methods to determine if their tubes are open.” Other options include:
Hysterosalpingogram: A hysterosalpingogram (HSG) procedure uses contrast infused into the uterus before an X-Ray is taken. The X-Ray will allow medical professionals to see if the contrast spills out of the tubes or not. Sonosalpingography: Sonohysterography is a procedure where air bubbles are infused into the uterus, then a sonogram is performed in order to see if the bubbles emerge from the tubes.
“Either of these options can be completed in under 10 minutes and neither requires any anesthesia or any surgery,” Zinger says.
A Word From Verywell
Chromotubation provides surgeons with an accurate way to look at the fallopian tubes and diagnose blockages. In addition, unlike procedures, it allows the surgeon the option of attempting a resection during the same surgery. However, because it is performed as part of laparoscopic surgery, the procedure carries inherent risks that some patients may not want to take and might consider other, less invasive options instead.
