Tubal Patency Test Research Articles

Laparoscopic salpingotomy using the floseal hemostatic sealant in patients with tubal pregnancy.

To present our initial experience with laparoscopic salpingotomy using the Floseal™ (Baxter International Corp., Deerfield, IL) hemostatic matrix for tubal pregnancy and to evaluate the efficacy and tubal patency after salpingotomy. A prospective study was conducted on 20 consecutive patients with tubal pregnancy undergoing laparoscopic salpingotomy using the Floseal hemostatic matrix. The outcome measures were treatment success rates and homolateral patency rates. Of 20 cases, 19 cases (95%) were successfully performed without any additional intervention, and 1 case was switched to salpingectomy during the initial surgery. During the mean β-human chorionic gonadotropin resolution time of 17.9±6.4 days, postoperative complications or persistent trophoblasts did not occur. Of 19 salpingotomy patients, only 12 patients received a tubal patency test using hysterosalpingography, and the homolateral tubal patency rate was 75% (9 of 12). The use of Floseal allows laparoscopic salpingotomy to be performed successfully and easily with comparable outcomes.

Hysterosalpingo-foam sonography, a less painful procedure for tubal patency testing during fertility workup compared with (serial) hysterosalpingography: a randomized controlled trial

To determine whether hysterosalpingo-foam sonography (HyFoSy) is a less painful first line tubal patency test than serial hysterosalpingography (HSG). A two-center, prospective, open-label, randomized, controlled trial. University hospital and teaching hospital. 40 subfertile women, ages 18 to 41years, with an indication for tubal patency testing as part of the fertility workup according to the Dutch Nederlandse Vereniging voor Obsteterie & Gynaecologie-guidelines. Tubal patency testing by HyFoSy versus serial HSG. Visual Analogue Scale (VAS) pain scores during tubal patency testing. The median VAS score for pain perception during the HyFoSy procedure was 1.7cm (interquartile range: 2.1) compared with 3.7cm (interquartile range: 4.2) during HSG. The HyFoSy procedure also had a statistically significantly shorter procedure time compared with HSG, with a median of 5.0minutes (interquartile range: 3.0) for HyFoSy versus 12.5minutes (interquartile range: 16.0) for HSG. The HyFoSy procedure is a less painful and less time-consuming tubal patency test compared with HSG. Netherlands National Trial Register NTR3457.

Select and treat at laparoscopy and dye test improves the spontaneous pregnancy

Infertility affects 1 in 7 couples in the UK. Tubal patency tests are an important part of infertility investigations. We conducted this observational study to determine the interval between a laparoscopy and dye test and spontaneous conception in women with unexplained infertility and minimal to mild endometriosis and pelvic adhesions treated during the procedure. The clinical records of 432 women coded as having had a laparoscopy and dye test or laparoscopy and tubal patency test between April 2007 and March 2010 were retrieved from a computerised theatre database. Pregnancies were identified through a computerised maternity booking system. Spontaneous pregnancies were recorded in 162 women following surgery (37.5%). There was a significant difference in conception rates between women with unexplained infertility and those with minor abnormalities treated at the time of diagnosis (43% vs. 58%, p = 0.019). Eighty percent of women who conceived spontaneously achieved their pregnancy within 18 months of surgery. A high proportion of women with unexplained infertility or minor abnormalities treated at the time of a laparoscopy and dye test conceived spontaneously within 12 months.

Definition and epidemiology of unexplained infertility.

The diagnosis of unexplained infertility can be made only after excluding common causes of infertility using standard fertility investigations,which include semen analysis, assessment of ovulation, and tubal patency test. These tests have been selected as they have definitive correlation with pregnancy. It is estimated that a standard fertility evaluation will fail to identify an abnormality in approximately 15% to 30% of infertile couples. The reported incidence of such unexplained infertility varies according to the age and selection criteria in the study population. We conducted a review of the literature via MEDLINE. Articles were limited to English-language, human studies published between 1950 and 2013. Since first coined more than 50 years ago, the term unexplained infertility has been a subject of debate. Although additional investigations are reported to explain or define other causes of infertility, these have high false-positive results and therefore cannot be recommended for routine clinical practice. Couples with unexplained infertility might be reassured that even after 12 months of unsuccessful attempts, 50% will conceive in the following 12 months and another 12% in the year after.

