Assessment Of Tubal Patency Research Articles

Hysteroscopic Tubal Cannulation & Foam Contrast Hydrotubation for the Treatment of Proximal Tubal Occlusion and Tubal Patency Assessment

<h3>Study Objective</h3> To assess the feasibility, benefits and advantages of combining hysteroscopic fallopian tube cannulation with selective foam contrast hydrotubation and pelvic ultrasonography in the treatment of proximal fallopian tube occlusion and simultaneous tubal patency confirmation. <h3>Design</h3> Case Series from September 2020 to March 2021. <h3>Setting</h3> Day case outpatient procedure in a hysteroscopy suite. <h3>Patients or Participants</h3> 10 patients diagnosed with proximal fallopian tube occlusion, desirous of natural fertility and consented for hysteroscopic tubal cannulation and foam contrast hydrotubation and pelvic sonography. <h3>Interventions</h3> Hysteroscopic fallopian tube cannulation, using a vaginoscopic approach under conscious sedation with the patient in the dorsal lithotomy position and under aseptic conditions, selective foam contrast hydrotubation at hysteroscopy simultaneous pelvic ultrasound assessment of tubal patency post procedure. <h3>Measurements and Main Results</h3> 1. Successful Hysteroscopy 2. Successful Tubal Cannulation and foam contrast hydrotubation. 3. Demonstration of tubal patency. 4. Pain Score. 5. Complications. 6 Procedure time 7. Patient convalescence. 8. Pregnancy outcome post procedure. <h3>Conclusion</h3> Outpatient hysteroscopic tubal cannulation with foam contrast hydrotubation in patients with proximal fallopian tube occlusion is a safe, feasible, comfortable method that allows for simultaneous confirmation of tubal patency. The method avoids the need for a simultaneous laparoscopic or radiographic procedure thus saving time and reducing costs.

Hystero-salpingo scintigraphy for fallopian tubal patency assessment: results from a prospective study

Objective To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (HSSG), for tubal patency assessment of infertile women. Material and methods Prospective cohort study involving women in the infertility workup at the University of Debrecen, Hungary. Seventy infertile patients were scheduled to either basic dynamic HSSG, post-purge dynamic HSSG, or post-purge dynamic HSSG followed by SPECT/CT for reducing tracer contamination. The primary endpoint was the evaluation of the diagnostic accuracy of HSSG for the three methods. Results During the basic dynamic group, the examination yielded a sensitivity of 87.5%, with a specificity of 71.7%, while positive and negative predictive values were 31.8%, and 97.4% respectively. Using post purge dynamic HSSG, it resulted in a sensitivity of 87.5%, a specificity of 88.7%, a positive predictive value of 53.8%, and a negative predictive value of 97.9%. Adding SPECT/CT to post-purge dynamic HSSG increased diagnostic accuracy with 100% sensitivity and 88.7% specificity, while positive and negative predictive values were 57.1% and 100%, respectively. Conclusion HSSG is a non-invasive and well-tolerated technique for tubal patency. It could be used initially to predict tubal patency in case of infertility. Its diagnostic accuracy is higher when it is carried out by adding SPECT/CT to the post-purge dynamic method.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

Assessment of Tubal Patency with Selective Chromopertubation at Office Hysteroscopy versus Modified Minilaparoscopy in Infertile Women.

Objectives:Tubal factor is the leading cause of female infertility. Diagnostic hysterolaparoscopy with chromopertubation plays a pivotal role in its evaluation. Office hysteroscopy (OH) has gained popularity as the outpatient procedure for diagnostic purposes. OH being a less invasive approach, the current study was undertaken to compare the accuracy of assessment of tubal patency with chromopertubation at OH with modified minilaparoscopy in infertile patients.Materials and Methods:The present study was a pilot study conducted from March 2017 to August 2018. Eighty patients were recruited. OH was done without anesthesia. Diluted methylene blue dye was injected. The eddy current of blue dye, “Visualizable flow” at ostium, and disappearance of blue dye from the uterine cavity through ostium was documented as evidence of patent tubal ostium. In case of tubal occlusion, uterine cavity became blue due to backflow of dye. After OH, minilaparoscopy with chromopertubation was performed under general anesthesia. Both tubes were assessed separately for tubal patency.Results:All patients underwent OH followed by minilaparoscopy in the same sitting. OH was 87.5% sensitive with positive predictive value of 95.2%. Compared to minilaparoscopy, OH is 85.6% accurate in predicting tubal patency. The area under receiver operating curve was 0.96 (SE is 0.15 with 95% confidence interval of 0.93–0.99, P < 0.001). It implies that, OH should correctly identify all laparoscopic cases with probability of 0.96.Conclusion:OH chromopertubation can be used as an alternative to laparoscopy for assessing tubal patency with added advantages of lack of requirement of anesthesia, minimal cost, and better patient acceptance. Moreover, the procedure is less time-consuming and less invasive with high sensitivity and moderate specificity.

