Organic vs functional obstruction of the fallopian tubes: differentiation with prostaglandin antagonist- and beta 2-agonist-mediated hysterosalpingography and selective ostial salpingography.

In order to determine the prevalence and cause of functional vs organic obstruction of the fallopian tubes, hysterosalpingography was repeated after pharmacologic manipulation with a prostaglandin antagonist (aspirin) and/or a beta 2-agonist (terbutaline) in 100 patients in whom the fallopian tubes did not fill with contrast medium on the initial hysterosalpingogram. Selective ostial salpingography was performed in those in whom the fallopian tubes did not fill on the second hysterosalpingogram. Patients referred from three infertility clinics were included in the study if they could be rescheduled for a second hysterosalpingogram after at least 1 week of preparation with aspirin. Hysterosalpingograms obtained after administration of aspirin showed normal filling in 21 of 100 patients with initially obstructed tubes; the tubes filled in four more patients after administration of terbutaline. Selective ostial salpingography opacified the tubes in another 36 patients in whom the tubes had so far failed to fill. On the basis of the radiographic appearance and sometimes laparoscopic observation, initial nonfilling was attributed to spasma and debris in 49 patients, submucosal fibroids in six, synechiae in three, salpingitis isthmica nodosa in two, and septated uterus in one. Hysterosalpingography, after pharmacologic manipulation with aspirin and/or selective ostial salpingography, revealed false-positive and functional tube obstructions in 61 of 100 patients. Moreover, the radiologic appearance improved categorization of organic obstructions.