Laparoscopic Chromopertubation Research Articles

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study.

Although the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) has relatively good diagnostic accuracy for assessing the patency of the fallopian tubes, the evaluation process mainly relies on morphological findings of the fallopian tubes and pelvic cavity. The purpose of this study was to explore the relationship of peak injection pressure during 4D-HyCoSy and tubal patency to provide a quantitative indicator for the evaluation of fallopian tube patency. This study included infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation (LC) between 2020 and 2022, with LC serving as the reference test for assessing tubal patency. For the HyCoSy procedure, the ultrasound contrast agent was injected automatically using a liquid injection machine, and real-time pressure values were recorded. Patients were classified based on tubal patency status in LC as bilaterally patent, unilaterally patent, or bilaterally nonpatent. The average peak injection pressure and contrast agent volume of different groups were compared. Receiver operating characteristic (ROC) curve analysis was employed to determine the cutoff value. A total of 268 infertile patients were enrolled in the study. With LC as the standard examination, the sensitivity and specificity of 4D-HyCoSy in diagnosing nonpatent fallopian tubes were 91.1% and 95.1%, respectively. In general, peak injection pressure was observed to gradually increase as tubal patency decreased (P<0.001), with average peak injection pressures of 233.5±66.3, 338.8±99.8, and 469.6±63.1 mmHg in the bilaterally patent, unilaterally patent, and bilaterally nonpatent groups, respectively. The volume of contrast agent used in patients in the bilaterally nonpatent group was significantly lower than that in the other two groups (P<0.01), with average volumes of 22.7±6.3, 24.3±9.3, and 18.9±9.2 mL, respectively. When one fallopian tube was patent, the area under the curve (AUC) for distinguishing obstruction from patency of the other fallopian tube was 0.827, with a sensitivity of 79.8% and a specificity of 74.3% (cutoff value: 254.3 mmHg). Similarly, when one fallopian tube was nonpatent, the AUC was 0.866, with a sensitivity of 90.6% and a specificity of 78.3% (cutoff value: 401.3 mmHg). Peak injection pressure during 4D-HyCoSy demonstrates promising diagnostic performance in evaluating fallopian tube patency in infertile patients.

Efficacy of 2D/3D HyCoSy with new contrast medium lignocaine and saline comparing with HSG - A single centre prospective study

Tubal patency significantly impacts female infertility, with a substantial portion of cases linked to tubal damage. This hinders gamete and embryo transfer. While laparoscopic chromo-pertubation is the gold standard, its invasiveness prompts the search for alternatives. Common methods for assessing tubal health are Hysterosalpingography (HSG) and Hysterosalpingo Contrast Sonography (HyCoSy).The objective of this study is to assess and compare the efficacy of a budget-friendly 2D/3D HyCoSy method using a unique contrast agent with traditional HSG for diagnosing tubal patency in women with infertility issues.A prospective observational study was conducted within a single clinical setting over a five-year duration. A total of 117 infertile women underwent assessment using both the 2D/3D HyCoSy and HSG techniques.Participants had a mean age of 27.7 years (standard deviation: 4.2, range: 19-45 years). The diagnostic accuracy of 2D/3D HyCoSy was determined with a sensitivity of 91.86%, specificity of 89.18%, a positive predictive value of 90.40%, and a negative predictive value of 90.82%. Comparative analysis revealed that when evaluating tubal patency in both tubes collectively with HyCoSy, the sensitivity, specificity, and overall accuracy were 91.86%, 89.18%, and 90.59%, respectively. The study findings demonstrated that employing 2D/3D HyCoSy with lignocaine gel proved to be a superior diagnostic approach compared to HSG for assessing tubal patency in women experiencing infertility.

