What are the options if tubes are found blocked in HSG?
You still can consider SSG (Sonosalpingography) or SIS (Saline Infusion Sonography) as a second test to check tubal patency. SSG is an option before you take the final decision. However, if SSG also shows the “block�, then there are simply two options. You can consider laparoscopy or go for IVF straightforward. It depends on your age, other fertility factors (condition of the sperms and ovaries), duration of infertility and your wish.

Why and how Laparoscopy is done?
If HSG or SSG show both the tubes are blocked, then the only way to confirm the blockage is by laparoscopy. This is, because, sometimes, the spasm of the muscles of the tube during HSG or SSG can lead to“false positive� result; that means if tubes are found to be blocked by those tests, the tubes may actually be found open actually during laparoscopy. Laparoscopy is also advised to check the tubal patency, if there are other reasons (like removal of cyst or severe pain) or when HSG or SSG could not be done for technical difficulties. Laparoscopy is done under general anaesthesia with two or three small opening (key-hole surgery) in the abdomen and a coloured material (“dye�) is introduced through the uterus.

What is "Hysteroscopic Tubal Cannulation"?
During laparoscopy, we can make attempt to remove the block by simultaneous use of Hysteroscopy. Hysteroscopy is done by inserting a small telescope with camera inside your womb (uterus) through the vagina) under the anaesthesia. During Cannulation, a small wire is passed through the hysteroscope through the womb into the tube. Laparoscope is used to see the passage of the wire through the tube. This can open the blocked tubes in many cases.Please remember, you need laparoscopy and hysteroscopy at the same sitting. So,there is no need of two operations separately.

When Hysteroscopic Tubal Cannulation is done?
If you are at younger age, other fertility factors normal and the infertility is of shorter duration, laparoscopy may be the suitable approach for you. That means, if there is good chance that you can conceive without IVF, this operation is suitable for you.

What is the next step if this operation is "Successful"?
The operation is "SUCCESSFUL" when the "blocked" tube(s) are opened by this operation. In that case, you can try for pregnancy naturally, by ovulation induction or by IUI (Intrauterine Insemination), depending on your circumstances. If you fail to conceive within 6-12 months’ time after laparoscopy, even when the tubes were found open, you may need to consider IVF.

What to do if the operation FAILS to open the blocked tube?
Unfortunately in that case, you will require IVF.

When Hysteroscopic Tubal Cannulation is NOT advisable?
If the conditions of your ovaries or partner’s sperms are not satisfactory, your age is on the higher side, or infertility is of long duration, directly going for IVF would be the better option for you. Because, in these cases, even if tubes can be opened, there is fair chance that you will require IVF. By opting for IVF directly in such cases,, you can avoid the risks and costs related to laparoscopy.

What are the RISKS involved in this operation?
This is a very safe operation. But like any other surgeries, there is small risk of complications. Majority of the women undergoing this surgery, will not face any problems. However, out of 1000 women having the surgery, 1-2 can face problems like infection, excessive bleeding, damage to the organs (ovaries, tubes, uterus, bowel, urinary tract). There is small risk that the patient may need open operation and rarely second operation. Out of the 12000 women undergoing this operation, one can have life-threatening complications.

Conclusion-
If there is good chance that you can conceive naturally, after seeing blocked Fallopian tubes in HSG and SSG, Hysteroscopic Tubal Cannulation can be a good option for you.