The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques

Key content The pathogenesis of infertility is multi‐factorial; investigative and treatment approaches should therefore be individualised. There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function. There is often a clear need for in vitro fertilisation (IVF) in the management of infertility. This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART). Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans‐vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency. To understand the role of Chlamydia trachomatis serology in tubal patency testing. To evaluate the role of tubal patency test in the hierarchy of investigations for infertility. To understand the role of tubal surgery in modern management of infertility. To understand the importance of medical history taking in infertility. Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception. Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF? There may be psychosocial issues or anxiety so a multidisciplinary approach is important.

Editorial

Editorial

Review of lipiodol treatment for infertility – an innovative treatment for endometriosis‐related infertility?

A lipiodol hysterosalpingogram was the routine test for tubal patency as recently as the 1970s. Observational studies, then randomised controlled trials, provided evidence of a fertility enhancing effect of lipiodol. It has been found to improve fertility for women with normal tubal patency, particularly where the woman has a history of endometriosis. Previous successful treatment for infertility with lipiodol is a marker of further successful treatment for infertility in a repeat procedure. Whilst lipiodol is probably effective at flushing debris that could hinder fertility from fallopian tubes, it also exerts immunobiological effects in pelvic peritoneum and on the endometrium that could be responsible for fertility enhancement. Effects of lipiodol on the endometrium that might be important at the time of the implantation window are a reduced expression of osteopontin and an increased number of uterine natural killer cells postlipiodol. The effect of lipiodol uterine bathing for women with endometriosis, repeat in vitro fertilisation (IVF) implantation failure and other reproductive disorders merits further investigation. Lipiodol presents a new, simple, low invasive, inexpensive treatment option for endometriosis-related infertility and might have wider applications.

First Experiences with Hysterosalpingo-Foam Sonography (HyFoSy) for Office Tubal Patency Testing

First Experiences with Hysterosalpingo-Foam Sonography (HyFoSy) for Office Tubal Patency Testing

The basic fertility workup in women with polycystic ovary syndrome: a systematic review

To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems. Systematic review. Not applicable. The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant). Performance of a semen analysis or tubal patency test before or during treatment. Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests. Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available. Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.

Use of Gaseous Spring Water for Tubal Patency Test

Brief Description of the Purpose of the StudyThe purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure.MethodsThis technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube.Main ResultsOut of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes.Importance of the ConclusionsThe Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women. Brief Description of the Purpose of the StudyThe purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. The purpose of this study was to try Gaseous Spring water as an alternate contrast agent in Tubal Patency test which would be easily available and to reduce the cost of the procedure. MethodsThis technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. This technique is common to all procedures, regardless of the contrast agent chosen. A balloon catheter is preferred as it is less likely to dislodge and creates a better seal at the internal cervical os. Following the insertion of the catheter, the speculum is removed and the transvaginal ultrasound probe reinserted. Under Ultrasound control about 5-10 CC of echo-enhancing agent ie gaseous spring water is inserted very slowly so that Micro Air bubbles are not destroyed. Tubal patency was assessed by direct imaging of micro air bubbles at the Cornual end and by seeing the bubble constantly moving at the Cornual ean of 5 to 10 seconds to made the diagnosis of patent tube. Main ResultsOut of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Out of 360 patients examined by gaseous spring water 288 patients i.e. 80% were found to have bilateral Patent Tubes. Importance of the ConclusionsThe Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women. The Tubal Patency assessment with gaseous spring water was found to be cost effective, safe, easily available and less time consuming then HSG. It is recommended that spring water should be used to check tubal patency in sub fertile women.