Role of Doppler Saline Sonosalpingography in Evaluation of Tubal Factors in Women with Infertility: A Cross-sectional Study

Introduction: The contribution of tubal factors to infertility is up to 30%. One of the tests used to evaluate tubal factor infertility is Doppler saline Sonosalpingography (SSG). The basic principle of SSG is to distend the uterine cavity with isotonic saline, which helps identify the uterine contour, intrauterine pathology, endometrial thickness and the presence of fluid in the Pouch of Douglas (POD). Adding Doppler increases its efficiency and accuracy. Aim: To ascertain the role of Doppler saline SSG in tubal infertility. Materials and Methods: This cross-sectional study was done for 18 months in the Obstetrics and Gynaecology Department of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India involving 200 women with either primary or secondary infertility. These women were recruited in the midfollicular phase after obtaining written informed consent. Patients underwent Doppler SSG to assess tubal patency and the findings were compared with Diagnostic Hysterolaparoscopy (DHL). Diagnostic tests were used to calculate sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Inter-rater kappa agreement was used to find out the strength of the association between Doppler Saline SSG and diagnostic laparoscopy. A p-value of less than 0.05 was considered significant. The data was entered into an MS Excel spreadsheet and analysis was done using the licensed version of Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age and mean duration of infertility were reported to be 29 years and five years, respectively. The sensitivity of Doppler SSG for tubal patency was reported as 85.4%, the specificity as 95.8%, PPV as 95.3%, NPV as 86.8% and the accuracy for tubal patency was 90.6%. Doppler SSG and laparoscopic chromopertubation findings had substantial association (k value -0.62). Conclusion: Doppler SSG is a reliable method for the assessment of tubal factors and can be used as a screening modality with high sensitivity and specificity.

Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility.

Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress.

Diagnostic accuracy of hysterosalpingo-lidocaine-foam sonography combined with power Doppler (HyLiFoSy-PD) compared to laparoscopy and dye testing in tubal patency assessment in cases of infertility

BackgroundTubal patency testing is an essential part of female subfertility evaluation. Hysterosalpingogram is less invasive and less expensive compared to laparoscopy and dye testing (LDT), i.e., laparoscopic chromopertubation. Hysterosalpingo-foam sonography (HyFoSy) uses commercial echogenic gel foam that is easily visible on ultrasound to assess the tubes. It offers a safer and less painful alternative to HSG, with no radiation exposure. Hysterosalpingo-lidocaine-foam sonography with power Doppler (HyLiFoSy-PD) uses lidocaine-made gel foam as a contrast medium. It was postulated to as to be less painful and easier to detect on ultrasound, compared with hysterosalpingo-foam sonography using other contrast media and that it can also be used whenever the commercial gel used with HyFoSy is not available or is relatively expensive.MethodologyThis prospective diagnostic accuracy study was carried out between February 2018 and 2020 at the Cairo Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University. One hundred twenty-two infertile patients, who were already scheduled for LDT as a part of their infertility work-up, were consecutively recruited for this study. The HyLiFoSy-PD (index test) was performed 1 week before the scheduled LDT for these patients. Using an intrauterine pediatric Folley’s balloon catheter, 20 ml of lidocaine-made gel foam was slowly infused intrauterine, while observing their flow in both fallopian tubes using a grayscale and power Doppler transvaginal two-dimensional ultrasound system. All patients then underwent LDT (reference test). The results of HyLiFoSy-PD were compared with those of LDT to determine the accuracy of HyLiFoSy-PD in tubal patency assessment. We also assessed the procedure duration, associated pain, and other complications.ResultsComparing HyLiFoSy-PD with LDT in the 115 patients who completed the procedure, results showed 98.1% sensitivity, 90% specificity, 99% positive predictive value, 81.8% negative predictive value, 9.81 positive likelihood ratio, 0.02 negative likelihood ration, and 97.4% overall accuracy in the assessment of tubal patency (odds ratio = 463.5 with confidence interval = 79.39–2706; P-value: 0.687). The median procedure duration was 11 min. All patients experienced some degree of pain during the procedure with 91 patients (79%) reported mild pain and 24 patients (21%) reported moderate pain.ConclusionHyLiFoSy-PD was found to be an accurate tool in tubal patency assessment. It was also found to be safe and well-tolerated.

The Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study.

