Role of hysteroscopy in the evaluation of tubal patency in infertile women

Abstract

Abstract Study objective To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. Design Prospective cohort study. Setting Infertility clinic of the Ain-shams University maternity hospital. Materials & methods Sixty-four infertile women underwent hysteroscopy (HSC) and hysterosalpingography (HSG) on two consecutive days. Transvaginal ultrasonography (TVS) was carried out before and after hysteroscopy in order to measure the fluid in the cul-de-sac. The difference between the two methods in the diagnosis of tubal patency was compared using laparoscopy/chromotubation as a gold standard. Main outcome measures Fluid volume measurements were used to determine a cut off value for tubal patency. Pain was recorded at the end of the process. Results According to the laparoscopy, the sensitivity and specificity of HSC and HSG in detecting tubal patency were 94.6% and 100% vs. 92.8% and 50%, respectively. The best cut off point of the fluid volume in the cul-de-sac at which both tubes are patent is 6 ml. All of the patients reported significantly less pain during hysteroscopy in response to HSG. Conclusions Office hysteroscopy combined with TVS may be used as an alternative to HSG, as an effective, easy, safe and minimal invasive office procedure that can be offered as a first line method for the evaluation of the uterine cavity along with the tubes in infertile women.