Use of Gaseous Spring Water for Tubal Patency Test

Use of Gaseous Spring Water for Tubal Patency Test

Role of Hysterosalpingosonography in Diagnosing Pyosalpinx

The purpose of the study was to distinguish hydrosalpinx/pyosalpinx from other adnexal masses by hysterosalpingosonography(HSS) using spring water. Here we report a case of 30 years old female who presented with complains of secondary infertility, previous two ultrasounds done showed endometriotic cyst/ T.O. mass. Since she had secondary infertility the gynaecologist wanted to know the status of her tubes hence advised tubal patency test. On ultrasound we found a complex mass on left side predominantly cystic with internal echoes and some solid tissue at the periphery measuring 9.0 x 8.0 cms. She was than subjected to HSS(hysterosalpingosonography) with spring water(a new technique) for testing her tubal patency. HSS was done using spring water for testing her tubal patency and comet tail artifact of spring water were seen spurting out into the mass from the interstitial end of uterus confirming the diagnosis of pyosalpinx. This was further confirmed on laproscopy. Paper will highlight the entire procedure recorded on videotape at our centre and will show the moving micro air bubbles into the adnexal mass(pyosalpinx) which was initially thought to be endometriotic cyst/ T.O. mass.

Automated three‐dimensional coded contrast imaging hysterosalpingo‐contrast sonography: feasibility in office tubal patency testing

To evaluate the feasibility of transvaginal hysterosalpingo-contrast sonography (HyCoSy) with new automated three-dimensional coded contrast imaging (3D-CCI) software in the evaluation of tubal patency and visualization of tubal course. Patients undergoing HyCoSy with automated 3D-CCI software were evaluated prospectively. First, to evaluate the feasibility of 3D visualization of tubal course, we performed consecutive volume acquisitions while injecting SonoVue contrast agent. We then performed conventional two-dimensional (2D) real-time HyCoSy to confirm tubal patency status by detection of saline and air bubbles moving through the Fallopian tubes and around the ovaries. We also evaluated visualization with CCI of the contrast agent around the ovaries, side effects and pain during and after the procedure, by visual analog scale (VAS) (ranging from 0 to 10, with 0 corresponding to no pain and 10 corresponding to maximum pain). A total of 126 patients (252 tubes) underwent 3D-CCI HyCoSy followed by 2D real-time HyCoSy. According to the final 2D real-time evaluation, bilateral tubal patency was observed in 111 patients, bilateral tubal occlusion in four patients and unilateral tubal patency in 11 patients. The concordance rate for tubal patency status between the first 3D volume acquisition and the final 2D real-time evaluation was 84% and that between the second 3D volume acquisition and the final 2D real-time evaluation was 97%. A pain score >5 on VAS was recorded in 58% of patients during the procedure, but a pain score ≤ 5 was recorded in 85.7% of patients immediately after the procedure. HyCoSy with automated 3D-CCI technology retains the advantages of conventional 2D HyCoSy while overcoming the disadvantages. 2D HyCoSy is highly observer-dependent and is only accurate in the hands of experienced investigators; by obtaining a volume of the uterus and tubes, automated 3D volume acquisition permits visualization of the tubes in the coronal view and of the tubal course in 3D space, and should allow less experienced operators to evaluate tubal patency status relatively easily.

Tubal patency tests: cost effective in subfertile women?

Tubal patency tests: cost effective in subfertile women?

Cost‐effectiveness of tubal patency tests

Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL.