There are limited data on how non-infectious risk factors influence tubal patency in women with subfertility. With hormonal shifts influencing tubal secretions, it has been argued that subfertile women with polycystic ovary syndrome (PCOS) have lower tubal patency. In a retrospective study, 216 women, who underwent diagnostic evaluation for PCOS and infertility, were included. Fallopian tube patency was tested using HSG, HyCoSy, and laparoscopic chromopertubation in 171 (79.2%), 28 (13.0%), and 17 (7.9%), respectively. Bilateral patency was found in 193 women (89.4%), unilateral patency in 13 (6.0%) and bilateral occlusion in 10 (4.6%) patients. Women with PCOS phenotypes C (odds ratio, OR 0.179, 95% CI: 0.039–0.828) and D (OR 0.256, 95% CI: 0.069–0.947) demonstrated lower risks for Fallopian tube occlusion. In conclusion, our data suggest that about 5% of infertile women with PCOS also have bilateral tubal occlusion, which seems similar to the rate in non-subfertile women. With 11% of participants having unilateral or bilateral tubal occlusion, this should reassure women with PCOS that their hormonal challenges do not seem to increase their risk for tubal factor subfertility.

Are the Stage and the Incidental Finding of Endometriosis Associated with Fallopian Tube Occlusion? A Retrospective Cohort Study on Laparoscopic Chromopertubation in Infertile Women.

Endometriosis seems to have a strong negative effect on female fertility. The aim of this study was to assess the rate of tubal occlusion diagnosed via laparoscopic chromopertubation in infertile women with endometriosis and compare the results to infertile women without endometriosis. In this retrospective cohort study, 275 infertile women with endometriosis and 49 infertile women without endometriosis undergoing diagnostic laparoscopy for primary or secondary infertility with chromopertubation at the Medical University of Vienna between January 2012 and December 2020 have been investigated. During the laparoscopic assessment of tubal patency, significantly more fallopian tubes were occluded in the endometriosis group compared to the control group (25.8 versus 15.3%; p = 0.029). Unilateral and bilateral occlusion was found significantly more often in patients with endometriosis (p = 0.021). In the multivariate analysis, only the rASRM stage (the revised classification of endometriosis by the American Society for Reproductive Medicine) showed a significant association with bilateral occlusion (OR 1.400, 95%CI: 1.018–1.926; p = 0.038). Both a higher rASRM stage (OR 2.181, 95%CI: 1.191–3.995; p = 0.012) and secondary infertility (OR 1.514, 95%CI: 1.156–1.983; p = 0.003) were associated with an increased risk for any kind of fallopian tube occlusion. Endometriosis seems to be associated with an increased risk for fallopian tube occlusion. The rate of tubal occlusion increased significantly with the rASRM stage.

Fallopian tube patency diagnosed by laparoscopic chromopertubation in women with polycystic ovarian syndrome and non-subfertile controls: a retrospective case-control study

Background: Hyperandrogenism has been associated with tubal dysfunction. Previous studies have not used non-subfertile controls when assessing hyperandrogenic women through laparoscopic chromopertubation (LC), the gold standard for tubal patency testing. Methods: The objective of this retrospective study was to compare the results of LC between women with medication-resistant anovulatory polycystic ovary syndrome (PCOS, n = 202) and non-subfertile women with ovarian cysts (controls, n = 48). Results: There were no statistically significant differences between PCOS women and controls for the prevalence of bilateral tubal occlusion (2.5% versus 4.2%, respectively; p = 1.000) or overall rates for occlusion (7.4% of tubes assessed versus 6.3%, respectively; p = 0.828). More PCOS patients needed high pressure chromopertubation to demonstrate bilateral tubal patency than controls (12.4% versus 2.1%; p = 0.036). In the PCOS group, patients needing higher pressure to achieve patency demonstrated higher testosterone levels than women requiring typical pressure (0.66 ± 0.17 versus 0.47 ± 0.24 ng/mL; p = 0.001). Conclusions: For women with ovarian cysts and without subfertility, six percent of all Fallopian tubes are occluded. PCOS patients have similar rates of tubal occlusion, making these women a reasonable but more available control group for LC studies. Higher total testosterone levels were associated with higher LC pressures to demonstrate bilateral patency.

Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know.

Impaired tubal patency accounts for up to 35% of cases of subfertility and infertility. Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) represents a first-line test in evaluating fallopian tube patency. Despite the association of HSG with ionizing radiation, HSG is a reference standard in assessing fallopian tube patency and tubal conditions such as tubal occlusion, salpingitis isthmica nodosa, and hydrosalpinx. HSG is widely available and utilizes either a water-soluble contrast medium (WSCM) or an oil-soluble contrast medium (OSCM). Compared with WSCM, HSG with OSCM results in a higher incidence of non-in vitro fertilization pregnancies and, therefore, may be preferred in women younger than 38 years with unexplained subfertility. HSG may also be helpful in assessment after sterilization or before fallopian tube recanalization. US-based tubal tests are free of ionizing radiation and include HyCoSy, with either air-saline or microbubble US contrast material, and hysterosalpingo-foam sonography (HyFoSy), a tubal patency test that utilizes a gel foam. A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion sonohysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromopertubation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care. Online supplemental material is available for this article. ©RSNA, 2021.

Decreased occurrence of endometriosis in women with Chlamydia trachomatis infection.

Despite abundant reports on the risk role of uterine outflow tract obstruction in endometriosis, information on the occurrence of endometriosis in women with Chlamydia trachomatis infection causing fallopian tube obstruction is unknown. We investigated the role of Chlamydia trachomatis infection with or without fallopian tubal patency in the occurrence of endometriosis. This is a retrospective case-controlled cohort study with 539 women who had laparoscopic surgery for several indications during the period between January, 2003 and June, 2010. Women with ectopic pregnancy, uterine anomaly, chromosomal abnormality, primary amenorrhea, and perimenopausal women were excluded. Endometriosis was diagnosed by laparoscopic inspection and confirmed by histopathology. Tubal patency was diagnosed by HSG or laparoscopic chromopertubation test. Presence of chlamydia infection was examined by RT-PCR and serological test. Two-hundred and seven women were enrolled. Eighty-six (41.5%) women had chlamydia infection. Tubal patency and occurrence of endometriosis were significantly decreased among women with chlamydia infection comparing to women without it (P=.005 and P=.0008, respectively). Even among women with patent tube, laparoscopic detection of endometriosis was significantly decreased in chlamydia infected comparing to non-infected women (P=.02). Multiple logistic regression model revealed that previous history of chlamydia infection significantly decreased the occurrence of endometriosis, and was independent of age, menstrual status, parity and tubal patency (odds ratio .44; 95% confidence interval .24-.80; P=.007). A decreased occurrence of peritoneal endometriosis was observed in women with Chlamydia trachomatis infection. The possible impairment of retrograde menstrual flow by chlamydia-infected tubal damage may decrease the risk of endometriosis.

The sensibility and specificity of 3D/4D HyCoSy to evaluate tubal patency in clinical setting

Aim. The objective of this study was to evaluate the performance of 3D/4D hysterosalpingo-contrast sonography (HyCoSy) for the assessment of tubal permeability in the infertile patient. Methodology. Tridimensional HyCoSy was performed in a lot of 21 patients diagnosed with primary or secondary infertility, who were referred to our clinic for diagnostic laparoscopy between January and June 2019. Diluted SonoVue® was injected through a 6-8 Fr Foley catheter in the uterine cavity a day before the surgical act. The flow and the spillage of the contrast medium around ovary were recorded using 4D and 3D volumes, and the data were saved for later analysis. The sonographer and the surgical team were blinded regarding patients’ identity and the ultrasound results. The results and the duration of the procedures were noted and compared. Results. Thirty-nine salpinges were evaluated (three previous salpingectomies, two for ectopic pregnancy, one hydrosalpinx), and the overall accordance between 3D/4D HyCoSy and laparoscopic chromopertubation was 84.61%. The sensibility to identify a patent tube was 93.13% and the specificity was 60%. The positive and negative predictive values were 87.1% and 75%, respectively. Conclusions. Hysterosalpingo-contrast sonography using 3/4D acquisition and contrast software is a useful procedure to evaluate tubal patency.

Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

Tubal diseases are responsible for 25% to 35% of female infertility. Laparoscopic chromopertubation is the gold standard for assessing tubal patency when female infertility is suspected. Intravasation is a complication of intrauterine procedures involving the passage of fluid filling the uterine cavity into the bloodstream through endometrial vessels (from the myometrial veins to the uterine venous plexuses). This complication has been described during hysterosalpingography and sonohysterosalpingography. We herein present a report of three cases in which severe intravasation occurred during laparoscopic chromopertubation using methylene blue as a contrast agent. The intravasation manifested as green urine (i.e., the “green urine sign”). The presence of methylene blue in the urine and blood was confirmed by laboratory tests. All three patients had risk factors for intravasation as described in the literature (unilateral or bilateral tubal obstruction, endometriosis, and previous intrauterine procedures for Mullerian duct anomalies and Asherman’s syndrome). The green urine sign appeared a few hours after laparoscopic chromopertubation and spontaneously resolved after 24 hours. Cystoscopy was performed to rule out bladder injury. All three patients required only clinical observation.

Comparison of Hysterosalpingography and Laparoscopy as Diagnostic Tool for Tubal Infertility in Bangladesh

Background: Tubal evaluation is an integral part of the evaluation of female infertility. Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes, which has been used as a first-line test for tubal assessment since 1920s. Laparoscopy is considered to be the gold standard for the diagnosis and management of tubo-peritoneal pathology. The objective of this study is to evaluate and compare the diagnostic value of both HSG and laparoscopy for assessment of tubal occlusion. Methods: This is a prospective cross-sectional study. Laparoscopic chromopertubation was conducted on 125 consecutive infertile women who attended the “Infertility Management Center” from October 2018 to September 2019. All patients had HSG performed in the radiology department of different hospitals. Laparoscopic findings were used as a reference standard to analyze the findings of HSG for tubal occlusion. Data were analyzed by SPSS software (version 16). Results: Normal HSG findings were seen in 53 patients (42.4%). Unilateral tubal occlusion was present in 38 (30.7%), and bilateral occlusion in 34 (27.2%) patients. Laparoscopy showed normal findings in 85 (68.0%) patients. Unilateral tubal occlusion was demonstrated in laparoscopy in 27 (21.6%) and bilateral tubal occlusion in 13 (10.4%) patients. HSG findings for diagnosis of tubal occlusion was true positive in 30 (24%) cases, false positive in 42 (33.6%) cases, false negative in 10 (8%) cases, and true negative in 43 (34.4%) cases in comparison to laparoscopy findings. Sensitivity of HSG was found to be 75.0%, specificity 50.6%, and accuracy 58.4%. Positive predictive value and negative predictive value were 41.7% and 81.1%, respectively. Conclusion: HSG is widely used for tubal assessment in Bangladesh as it is a relatively inexpensive, low-risk office procedure. But it has a low specificity and positive predictive value with a relatively high negative predictive value. Laparoscopy, on the other hand, is preferable when there is high suspicion of tubal pathology.

A two-third majority of infertile women exhibit endometriosis in pre-ART diagnostic hysteroscopy and laparoscopic chromopertubation: only one-third have a tubal obstruction.

