Infertility affects a significant proportion of couples worldwide, and tubal factor infertility is one of the most common causes in women. Determining the patency of the fallopian tubes is crucial in the evaluation of infertility. Among the various diagnostic modalities, the laparoscopic “lap and dye” test is considered the gold standard due to its accuracy, safety, and simultaneous therapeutic potential.

Also known as laparoscopic chromopertubation, the lap and dye test allows the surgeon to directly visualize the fallopian tubes and peritoneal cavity while assessing tubal patency using colored dye. This minimally invasive technique, pioneered and standardized by experts like Dr. R. K. Mishra, has become an essential procedure in modern reproductive medicine.

Indications

The lap and dye test is indicated in women with:

Primary or secondary infertility of unexplained cause

History of pelvic inflammatory disease (PID) or previous pelvic infection

History of pelvic surgery, including cesarean section or appendectomy

Suspected tubal blockage or adhesions

Endometriosis or pelvic pain requiring diagnostic laparoscopy

It is particularly valuable because it combines diagnostic and therapeutic potential, allowing the surgeon to detect and treat pelvic pathology in the same session.

Preoperative Preparation

Patient Assessment: Complete history, physical examination, and basic infertility work-up (hormonal profile, semen analysis, ultrasound).

Informed Consent: Patients are informed about the procedure, risks, benefits, and alternative tests.

Anesthesia: General anesthesia is preferred for patient comfort and optimal pelvic relaxation.

Bladder and Bowel Preparation: Bladder should be emptied prior to surgery; bowel prep is optional depending on surgeon preference.

Technique

The lap and dye test is performed using standard laparoscopic principles:

Laparoscopic Access

Patient is placed in the supine position with Trendelenburg tilt to displace bowel loops.

A pneumoperitoneum is created using a Veress needle or open (Hasson) technique.

Standard ports (umbilical camera port and accessory working ports) are placed.

Inspection of Pelvic Organs

The uterus, ovaries, fallopian tubes, and pelvic peritoneum are inspected for abnormalities such as adhesions, endometriosis, or cysts.

Any pathology identified can be treated during the same procedure.

Chromopertubation (Dye Test)

A cervical cannula or uterine manipulator is placed in the cervical canal.

Colored dye (commonly methylene blue or indigo carmine) is introduced into the uterine cavity.

The surgeon observes the fallopian tubes under laparoscopic vision to see if the dye passes through and spills into the peritoneal cavity near the fimbrial ends.

Interpretation:

Patent Tubes: Free flow of dye from both fimbrial ends into the peritoneal cavity

Partial Blockage: Delayed or minimal dye spillage

Complete Blockage: No dye seen exiting the tube

Advantages of the Lap and Dye Test

Direct Visualization: Allows simultaneous assessment of tubal patency, pelvic organs, and peritoneal cavity.

Therapeutic Potential: Adhesions, endometriosis, or mild tubal obstruction can be treated immediately.

Accuracy: Considered the gold standard with higher sensitivity and specificity than hysterosalpingography (HSG) or sonohysterography.

Fertility Counseling: Results help guide subsequent fertility treatment, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

Safety and Complications

The lap and dye test is generally safe but carries some risks:

Infection: Rare, minimized by prophylactic antibiotics in high-risk patients

Bleeding: Minor bleeding at port sites or from pelvic organs

Injury to pelvic organs: Rare if performed by trained laparoscopic surgeons

Allergic reaction to dye: Very rare

Dr. R. K. Mishra emphasizes meticulous technique, proper patient selection, and gentle handling of pelvic structures to minimize complications.

Postoperative Care

Most patients recover within 24 hours.

Pain management is usually mild with oral analgesics.

Patients are advised to resume normal activities within 48 hours.

Fertility counseling is provided based on test findings and additional pelvic pathologies.

Clinical Significance

Helps identify tubal factor infertility, which accounts for approximately 25–35% of female infertility.

Detects pelvic adhesions, endometriosis, and ovarian pathology that may impact fertility.

Guides the choice of assisted reproductive technology.

Can improve fertility outcomes when combined with adhesiolysis or treatment of endometriosis during the same procedure.

Conclusion

The lap and dye test is a safe, accurate, and highly informative procedure for evaluating tubal patency and pelvic health in women with infertility. By providing direct visualization of pelvic organs and the ability to treat pathology simultaneously, it offers both diagnostic and therapeutic advantages.

Under the guidance of expert surgeons like Dr. R. K. Mishra, lap and dye testing has become a cornerstone of modern infertility management, improving both diagnostic accuracy and reproductive outcomes. For couples facing infertility, it represents a minimally invasive, effective, and comprehensive approach to uncovering the causes of tubal and pelvic factors.