Novel Use of Hysteroscopy in the Assessment of Tubal Patency in Difficult Cannulation.

The objective was to assess the method of chromopertubation (CPT) in cases of difficult cannulation to minimize the false-negative cases of tubal block. We had performed laparoscopy and hysteroscopy in 66 females as infertility workup. In all these females, cannulation through the cervical canal was difficult and tubal patency test showed tubal block with Leech–Wilkinson cannula. Then, through the inlet of hysteroscope, methylene blue dye was injected and the patency of tubes was assessed again. In 59 out of the 66 females, we observed that when cannulation and dilation of cervix was difficult, then CPT with hysteroscope showed positive tubal patency test. Introduction of hysteroscope with visualization bypasses cervical factor and reduces false-negative results of tubal patency that is an added advantage of hysteroscope that has not been reported earlier.

Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study

OBJECTIVETo determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODSThis was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTSNine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21−45) years and median body mass index was 23 (range, 16−41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1−16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0−10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSIONHYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

Evaluation of Diagnostic Hysteroscopy as a Tool for Diagnosis of Tubal Factor of Infertility in Comparison to Diagnostic Laparoscopy

Background: Fallopian tube obstruction is believed to play a role in 12-33% of subfertile couples. Therefore, the patency evaluation of fallopian tubes is a significant part of subfertile couple’s work. Objective: To compare the sensitivity and specificity of the hysteroscopic assessment of tubal patency by the bubble test to diagnostic laparoscopy and hysterosalpingogram in infertile patients. Subjects and Methods: A total of 100 women were recruited to the study during the period between January 2020 and June 2020. 100 patients underwent a diagnostic hysteroscopy followed by laparoscopy. Each Fallopian tube has been considered to be an individual case. Patency was evaluated in 200 Fallopian tubes. Results: A polyp was detected at three tubal orifice. Hyperemia was detected around two tubal orifice. Adhesions were detected at one tubal orifice. The tubes were patent in 113 cases with both methods. In 70 cases both laparoscopy and hysteroscopy found occluded tubes. The tubes were patent by laparoscopic dye in 10 cases, but could not be detected by hysteroscopy as such. Occlusion was observed by laparoscopy in 7 cases but patency was detected during hysteroscopy. Of the non-patent cases, 70 out of 77 laparoscopic findings were consistent with the hysteroscopic result, yielding a specificity estimate of 90.9% (95% CI 84.5% to 96.4%). Conclusion: Based on statistical analysis (sensitivity and specificity) of our data, diagnostic hysteroscopic bubble test is accurate and reliable compared to the laparoscopic test, which is considered a global standard criterion.

OC15.02: Hysterosalpingo‐foam (Hyfosy) ultrasonography and power Doppler, compared to laparoscopy in assessment of tubal patency in cases of infertility

OC15.02: Hysterosalpingo‐foam (Hyfosy) ultrasonography and power Doppler, compared to laparoscopy in assessment of tubal patency in cases of infertility

Lipiodol hysterosalpingogram: A modified HSG technique to minimize risks associated with lipiodol use.

Assessment of tubal patency and therapeutic tubal flushing using Lipiodol, an oil-soluble contrast media (OSCM), has been shown to enhance fertility, resulting in increased interest in the use of Lipiodol. A modified hysterosalpingogram (HSG) technique, including a supplementary ultrasound with the contrast in situ, is recommended when using Lipiodol, taking into account both safety issues and technical challenges specific to Lipiodol.