Intra uterine insemination an experience in rural population

Objective:1) To find out efficacy of various ovulation induction protocols in IUI 2) To find out the efficacy of IUI in treatment of infertility Method: All infertility patients of our OPD underwent a standard investigation protocol The infertility work-up included patients’ history, physical examination, conformation of ovulation by follicular monitoring, tubal patency test by diagnostic laparoscopy, and semen analysis of male partner & PCT. All women underwent a standard treatment protocol that included either natural cycle or ovulation induction to achieve superovulation by clomiphene citrate alone, or combined with gonadotrophins. Follicula monitoring using transvaginal sonography was done from D6-8 onwards and all women were given injection Human chorionic gonadotrophin 5000 U for LH surge when the dominant follicle was ≥18 mm. IUI was Performed at 18 hours and 40 hours from the time of HCG injection. Semen for IUI was prepared by the standard Swim Up technique, or by the Density Gradient method. Progesterone (Transvaginal micronized progesterone 200mg/day) for luteal phase support for 14 days following IUI was given to patients who were affording. Results: Majority of couples were having primary infertility (60.97%) Patients of secondary infertility were of 39.03% only. In our study only 11.82% patients were having multiple factors contributing to infertility. Male factor was in 42.59% of couples as against 30.34% of couples were having only anovulation as causative factor for infertility. Unexplained infertility was present in 13.82% patients only. The outcome variable for success of IUI was occurrence of pregnancy. This was defined by delay in menses associated with presence of positive pregnancy test or a detectable rise in serum beta HCG levels. In our study overall pregnancy rate per cycle was 8.01% & per couple it was 21.65%. Per cycle fecundity according to the factor responsible for infertility, the highest success rate was observed in cervical factor (33.33%). For male factor it was 7.74% and for combined factors overall it was 5.92%. Out of 152 pregnancies that occurred during study 108 had Full Term live birth of the baby (71.05% Miscarriage was there in 9.87% patients only. Only three patients had multiple pregnancies (1.97%) and one patient had ectopic pregnancy. Per cycle fecundity was little better in patients with only anovulation( 10.51%). When we compared various regimen used for ovulation induction for IUI we found that though percentage of pregnancies achieved by Low dose HMG either with (13.89%) or without Clomiohene (15.58%), pregnancy rate achieved with clomiphene alone was 7.43% . This was promising at low affordable cost. In our study, we achieved 40.13% pregnancy with second attempt and collectively with first two attempts pregnancy rate achieved was 71.71%.

The Use of a New Gel Foam for the Evaluation of Tubal Patency

Aims: To evaluate the feasibility and the reliability of hysterosalpingo-foam sonography (HyFoSy) using gel foam in the assessment of tubal patency. Methods: Nonrandomized, observational, academic and single-center study of 20 women being investigated because of subfertility and scheduled for a laparoscopy with chromopertubation. A detailed description of HyFoSy with a newly developed gel foam is given in the way it proved to be most efficient in our hands. The results of HyFoSy are compared to the data regarding tubal patency testing during laparoscopy by chromopertubation. Results: All 20 HyFoSy were technically successful. Four of the 40 tubes, 1 right tube and 3 left tubes, were not patent at HyFoSy (3 tubes with proximal block and 1 tube with distal block). There was a 100% agreement between tubal patency data according to HyFoSy testing and laparoscopic chromopertubation testing. Conclusion: HyFoSy is both feasible and accurate in the diagnosis of tubal patency.

The Prognostic Value of Tubal Patency Test After Medical Treatment of an Ectopic Pregnancy

Background : Ectopic pregnancy (EP) is defined as the abnormal implantation of the blastocyst outside the uterine endometrium. The most common site of implantation is the Fallopian tube. The effect of different management strategies on subsequent fertility following tubal ectopic pregnancy is unknown. Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. The aim of this study is to evaluate the tubal patency after successful medical treatment of an un-ruptured tubal ectopic pregnancy with systemic methotrexate (MTX). M ethods: This is an observational retrospective study carried out on 72 women diagnosed as un-ruptured tubal ectopic pregnancy. Systemic treatment with a single dose methotrexate (50 mg/m 2 intramuscularly) was used for 32 women and 40 cases underwent surgery. Hysterosalpingography (HSG) was performed on 30 patients (successfully managed with methotrexate) and 40 cases that underwent unilateral salpingectomy (as initial treatment). Results: The medical treatment with single dose MTX for EP was effective (93.8%) as a primary treatment. In the MTX group, the HSG findings from the ipsilateral tube showed that 83.3% the diseased tubes were open and 16.7% were obstructed. The contralateral tube was patent in 93.3% and obstructed in 6.7%. In salpingectomy group the contralateral tube was patent in 82.5% and obstructed in 17.5%. Conclusion: For an un-ruptured tubal EP, the medical treatment with MTX is effective. Routine HSG following medical treatment does not seem necessary but might be considered in selected risk cases. doi: http://dx.doi.org/10.4021/jcgo48w

