Evaluation of Selective hydrotubation under hysterofiberscopy

Abstract

Objective: Tubal disease is the main cause of infertility and 10-25% of the cases are due to proximal tubal obstruction. Hysterosalpingography (HSG) is part of the standard diagnostic work-up for infertility; however, the diagnostic accuracy of HSG has been criticized. Selective hydrotubation is a useful tool by which to evaluate tubal obstruction. The aim of this study was to estimate the diagnostic findings and fertility outcomes after selective hydrotubation and to determine the prognostic significance of Chlamydia trachomatis infection for recanalization.Patients: Fifty-seven women undergoing selective hydrotubation for proximal tubal obstruction detected on HSG between January 2000 and December 2007 in the Department of Obstetrics and Gynecology of the University of Tokyo were studied.Results: Of the proximally occluded tubes detected by HSG, 41.9% were shown to be patent after selective hydrotubation. The success rate of recanalization by selective hydrotubation in unilateral obstruction (62.5%) was significantly higher than in bilateral obstruction (17.6%; P<0.01) . After recanalization by selective hydrotubation, 33.3% of the patients conceived without IVF or ICSI. With respect to C. trachomatis infection, the success rate of recanalization in patients with negative chlamydial antibodies was significantly higher (65.6%) than in patients with positive chlamydial antibodies (30.4%; P<0.01) .Conclusions: Selective hydrotubation is a useful tool in the diagnosis and treatment of proximal tubal obstruction detected by HSG. Especially in cases of proximal tubal obstruction with negative chlamydial antibodies, the success rate of recanalization can be high.