HYSTEROSALPINOGRAPHY VERSUS DIAGNOSTIC LAPAROSCOPY IN ASSESSMENT OF TUBAL PATENCY

Background: Investigations of tubal factor of infertility include hystero-salpingography, saline infusion sonohysterography as well as diagnostic laparoscopy with chromotubation. Hysterosalpingography (HSG) is a contrast study of the uterine cavity and fallopian tubes. Objective: To compare the role of laparoscopy and hysterosalpingograpy in the assessment of tubal factor of infertility. Patients and Method: This study was carried out on eighty patients attending the gynecology outpatient clinic of Al-HusseinHospital, Al-AzharUniversity. It included forty patients with primary infertility and forty patients with secondary infertility, all with minimum duration of one year after taking a written consent. complete laboratory investigation was done including CBC, PT, PTT, INR, HBV, HCV, HIV, Cr, Urea, ALT, AST. This study started at Oct 2017 and finished at Aug 2019. Results: Results of comparison of tubal patency assessment during Laparoscopy and its compatibility with previous hysterosalpingography results in case of female infertility were: In 55 cases that were diagnosed as free from tubal block by diagnostic laparoscopy {DL}, only 40 cases were confirmed by HSG (73.2%), while the other 11 cases were diagnosed as (2 cases bilateral block (4.9%), 4 cases Lt. block (9.8%), 3 cases minimal spill (7.3%) and 2 cases as Rt. Block (4.9%). In the 9 cases that were diagnosed as bilateral tubal block by DL, only 4 were confirmed by HSG (42.9%), while the other 5 cases were diagnosed free by HSG (57.1%). Twelve cases were diagnosed as unilateral tubal block by DL, 3 cases were confirmed by HSG, while 7 cases were diagnosed as free and one case was diagnosed as bilateral block by HSG. Peritubal adhesions were seen in 18.3% in all cases, of which 18.8% had Rt block, 27.3% had Lt block, and 54.5% had bilateral tubal patency. In 11 cases diagnosed as unilateral peritubal adhesion by DL, only 2 cases (Rt & Lt) were confirmed by HSG (39.3%). Fifty three cases were diagnosed as the Rt tube was free of adhesion by DL, 4 cases HSG were diagnosed as Rt peritubal adhesion (7.5%), while 56 cases were diagnosed as Lt tube free of adhesion by DL and 5 cases HSG were diagnosed as Lt peritubal adhesion (8.9%). Conclusion: Diagnostic laparoscopy has more accuracy in assessment of tubal patency in infertile patients more than hysterosalpingogram.

Safety of Lipiodol use for assessment of tubal patency and therapeutic tubal flushing – Fluoroscopy versus ultrasound?

Safety of Lipiodol use for assessment of tubal patency and therapeutic tubal flushing – Fluoroscopy versus ultrasound?

Lower Abdominal Pain During Office Hysteroscopy as a Guide in the Assessment of Tubal Patency in Infertile Women

Objective: to test the accuracy of pain score measuring on each side of the lower abdomen for diagnosis oftubal patency.Material and Method: 60 patients underwent Office hysteroscopy and pain score on each side of the lowerabdomen was measured during hysteroscopy using Visual Analogue Score. Transvaginal ultrasonographywas done after hysteroscopy to assess the presence of fluid in Douglas pouch. One week later, laparoscopywas done as a reference test for tubal patency.Results: Pain score was significantly higher on the side of lower abdomen if the respective tube was patent(p value &lt;.001). Area under ROC curve for the pain score test was 0.77 (95%CI: 0.85 to 0.9), p value &lt;0.001denoting good accuracy. The optimum cutoff for pain score to discriminate tubal patency was &gt;10 withsensitivity and specificity 79.8%and 93.6%, respectively.Conclusions: The pain score during hysteroscopy can be used to diagnose tubal patency. The optimumcutoff score is &gt;10.

Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques

To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. Prospective randomized clinical trial. From May to October 2019, women with subfertility undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate in the study. The primary outcome was accuracy of Fallopian tube patency relative to the gold standard of laparoscopic chromopertubation. Sixty women with subfertility. Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. Hysteroscopic prediction of fallopian tube patency was possible in a statistically significant manner in both study groups (p <0.05). The Parryscope technique achieved higher sensitivity (90.6%, 95% CI: 61.7-98.4) and specificity (100%, 95% CI: 90.0-100.0) than the flow technique (sensitivity: 73.7%, 95% CI: 48.8-90.9 and specificity: 70.7%, 95% CI: 54.5-83.9). Using the Parryscope technique to determine if air bubbles traverse the ostia can provide valuable additional information during hysteroscopy and is more accurate in predicting fallopian tubal occlusion than the flow method.

