Ultra Test of Tubal Patency Using Levovist (a test for fallopian tube patency)

Welcome to Women’s Ultrasound Melbourne at the Epworth Freemasons and at Tooronga Village.

We are a group of specialist Obstetricians and Gynaecologists with additional qualifications and experience in women’s ultrasound. We are committed to personalized scanning by medical practitioners in a welcoming environment that is comfortable and respectful of women. The doctor who sees you will perform the whole ultrasound examination, issue the report, and explain and discuss results directly with you. You will know the results of your scan before you leave our practice.

The reproductive organs in a female consist of the vagina, cervix, uterus, fallopian tubes and the ovaries (see above diagram). The ovary produces the eggs which are fertilized in the fallopian tubes. The embryo then travels along the fallopian tube in the first few days of life and eventually attaches itself in the cavity of the uterus, growing into a full term baby. One of the common causes of infertility (inability to fall pregnant) is a blockage of the fallopian tubes. The fallopian tubes are about 15cm long and arise from the upper uterus on both sides. The other end of the tubes has a wide opening which lies over the ovary to pick up the egg at the time of ovulation. The patency (openness) of the fallopian tubes can be confirmed by performing a tubal patency test with an ultrasound contrast medium called Levovist.

It should be noted that this test cannot detect mild endometriosis or adhesions in the pelvis.

 

How is the test performed?
A fine catherer is inserted into the uterus to allow for the contrast to be injected close to the tubal openings in the uterus (see below for details).

Vaginal ultrasound examination is used to visualize the contrast as it passes through the uterus and into the tubes, and as it spills around the ovaries.
The most commonly used dye is a special ultrasound contrast agent (echo-enhancing agent) called Levovist. It is a suspension of galactose (a form of sugar) and palmitic acid, both of which occur naturally in the human body and therefore are non toxic. When shaken together they form tiny bubbles which are detectable by ultrasound. This substance is also non allergic.

What happens on the day?
A vaginal ultrasound examination is performed before the tubal patency test to assess the pelvic organs. We search for any abnormalities that may be relevant to your fertility or future pregnancies. Common abnormalities found are uterine fibroids and polyps. Sometimes the abnormal findings point to a cause of the fertility problems such as endometriosis, so that surgical treatment may be necessary. In these circumstances the Tubal patency test may be replaced by a tubal assessment at the time of any future surgery.

After the vaginal ultrasound examination is finished a speculum is inserted into the vagina as in a pap smear. The cervix is visualized and then cleansed by an antiseptic solution. The thin catheter is then introduced into the cervix and passed up into the uterine cavity. Very occasionally the catheter cannot be inserted into the cervix. If this occurs, the test is abandoned at this point. Once the catheter is in place a small balloon at the tip of the catheter is blown up to keep the catheter in place. At this time some patients may experience a period like discomfort.

Once the catheter is in place the speculum is removed and the vaginal probe is reinserted into the vagina. A small amount of saline is first introduced into the catheter to enhance the views of the cavity and to assess whether the cavity shape is normal, and to also exclude a polyp or other pathology. The Levovist solution is then injected into the catheter, and the movement of the Levovist micro bubbles can be clearly seen on the screen as the solution passes through the cavity and into the fallopian tubes. The ultrasound specialist performing your test will be able to determine whether the tubes are patient and will inform you straight away.

When is the best time to do the test?
The best time to do the Tubal Patency test using Levovist is between day 5 and 12 of the menstrual cycle. This is to avoid disruption of a pregnancy should there be one in the uterus in the second half of the cycle.

Do I have to have any special preparation?
There is no real preparation necessary except that you should take some mild painkillers such as Naprogesic about 1 hour before the test. Most women easily tolerate the test with very little discomfort. Most women like to have a friend or relative with them to provide support.

What happens after the test?
The vaginal examination and tubal patency test will take about 20minutes. You will need to allow about 1 hour at the practice. You can resume normal activity as soon as you leave the clinic, including returning to work. You may experience some mild crampy, period like discomfort after the test which could last for up to 1 hour. You will be given a sanitary pad to wear for the rest of the day as there will be a small leakage of fluid and blood from the vagina. If you continue to experience significant discomfort more than 24 hours after the test you must contact the doctor who referred you because of the very small chance of an infection.

Very occasionally a woman may experience severe pain and faintness. This could be due to tubal spasm or rarely due to cervical shock. Some women have a very sensitive cervix and are prone to cervical shock; if this is known about in advance it is a contra-indication to the test. These more severe symptoms always resolve within a few hours.

What does it cost?
The fee charged by the doctor performing the test is partially covered by Medicare, but unfortunately the Levovist solution and the special catheter are not covered by Medicare. Therefore the out of pocket cost is more than for a normal ultrasound examination. The exact cost is available from the WUME or from your referring doctor.

Summary
The Tubal Patency Test using Levovist is a very safe and effective test to examine the patency of the fallopian tubes. In comparison to laparoscopy, which is also used to determine tubal patency, no general anesthetic is required, and it is much less painful. Mild period like cramps should be expected. There is no specific preparation necessary, but taking pain tablets one hour beforehand may reduce your discomfort (if any). Ideally you should have the test performed just after you have finished your period. The results will be explained by the specialist doctor as soon as the test is completed.

About WUME
All ultrasound scanning and procedures at WUME are performed by highly trained obstetricians and gynecologists who have specialized further in the area of ultrasound diagnosis and management. If you have any questions about this test they will be happy to answer them, and can thus also give you your results immediately.