This study was undertaken to evaluate the prevalence of endometriosis in infertile women of couples with non-male factor infertility. A retrospective validation analysis was carried out of consecutive women of infertile couples with non-male factor infertility who received combined diagnostic hysteroscopy and laparoscopy, in the period from January 2017 to August 2019 in the Department for Gynecology and Reproductive Medicine (n = 300). Type, stage and site of endometriosis were assessed and matched with the occurrence of tubal stenosis. Binary regression analysis was used to estimate the prevalence of endometriosis. Endometriosis was diagnosed in 67% (n = 201). Primary infertility (OR 1.76; p = 0.036), dysmenorrhea (OR 2.47; p = 0.002), and a shorter cycle length (OR 0.972; p = 0.036) were independent risk factors for detection of endometriosis in diagnostic hystero-laparoscopy. The most frequent endometriosis sites were pelvic side wall (53.2%) and uterosacral ligaments (41.8%). Patients with endometriosis showed less often a tubal occlusion (34.32% vs. 41.4%; p = 0.205) and presented a lower rate of bilateral obstruction (9.5% vs. 18.8.%, p = 0.024). Women with endometriosis of a Fallopian tube showed a higher rate of tubal occlusion on the same side (right side p = 0.002; left side p = 0.001). Patients with rASRM score III showed the highest rate of tubal obstruction. The prevalence of endometriosis in infertile women was higher than expected. The indication for operative infertility diagnostics by minimal invasive techniques should be made much more generous as well as the complete clarification of the causes of female infertility.

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.

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.

The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility.

Background and Objectives:The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility.Methods:We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation.Results:In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727).Conclusion:Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.

Accuracy of a new hysteroscopic method in the assessment of tubal patency: Hysteroscopic Chromotubation

ObjectiveThe aim of this study was to evaluate the diagnostic accuracy of hysteroscopic chromopertubation (HCT) in the assessment of tubal patency by comparing its results with laparoscopic chromopertubation (LCT).Study DesignThe population of this prospective cohort study consisted of both fertile and infertile women. Sixty-four women were included to the study. HCT was assessed by the observation of the transport of highly concentrated methylene blue from uterine cavity to tubal ostia. The results of HCT were compared with the results of LCT as a gold standard. The accuracy of HCT, sensitivity, specificity, positive and negative predictive values in diagnosing tubal patency were calculated.ResultsThe results of HCT and LCT were evaluated for right and left tubes, separately. One hundred and twenty-eight tubes were determined. Sensitivity, specificity, positive and negative predictive values for HCT were; 85.85%, 59.09%, 91% and 46.43%, respectively.Conclusion This study’s result showed that HCT had high sensitivity and moderate specificity values in the assessment of tubal patency. HCT during office hysteroscopy could give the chance to practitioners to assess tubal patency without subjecting the patient to multiple procedures.

Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility

It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI.Impact statementWhat is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy.What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012).What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.

Assessment of tubal fimbria patency by combination of transvaginal four-dimensional hysterosalpingo-contrast sonography with uterine tubal liquid poking

Objective To investigate the clinical value of combination of transvaginal four-dimensional hysterosalpingo-contrast sonography(TVS 4D-HyCoSy) with uterine tubal liquid poking in assessment tubal fimbria patency. Methods Sixty-two female infertile patients with obstruction at tubal fimbria, or partial obstruction with pelvic adhesion were included.All of them were underwent 4D-HyCoSy as well as uterine tubal liquid poking, and were followed with laparoscopic chromopertubation (LPC) using Methylene blue in three months. Results Comparing with laparoscopy, the total coincidence rate of 4D-HyCoSy to assess the tubal fimbria patency was 94.3%, with the sensitivity of 90.1% and specificity of 94.1%. Imaging results showed that the obstruction at tubal fimbria, uncircle-like wrapping contrast medium can be seen around ovary accounted for 80%. The patent fallopian tube fimbria, circle-like wrapping of contrast medium can be observed around ovary accounted for 85.5%. Conclusions The combination of TVS 4D-HyCoSy with uterine tubal liquid poking is highly in accordance with LPC by providing real-time dynamic visualization on overflowing of contrast medium from tubal fimbria, as well as the pelvic adhesion surrounding ovaries. The 4D-HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesion surrounding ovaries with its advantages of accuracy, non-invasion and a good safety profile. Key words: Ultrasonography, three-dimensional; Hysterosalpingography; Fallopian tubal patency tests