Assessment Of Tubal Patency Research Articles

A novel concept for female infertility exploration: the Fertiliscan©, a dedicated all-in-one 3D ultrasound exploration

The investigation of the probable cause of infertility is mandatory to propose an accurate therapeutic option to the infertile couple i.e. good chance of pregnancy. Usually, this investigation in woman includes at least hormonal dosages to estimate the ovarian function and reserve, a pelvic ultrasound scan and a hystero-salpingography to determine tubal patency. We introduce a unique investigation based on the realization of a high quality 3D ultrasound scan that involves the assessment of tubal patency. It is called Fertiliscan as opposed to the standard pelvic scan. The Fertiliscan assesses both the anatomy and the function of the uterus, the ovaries as well as the tubes. It includes a hystero-sonography for the analysis of the uterine cavity and with respect to tubal patency, a hysterosalpingo-foam-sonogography (Hyfosy). The investigation is woman-friendly, cheaper and shorter. It allows a fast track to a treatment if needed and shortens “time to pregnancy” for the couple.

Predictive values of bubble test during office hysteroscopy in assessment of tubal patency

Predictive values of bubble test during office hysteroscopy in assessment of tubal patency

Evaluation of 3-D Sonohysterogram Using Ex-Foam Compared to Saline in Diagnosis of Tubal Patency

Both hysterosalpingogram (HSG) and sonohysterogram are used to evaluate the patency of fallopian tubes in an infertility workup. This study aims to evaluate the advantages of using ex-foam compared to agitated saline in sonohysterogram for the diagnosis of tubal patency. A retrospective chart review was done of 167 infertile females seen at New Life Fertility Clinic from January 2014 to May 2017. All of them underwent both an HSG and a 3-D sonohysterography using ex-foam or saline alone. The results of both tests were compared. The outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. No significant differences were found between the two groups. The overall accuracy of predicting tubal obstruction or patency is better when ex-foam is used compared to saline. Since no significant differences were found in respect to sensitivity, specificity, PPV or NPP, the assessment of tubal patency using ex-foam in D sonohysterogram is not preferred over saline because it is more expensive.

EP16.04: Three‐dimensional (3D) hysterosalpingo‐contrast‐sonography (HyCoSy) with new contrast lignosal (mixture of lignocaine 2% jelly and normal saline) for the assessment of tubal patency

To assess the accuracy of 3D HyCoSy using the new contrast lignosal (mixture of 2% lignocaine jelly and normal saline) for the evaluation of tubal patency in infertile women. It is a prospective observational single centre study. We have recruited 35 patients undergoing 3D HyCoSy with lignosal contrast before standard diagnostic laparoscopy with chrompertubation (lap and dye). Tubal patency was assessed by our new contrast lignosal using the GE Voluson expert with 5-9 3D TVS probe with automated coded contrast imaging software. Initially all patients underwent 2D real time HyCoSy with lignosal contrast and tubes visualised as echogenic and spill seen from fimbrial end as shower and simultaneously 3D volume acquisition of tubes done in all cases and findings were compared with the results of lap and dye. For detecting tubal patency among the 70 fallopian tubes assessed, 3D HyCoSy with lignosal had a sensitivity of 92%, specificity of 85%, positive and negative predictive values of 86% and 91% respectively, and diagnostic accuracy of 90%. The test positive rates of 3D HyCoSy with lignosal versus lap and dye were not significantly different. Further, 7 patients conceived after 2-3 months of procedure. Transvaginal HyCoSy with new contrast lignosal with 3D volume acquisition of entire tubes and uterus was found to be very accurate and safe and less expensive, non-invasive procedure for tubal patency evaluation. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome.