Advanced Imaging in Female Infertility.

This review highlights the role of imaging in the diagnosis and management of reproductive disorders. The additional information that imaging studies can contribute to reproductive medicine is emphasized, including the role of pelvic ultrasonography (US, including sonohysterography and contrast-enhanced hysterosalpingosonography), hysterosalpingography (HSG), and magnetic resonance imaging (MRI) of the female reproductive tract. In addition, the implications of congenital causes of infertility on the urinary tract in females are reviewed. While the evaluation of infertility in women is initially focused on the assessment of ovulation via serum hormone levels, imaging plays a role in evaluating other causes of infertility. Recent research in this field focuses on the establishment of a comprehensive single imaging study for the assessment of female reproductive disorders. Two proposed methods are MR hysterosalpingography and Fertiliscan, a combination of high-quality 3D ultrasound and assessment of tubal patency with hysterosalpingo-foam-sonography, though more research is needed to determine the risks and benefits of each method, as well as their reliability.

EP35.02: SonoVue® in hysterosalpingo‐contrast‐sonography (HyCoSy) for fallopian tubal patency assessment: a systematic review with meta‐analysis

EP35.02: SonoVue® in hysterosalpingo‐contrast‐sonography (HyCoSy) for fallopian tubal patency assessment: a systematic review with meta‐analysis

OP18.02: Hysterosalpingo‐contrast‐sonography for tubal patency assessment in patients with endometriosis

OP18.02: Hysterosalpingo‐contrast‐sonography for tubal patency assessment in patients with endometriosis

Comparative Study of Saline Sono Salpingography (SSG) and Laparoscopy with Chromopertubation in Evaluation of Tubal Patency

Background In the field of infertility, tubal factor has a great role. So the assessment of tubal patency belongs to the initial diagnostic tests in the work-up of an infertile woman. During the past few years, sonosalpingography has been suggested as the firstline method to study tubal patency. This comparative study of transvaginal saline SSG to the gold standard method of diagnostic laparoscopy with chromopertubation was performed for the assessment of tubal patency in infertile women.&#x0D; Methods At first thirty-four patients suffering from primary or secondary infertility were evaluated for tubal patency with sonosalpingography using a pediatric Foley urinary catheter using saline solution as a contrast medium. The uterine tubes were evaluated. One patient conceived and two patients denied before the scheduled laparoscopy. Ultimately they were excluded from the study. In the study, finally 31 patients were enrolled and the results of SSG were compared to the findings of laparoscopy and chromotubation performed independently.&#x0D; Results The findings of both methods agreed in 26 out of 31 tubes (concordance, 93.5%). The sensitivity of sonosalpingography in diagnosing tubal patency was 96.2% and the specifcity 80%. The positive predictive value for tubal patency by sonosalpingography was 96.29% and the negative predictive value 80%. Adverse events of sonosalpingography included mild abdominal pain in some patient. No infectious complications were recorded.&#x0D; Conclusions The results confirm that sonosalpingography using saline as a contrast medium is a reliable, simple and well-tolerated method to assess tubal patency in an outpatient setting. In addition, the procedure can be performed without prophylactic antibiotics.&#x0D; J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 52-58

Explorations de la perméabilité et des pathologies tubaires par imagerie

One of the greatest causes of hypofertility is tubal disease. Current methods of tubal patency assessment are hysterography, hysterosalpingosonography, with the gold standard laparoscopy. Hysterosalpingography is the only procedure that can see mucosal folds. Selective salpingography is used in proximal tubal occlusion. Pelvic inflammatory disease is the most current cause of tubal occlusion.

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

To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency. A prospective cohort study. 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. Seventy-two infertile women. Combined hysteroscopy and laparoscopy with chromopertubation. 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]). 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.

Hysteroscopic assessment of fallopian tubal patency by air bubble sign

Hysteroscopic assessment of fallopian tubal patency by air bubble sign