Performing the Parryscope technique gently for office tubal patency assessment.

OBJECTIVE: To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG). DESIGN: Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its University of Mississippi Medical Center Institutional Review Board protocol number is 2013-0230. SETTING: Academic hospital. PATIENT(S): Women undergoing office hysteroscopy and ultrasound, with a subset also having HSG. INTERVENTION(S): Air infusion into saline during office hysteroscopy. MAIN OUTCOME MEASURE(S): The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG. RESULT(S): When performed as described, this office technique has 98.3%-100% sensitivity to tubal occlusion and 83.7% specificity. The gentle technique is central to accurate outcomes, which is facilitated through use of a small-caliber (<3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG. Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique. CONCLUSION(S): Air-infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility. CLINICAL TRAIL REGISTRATION NUMBER: NCT02005263.

Proximal Tubal Patency Demonstrated Through Air Infusion During Flexible Office Hysteroscopy Is Predictive of Whole Tubal Patency.

STUDY OBJECTIVE: To determine whether air bubbles infused into saline during flexible office hysteroscopy can accurately predict tubal patency. DESIGN: Diagnostic accuracy study (Canadian Task Force classification II-1). SETTING: An academic hospital. PATIENTS: Women undergoing office hysteroscopy and ultrasound. INTERVENTIONS: Air infusion into saline during office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The primary outcome measures were whether air bubbles traverse the ostia at hysteroscopy, whether there is patency at abdominal surgery, and the rate of cul-de-sac (CDS) fluid accumulation from office hysteroscopy. Four hundred thirty-five patients underwent office hysteroscopy with air infusion, 89 of whom also had abdominal surgery. Depending on interpretation, sensitivity to tubal occlusion was 98.3% to 100%, and specificity was 83.7% with standard chromopertubation pressures; 95.3% to 100% of the time proximal patency was observed, whole tubal patency was observed through chromopertubation for patients with surgical data. Changes in CDS fluid volume from before to after office hysteroscopy were also used as an indirect proxy for tubal patency. Patients with risk factors for occlusion such as known or suspected tubal disease, known or suspected adhesions, and sonographic identification of adhesions through the sliding sign were all less likely to demonstrate a change in CDS fluid volume after hysteroscopy than women without these risk factors (p < .0001). Bilateral dispersion of air bubbles during hysteroscopy better predicted shifts in CDS volume than these risk factors and demonstrated shifts comparable with bilateral patency at laparoscopy (p < .001). CONCLUSION: Air-infused saline at office hysteroscopy can accurately assess tubal patency. Additionally, bilateral patency identified through office hysteroscopy may predict bilateral patency at surgery better than several commonly used historic and sonographic variables.