To compare saline infusion sonohysterography (SIS) versus hysterosalpingogram (HSG) for confirmation of tubal patency. Secondary analysis of a randomized controlled trial, Pregnancy in Polycystic Ovary Syndrome II (PPCOS II). Seven hundred fifty infertile women (18-40years old) with polycystic ovary syndrome (PCOS) were randomized to up to 5cycles of letrozole or clomiphene citrate. Prior to enrollment, tubal patency was determined by HSG, the presence of free fluid in the pelvis on SIS, laparoscopy, or recent intrauterine pregnancy. Logistic regression was conducted in patients who ovulated with clinical pregnancy as the outcome and HSG or SIS as the key independent variable. Among women who ovulated, 414 (66.9%) had tubal patency confirmed by SIS and 187 (30.2%) had at least one tube patent on HSG. Multivariable analysis indicated that choice of HSG versus SIS did not have a significant relationship on likelihood of clinical pregnancy, after adjustment for treatment arm, BMI, duration of infertility, smoking, and education (OR 1.14, 95% CI 0.77, 1.67, P = 0.52). Ectopic pregnancy occurred more often in women who had tubal patency confirmed by HSG compared to SIS (2.8% versus 0.6%, P = 0.02). In this large cohort of women with PCOS, there was no significant difference in clinical pregnancy rate between women who had tubal patency confirmed by HSG versus SIS. SIS is an acceptable imaging modality for assessment of tubal patency in this population.

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.

Chlamydia antibody titre as a predictor of tubal factor infertility

BACKGROUND: Genital Chlamydia trachomatis is major cause of tubal factor infertility. Assessment of tubal patency by hysterosalpingography (HSG) and laparoscopy are invasive and expensive. In low resource setting, there may be a place for Chlamydia Antibody Titre (CAT) in infertility work up.Objective: To determine the predictive value of Chlamydia antibody titre in tubal factor infertility.Materials and Methods: This was a prospective cross-sectional study of women presenting with infertility at the Human Reproduction Research Programme unit of the University of Benin Teaching Hospital, Benin City, Nigeria. All the women had serum Chlamydia antibody titre and hysterosalpingography and where indicated, laparoscopy and dye test. The predictive value of Chlamydia Antibody was assessed using likelihood ratios.Results: The prevalence of Chlamydia antibody among women with infertility was 32.1%. This was significantly higher among women with HSG diagnosed tubal damage (72.1% vs 27.9%; P = 0.000). The sensitivity and specificity of Chlamydia Antibody were 84.6% and 66.7% respectively while the sensitivity and specificity of Hysterosalpingogram were 85.7% and 50% respectively. The positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of CAT were 2.58 and 0.22 respectively while the LR+ and LR- of HSG were 1.72 and 0.28 respectively. Both tests showed comparable predictive value in screening for tubal damage.Conclusions: The predictive value of CAT was comparable to that of HSG. Chlamydia antibody titre determination is non-invasive and inexpensive and may be used in infertility screening to select patient for HSG and laparoscopy.

Unexplained Infertility: A Biomarker for Decreased Ovarian Reserve in Young Women [15B

INTRODUCTION: After 12 months of regular intercourse and appropriate evaluation to assure normal ovulation and sperm quality with patent fallopian tubes, no etiology is identified in up to 1/3 of couples. The treatment for Unexplained Infertility (UI), especially for younger couples (<35 years), is largely empiric. Recent IVF data suggests UI in younger women is associated with lower embryo quality and may be related to prematurely Decreased Ovarian Reserve (DOR). In the present study DOR, as measured by Anti-Mullerian Hormone (AMH), was assessed as part of the initial evaluation of young nulligravid couples with >12 months attempting pregnancy. METHODS: Three hundred and forty-three nulligravid couples (18-34 yrs) were evaluated with assessment of tubal patency, ovulatory and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of DOR with serum AMH. RESULTS: An infertility diagnosis was confirmed in 142/343 (41%): anovulation 30%; anatomic abnormality 9%; male factor 6%. UI, the default diagnosis, was made in 201/343 (59%). Of the 201 women with UI, AMH was <95% of age appropriate values in 118 (59%). Most surprisingly, 53/201 (26%) UI women <35 had an AMH value of <1.5. CONCLUSION: The results of this study suggest 1) In all women with UI, independent of age, assessment of ovarian reserve should be included in the initial evaluation of fertility status; 2) In young women with premature DOR, consultation with a fertility specialist is warranted to discuss appropriate treatment modalities; 3) Beyond fertility concerns, DOR may herald a premature perimenopausal transition with the associated cardiovascular health implications.

Evaluation of Efficacy of Transvaginal Sonography with Hysteroscopy for Assessment of Tubal Patency in Infertile Women Regarding Diagnostic Laparoscopy.