Laparoscopic Evaluation of Tubal Factors in Case of Patients With Sub Fertility

In this prospective study was carried out in the department of Obstetrics and Gynaecology (infertility) Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period of September 2010 to February 2011. For this purpose total number of 80 female partner of subfertile couples undergoing laparoscopy in the above centre. Patients have been evaluated in the infertililty out patient department with the detailed history of both husband and wife and also evaluated clinically. Patient suffering from both primary and secondary subfertility have been included in this study with the inclusion criteria women age 20-40 years. Male partners having normal semen analysis. Female partner tried unsuccessfully for 1 year and female partner having any pelvic pathology suggest by history and physical examination. They are selected for the diagnostic laparoscopy. Laparoscopy findings will be carefully recorded and showing in primary subfertility normal looking 30 (55.5%), peritubal adhesion 8(14.8%), signs of endometriosis 10 (18.5%), hydrosalphinx 6(11.1%) and in secondary subfertility normal looking 10(38.5%), peritubal adhesion 4(15.4%), signs of endometriosis 4(15.4%), hydrosalphinx 8(30.8%). In this study normal looking fallopian tube is more common in primary subfertility and hydrosalphinx is more common in secondary subfertility. Laparoscopic evaluation of fallopian tube among the patient with primary subfertility showing the condition of the fimbria normal looking 50 (92.6%), indrowing 2(3.7%), not visualized fimbria 2(3.7%) and in secondary subfertility normal looking 18(69.2%), indrowing 6 (23.1%), not visualized fimbria 2(7.7%). Fimbria normal looking more in primary subfertility and indrawing more in secondary subfertility. In peritubal adhesion 34pt among them 30(88.2%) are dye test negative. In endometriosis 30 patients among them 12(40%) are dye test negative. In pulmonary TB, salphingitis and ectopic pregnancy (100%) are dye test negative. In tubal patency test of the study patients were observed in case of primary and secondary subfertility. In primary subfertility both tube patent 24(44.4%), unilateral block 20(37%) and bilateral block 10 (18.5%) and in secondary subfertility both tube patent 12 (46.2%), unilateral block 8 (30.8%), bilateral block 6 (23.1%). Bilateral block more in secondary subfertility. No difference in case of both tube patent.
 JCMCTA 2012; 23(1): 17-20

Integration of patient characteristics and the results of Chlamydia antibody testing and hysterosalpingography in the diagnosis of tubal pathology: an individual patient data meta-analysis

Tubal patency tests are routinely performed in the diagnostic work-up of subfertile patients, but it is unknown whether these diagnostic tests add value beyond the information obtained by medical history taking and findings at physical examination. We used individual patient data meta-analysis to assess this question. We approached authors of primary studies for data sets containing information on patient characteristics and results from tubal patency tests, such as Chlamydia antibody test (CAT), hysterosalpingography (HSG) and laparoscopy. We used logistic regression to create models that predict tubal pathology from medical history and physical examination alone, as well as models in which the results of tubal patency tests are integrated in the patient characteristics model. Laparoscopy was considered to be the reference test. We obtained data from four studies reporting on 4883 women. The duration of subfertility, number of previous pregnancies and a history of previous pelvic inflammatory disease (PID), pelvic surgery or Chlamydia infection qualified for the patient characteristics model. This model showed an area under the receiver operating characteristic curve (AUC) of 0.63 [95% confidence interval (CI) 0.61-0.65]. For any tubal pathology, the addition of HSG significantly improved the predictive performance to an AUC of 0.74 (95% CI 0.73-0.76) (P < 0.001). For bilateral tubal pathology, the addition of both CAT and HSG increased the predictive performance to an AUC of 0.76 (95% CI 0.74-0.79). In the work-up for subfertile couples, the combination of patient characteristics with CAT and HSG results gives the best diagnostic performance for the diagnosis of bilateral tubal pathology.