Infertility affects millions of couples worldwide, and determining its cause often requires a thorough evaluation of the female reproductive system. Among the various diagnostic tools available, diagnostic laparoscopy combined with a tubal patency test is considered the gold standard for assessing pelvic pathology and evaluating the status of the fallopian tubes. This minimally invasive approach allows direct visualization of the pelvic organs and functional assessment of tubal patency, both of which are critical in infertility management.

What is Diagnostic Laparoscopy?

Diagnostic laparoscopy is a minimally invasive surgical procedure that involves inserting a laparoscope—a thin telescope-like instrument with a camera—into the abdominal cavity through a small incision, usually at the umbilicus. It enables the surgeon to directly visualize pelvic structures, including:

Uterus

Fallopian tubes

Ovaries

Peritoneum

Pelvic adhesions or endometriotic lesions

Unlike imaging techniques such as ultrasound or hysterosalpingography (HSG), laparoscopy provides a real-time, direct, and comprehensive view of the pelvic anatomy.

What is a Tubal Patency Test?

A tubal patency test assesses whether the fallopian tubes are open and functional. Since blocked tubes prevent the egg from meeting sperm, tubal pathology is one of the major causes of female infertility.

During laparoscopy, tubal patency is usually tested using chromopertubation:

A blue dye (such as methylene blue or indigo carmine) is introduced into the uterine cavity via a cannula inserted through the cervix.

The surgeon observes whether the dye passes through the fallopian tubes and spills into the peritoneal cavity.

Free spillage of dye indicates patent tubes, while absence of spill suggests tubal blockage.

Indications

Diagnostic laparoscopy with tubal patency testing is performed in the following scenarios:

Primary or secondary infertility – to evaluate tubal factors, adhesions, or endometriosis.

Suspected pelvic pathology – such as endometriosis, pelvic inflammatory disease, or adnexal masses.

Previous pelvic surgery – to rule out adhesions or scarring that may interfere with fertility.

Equivocal results from non-invasive tests – like inconclusive hysterosalpingography (HSG) or sonohysterography.

Procedure
Patient Preparation

The procedure is performed under general anesthesia.

The bladder is emptied, and the patient is placed in the lithotomy position.

A uterine manipulator or cannula is inserted for chromopertubation.

Creation of Pneumoperitoneum

A small incision is made at the umbilicus.

A Veress needle or open (Hasson) technique is used to insufflate the abdomen with carbon dioxide gas.

This creates working space for laparoscopic visualization.

Introduction of Laparoscope

A 10 mm trocar is placed at the umbilicus, and the laparoscope is inserted.

Accessory ports (5 mm) may be placed for manipulation if required.

Pelvic Assessment

The surgeon inspects the uterus, ovaries, fallopian tubes, pouch of Douglas, and surrounding peritoneum.

Any abnormalities such as adhesions, cysts, endometriotic lesions, or fibroids are noted.

Chromopertubation Test

A colored dye is injected into the uterine cavity.

The laparoscope allows the surgeon to observe whether the dye passes through the fallopian tubes and spills into the pelvic cavity.

Results:

Bilateral spill – both tubes patent.

Unilateral spill – one tube open, one blocked.

No spill – bilateral tubal occlusion.

Completion

Any minor pathology such as adhesions or small endometriotic spots may be treated during the same session.

The ports are removed, and incisions closed.

Advantages

Direct visualization – Provides the most accurate assessment of pelvic anatomy.

Simultaneous intervention – Allows treatment of minor pathologies such as adhesions or endometriosis during the same procedure.

High accuracy – Chromopertubation under laparoscopy is more reliable than HSG or ultrasound-based methods.

Minimal invasiveness – Small incisions, less pain, and quicker recovery compared to open surgery.

Limitations

Requires general anesthesia.

More invasive compared to imaging tests.

Higher cost than non-invasive alternatives.

Risk of complications, although rare, such as injury to bowel, bladder, or blood vessels.

Postoperative Care

Patients usually recover within a few hours and can be discharged the same day.

Mild abdominal pain, shoulder tip pain (from residual gas), or minor bleeding per vaginam may occur.

Patients are advised rest for 24–48 hours and can resume routine activities shortly thereafter.

Clinical Significance

Diagnostic laparoscopy with tubal patency testing remains the gold standard in infertility evaluation, especially when other tests provide inconclusive results. It not only confirms whether the fallopian tubes are functional but also identifies conditions like endometriosis or adhesions that may impair fertility. By combining diagnosis with therapeutic potential, this procedure significantly enhances the chances of achieving pregnancy through natural conception or assisted reproductive techniques.

Conclusion

Diagnostic laparoscopy and tubal patency test are indispensable tools in the evaluation of female infertility. They provide accurate, real-time insights into pelvic anatomy and tubal function, while offering the added advantage of simultaneous treatment when minor pathologies are detected. Despite requiring anesthesia and surgical expertise, the benefits of this minimally invasive procedure far outweigh its limitations, making it a cornerstone in modern reproductive medicine.