Which symptom indicates that a woman's fallopian tubes are patent during a fertility workup?

Shoulder pain is a significant indicator that a woman's fallopian tubes are patent during a fertility workup, particularly in the context of a specific procedure known as a hysterosalpingography (HSG). During this procedure, a dye is injected through the cervix into the uterine cavity and fallopian tubes to visualize the structures via X-ray. If the dye spills out of the tubes into the peritoneal cavity, it can irritate the diaphragm, leading to referred pain in the shoulder. This phenomenon is often described as Kehr's sign, where pain is felt in the shoulder because of diaphragm irritation due to underlying abdominal issues.

In contrast, back pain, abdominal pain, and leg cramps are not specific indicators of patent fallopian tubes and can occur for a myriad of reasons unrelated to tubal patency. For example, abdominal pain may be associated with various conditions such as ovarian cysts, endometriosis, or other pelvic pathologies. Similarly, back pain and leg cramps can stem from muscular issues or other non-reproductive factors. Therefore, while those symptoms might arise during a fertility workup, they do not provide the same diagnostic relevance as shoulder pain in confirming the patency of the fallopian tubes.