Background:Infertility, as one of the most common gynecological disorders, affects many people worldwide. To choose the clinical treatment, correct assessment of tubal patency can provide an important clue; therefore, it is considered as one of the major steps in workup examinations of infertile women. In this study, we aimed to compare the results of transvaginal ultrasonography (TVS) after hysteroscopy (HSC) with laparoscopy, as a gold standard, for assessing the fallopian tubal patency in infertile women.Materials and Methods:This is a cross-sectional study which included 49 infertile women referred to Shahid Beheshti Hospital affiliated with Isfahan University of Medical Sciences during the years 2015 and 2016. At first, patients who met the inclusion criteria were examined through HSC in by a specialist in gynecology and obstetrics in operating room because laparoscopy was performed after TVS with HSC, but HSC was performed without anesthesia. TVS was performed before and after of HSC to observe fluid in the pouch of Douglas. The findings of TVS with HSC and laparoscopy were compared.Results:There was a strong agreement between TVS after HSC and laparoscopy (kappa coefficient = 0.935, 95% confidence interval [CI]: 0.81, 1.00). The sensitivity of TVS after HSC was 100% (95% CI: 66.37, 100) and specificity was 97.50% (95% CI: 86.84, 99.94) with a positive predictive value of 90% (95% CI: 55.50, 99.75) and negative predictive value of 100% (95% CI: 90.97, 100).Conclusion:TVS after HSC is an accurate diagnostic tool for examination of fallopian tubal patency in infertile women.

Retrograde Dye Test for the Assessment of Tubal Patency in a Virgin: A Case Report and Review of Literature

Background: Hysterosalpingogram (HSG) and Laparoscopy and dye tests for tubal assessment for a virgin who places high premium on her virginity could be challenging. Routine HSG may result in loss or damage to the hymen and loss of virginity. Aim: The aim of the procedure of retrograde dye test was explored to see the possibility of assessing tubal patency during laparotomy. Case Presentation: At laparotomy and after myomectomy in a 32 year old virgin, a moderate sized Wilkinson’s cannula was gently inserted at the fimbrial end of the both tubes and 50mls of dilute Methylene-Blue solution was injected in each tube at a time to see whether the dye will appear at the vagina introitus. There was no resistance to flow of the dye in both tubes. Inspection of the vaginal introitus revealed a gush of dye flowing through it as the dye was introduced through each tube confirming the patency of both tubes. Conclusion: Retrograde dye test at the time of abdominal procedures like myomectomy, pelvic adhesiolysis and excision of endometriotic cyst can be cost effective. This procedure is also useful in assessing tubal patency for women who undergo laparotomy and also wish to preserve their virginity.

Hysterosalpingo-lidocaine-foam sonography combined with power Doppler imaging (HyLiFoSy-PD) in tubal patency assessment: 'flaming tube' sign.

Hysterosalpingo-lidocaine-foam sonography combined with power Doppler imaging (HyLiFoSy-PD) in tubal patency assessment: 'flaming tube' sign.

Effect of menstrual cycle phase and hormonal treatments on evaluation of tubal patency in baboons.

BackgroundWe evaluated whether menstrual cycle phase influences the assessment of tubal patency by hysterosalpingography (HSG) in baboons.MethodsRetrospective analysis of baseline tubal patency studies and serum estradiol (E2) and progesterone (P4) values obtained from female baboons used as models for development of non‐surgical permanent contraception in women. The main outcome measure was bilateral tubal patency (BTP) in relationship with estradiol level.ResultsFemale baboons (n = 110) underwent a single (n = 81), two (n = 26), or three (n = 3) HSG examinations. In 33/142 (23%) HSG examinations, one or both tubes showed functional occlusion (FO). The median E2 in studies with BTP (49 pg/mL) was significantly higher than in those studies with FO (32 pg/mL, P = .005). Among 18 animals with repeat examinations where serum E2 changed from <60 to ≥ 60 pg/mL, 13 results changed from FO to BTP (P = .0001). No sets showed a change from BTP to FO with an increase in estradiol.ConclusionIn baboons, functional occlusion of the fallopian tube is associated with low estradiol levels, supporting a role for estrogen‐mediated relaxation of the utero‐tubal junction.

