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Salpingoscopy: Fallopian Tube Endoscopy for Infertility Diagnosis and Treatment

Salpingoscopy (falloposcopy) is the endoscopic visualization of the fallopian tube lumen using a flexible micro-catheter (<1 mm) passed transcervically under hysteroscopic guidance.

Indications

Infertility workup (tubal factor suspected)
Recurrent implantation failure (IVF)
Proximal tubal occlusion (PTO) evaluation
Salpingitis isthmica nodosum (SIN) diagnosis
Pre-tubal surgery assessment

Procedure

Hysteroscopy first: evaluate uterine cavity, locate tubal ostia.
Salpingoscope advanced through ostium into isthmic/ampullary segments.
Visualize mucosa: folds (plicae), ciliary activity, vascular pattern, debris, adhesions.
Optional: tubal lavage, biopsy, catheter recanalization.

Findings & Classification

Therapeutic Applications

Tubal catheterization + wire recanalization for PTO
Adhesiolysis (mechanical/laser)
Tubal steroid injection (experimental)

Limitations

Technically demanding; limited availability.
Cannot assess outer serosa/peritubal adhesions (laparoscopy needed).
Risk: tubal perforation, infection, false passage.

Current Role

Largely replaced by HSG (hysterosalpingography) and laparoscopy + chromopertubation for routine evaluation. Reserved for select cases where mucosal detail changes management.

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Grade	Mucosal Appearance	Clinical Implication
Normal	Prominent folds, active ciliary motion, pale pink	Patent, functional
Mild	Flattened folds, sluggish cilia, patchy erythema	Early inflammation, SIN
Moderate	Loss of folds, granular, adhesions, no cilia	Significant damage; may need IVF
Severe	Obliterated lumen, dense adhesions, fibrosis	Irreparable; IVF indicated