Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation.

STUDY OBJECTIVE: To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency. DESIGN: A prospective cohort study. SETTING: In a prospective study, infertile women who underwent surgery because of infertility between March and November 2018 were included. The main outcome parameter was fallopian tube patency assessed by laparoscopic chromopertubation. The predictive parameter tested was the presence of hysteroscopic tube flow. PATIENTS: Seventy-two infertile women. INTERVENTIONS: Combined hysteroscopy and laparoscopy with chromopertubation. RESULTS: One-hundred forty-four fallopian tubes were evaluated, with 88 (61.1%) patent tubes at laparoscopic chromopertubation. A positive hysteroscopic flow effect was recorded for 94 (65.3%) ostia and was accurate in predicting patency (p < .001), with a sensitivity of 85.3% (95% confidence interval [CI], 76.1-91.9) and a specificity of 66.1% (95% CI, 52.2-78.2). A multivariate binary regression model revealed that the presence of a hydrosalpinx (odds ratio = 8.216; 95% CI, 1.062-63.574; p = .044) and peritubal adhesions (odds ratio = 3.439; 95% CI, 1.142-10.353; p = .028) were associated with a false-normal flow result. A hazy hysteroscopic picture was found in 15 of 21 (71.4%) and 5 of 51 (9.8%) cases with and without bilateral tubal occlusion, respectively (p < .001, sensitivity = 71.4% [95% CI, 47.8-88.7], specificity = 90.2% [95% CI, 78.6-96.7]). CONCLUSIONS: The presence of hysteroscopic tubal flow was a reliable indicator of tubal patency. A hydrosalpinx or peritubal adhesions increase the risk for a false-normal result. A hazy hysteroscopic picture suggests bilateral tubal occlusion. Using the hysteroscopic flow effect, one can provide additional information for the patient.

True, true, and unrelated: tubal patency, tubal architecture, and tubal function.

"To understand the actual world as it is, not as we should wish it to be, is the beginning of wisdom." - Bertrand Russell.

Chromopertubation--presentation of a modification of the standard technique.

BACKGROUND AND AIM: In this article, we describe an easy and cost-efficient technique to improve the applicability of blue dye for chromopertubation using a pediatric transurethral catheter. MATERIALS AND METHODS: We evaluated our technique at a University Hospital with 21 patients aged between 19 and 39 years with primary and secondary infertility, undergoing laparoscopical chromopertubation of the fallopian tubes using a transurethral Foley catheter. RESULTS: Our results show an easy and quick performance and distribution of a cost-efficient method. CONCLUSION: Using a transurethral catheter is a time-efficient, easy-to-handle, cheap and effective method for chromopertubation.

Transvaginal hydrolaparoscopy for diagnosis of tubal infertility.

OBJECTIVE: Infertility problem affects more than 70 million couples worldwide, 5-15% of which are couples in their reproductive age. Less and less invasive endoscopic methods like transvaginal hydrolaparoscopy have been developed by technological progress. This method enables not only precise identification, but is now increasingly used for treatment of tubal and peritoneal factor pathology, which cause approximately 35 per cent of female infertility. AIM: Evaluation of transvaginal hydrolaparoscopy (HLTV) usefulness for diagnosis of tubal infertility comparing to standard laparoscopy and hysterosalpingography (HSG). RESULTS: In evaluation of patent fallopian tubes results of HLTV and HSG examinations are coincide in 87%, while obstruction diagnosed in HSG is confirmed only in 37% during HLTV examination. Transvaginal hydrolaparoscopy and HSG have similar sensitivity and specificity in diagnosis of hydrosalpinx, which is up to 100% . In comparison with HLTV histerosalpingography is less effective in evaluation of peritubal dilatations and adhesions. Both laparoscopic surgery and transvaginal laparoscopy have the same high sensitivity in diagnostics of the fallopian tubes patency and hydrosalpinx, which is up to 100%. In evaluation of peritubal adhesions and dilatations the results are very similar. CONCLUSIONS: 1. HLTV is a highly useful method in evaluation of the fallopian tubes pathologies which is significantly more sensitive than HSG in evaluation of such lesions as peritubal adhesions and obstructed fallopian tubes. 2. HLTV is as effective as laparoscopy in evaluation of patency and lesions of the fallopian tubes. 3. HLTV is a less invasive method, much better tolerated than laparoscopy and more suitable for the group of overweight patients. 4. Final assessment of HTLV technique will be possible following performance of a greater number of studies, where the foregoing conclusions present only initial observations.

Transcervical tubal cannulation and salpingoscopy in the treatment of tubal infertility.

Transcervical tubal cannulation and salpingoscopy are two recent techniques used for the evaluation of tubal patency and pathology. Selective tubal cannulation cannot determine the nature of the obstructive process, although it does allow for the demonstration of potential tubal patency. This may be important in deciding whether therapies requiring tubal patency may be used in specific clinical situations. Because currently there are no controlled studies in the literature evaluating this technique, the therapeutic value of the procedure must be considered unproven at this time. Salpingoscopy gives more detailed information concerning the tubal mucosa. The identification of specific tubal lesions has been described with this modality. The predictive value of salpingoscopy in cases of severe anatomic distortion, ie, fibrous obliteration, seems obvious. However, its predictive value in the presence of more subtle lesions needs to be studied further because its role as a therapeutic modality is as yet undefined.

Evaluation of the FemTest device pre- and post-sterilization.

A study was conducted at the Universidad Austral, Valdivia, Chile, School of Medicine, to evaluate the safety, ease of use and effectiveness of the FemTest device* (FT), a new instrument to evaluate tubal patency. A total of 110 interval women were admitted to the trial between February 1985 and August 1986, all of whom wanted to be sterilized. The mean age of the women was 32.2 years and the mean number of live births was 3.1. Women underwent FT and hysterosalpingography (HSG) procedures pre- and post-sterilization in order to compare the results. Sixty-seven women were surgically sterilized and forty-three women were sterilized with transcervical application of methylcyanoacrilate. Complications and complaints experienced by the study participants included mild to moderate discomfort during FT procedures. Assessment of patient discomfort was not done during the HSG procedures. FT and HSG findings agreed in 97.2% of the women prior to sterilization. The simplicity and effectiveness of the FT procedure suggests it will be an excellent method to test for tubal patency after a non-surgical female sterilization procedure.