321 - Ultrasound-Guided Hysteroscopy- and Laparoscopy-Based Treatment of Different Mullerian Anomalies

This case series reports the evaluation and ultrasound-guided management of different Mullerian abnormalities by hysteroscopy and concomitant laparoscopy. 6 patients with septate uteri diagnosed by 2D/3D ultrasound and MRI showed 2 subseptate uteri, 1 arcuate uterus, 1 complete uterine septum, 2 complete uterine septum each with oblique vaginal septum and longitudinal vaginal septum. The procedure was transcervical resection of uterine septum with concomitant laparoscopy under ultrasound control. Incision with complete resection of the oblique and longitudinal vaginal septa was done using monopolar electrode. With concomitant laparoscopy, the pelvis was evaluated for pelvic masses, adhesions, fluid spillage into the pelvic cavity for tubal patency assessment, external fundal contour and the uterine cavity on transillumination. The advantages of post procedural evaluation of the uterine cavity by transrectal ultrasound guidance during hysteroscopic septoplasty are easy estimation of fundal thickness and depth of remaining septum.

Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women

The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80–95.90), sensitivity was 85.7% (95% CI 57.20–98.20), positive and negative predictive values were 70.6% (95% CI: 44.00–89) and 94.7% (95% CI: 82.30–99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.

Performing the Parryscope technique gently for office tubal patency assessment

To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG). Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its University of Mississippi Medical Center Institutional Review Board protocol number is 2013-0230. Academic hospital. Women undergoing office hysteroscopy and ultrasound, with a subsetalso having HSG. Air infusion into saline during office hysteroscopy. The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG. When performed as described, this office technique has 98.3%-100% sensitivity to tubal occlusion and 83.7% specificity. The gentle technique is central to accurate outcomes, which is facilitated through use of a small-caliber (<3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG. Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique. Air-infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility. NCT02005263.

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

Assessment of Fallopian Tube Fimbria Patency With 4-Dimensional Hysterosalpingo-Contrast Sonography in Infertile Women.

The purpose of this study was to evaluate the performance of 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy) for assessing fallopian tube fimbria patency in infertile women. Seventy-seven infertile female patients with obstruction at the tubal fimbria or partial obstruction with pelvic adhesions were included. All of the patients underwent 4D HyCoSy enhanced by dynamic observation after a flush of normal saline and were followed with laparoscopic chromopertubation using methylene blue within 6 months. The overall accordance between 4D HyCoSy and laparoscopic chromopertubation was 92.9%. The sensitivity and specificity of 4D HyCoSy with laparoscopic chromopertubation as a reference standard were 93.8% and 92.2%, respectively. Four-dimensional HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesions surrounding the ovaries, with its advantages of accuracy, noninvasiveness, and a good safety profile.

Pain Intensity During Ultrasound Assessment of Uterine Cavity and Tubal Patency With and Without Painkillers: Prospective Observational Study

Study ObjectiveTo determine the pain intensity and incidence of mild to severe pain during the ultrasound assessment of the uterine cavity and tubal patency using saline, air and saline, and foam as contrasts with and without painkiller. DesignProspective observational study (Canadian Task Force classification II-1). SettingPrivate clinic. PatientsThree hundred infertile women who were consecutively submitted to uterine cavity and tubal patency assessment by ultrasound using saline, air, and foam in single exam between October 2012 and November 2013. InterventionsNo painkillers were used until March 2013 when we started offering an effervescent codeine tablet containing paracetamol 500 mg and codeine phosphate 30 mg approximately 1 hour before the procedure. Measurements and Main ResultsPain intensity measured with an 11-point (0–10) numerical rating scale and incidence of moderate/severe levels of pain (numerical rating scale > 3) during the main components of the procedure (speculum insertion, catheter insertion, saline infusion, air and saline infusion, foam infusion, and after the procedure [0 minutes, 15 minutes, 30 minutes, and 24 hours]) were assessed. The incidence of moderatesevere pain was significantly lower in women using painkillers considering any moment of the procedure: 49 of 175 (28%) versus 65 of 125 (52%); relative risk, .54; 95% confidence interval, .40–.72; p < .001; number needed to treat, 4. Less women presented with moderate/severe pain during air and saline compared with foam infusion: 31 of 300 (10%) versus 75 of 300 (25%); p < .001; relative risk, .41, 95% confidence interval, .28–.61. ConclusionThe incidence of moderate/severe pain during the ultrasound assessment of the uterine cavity and tubal patency is common. Our results suggest that using paracetamol + codeine before the procedure reduces the pain level, but randomized controlled trials are required.

3D and 4D studies from human reproduction to perinatal medicine.

Three-dimensional ultrasound (3D US) is a modality of choice for prenatal diagnosis of congenital malformations. But 3D-four-dimensional US(4D US) is of utmost importance also to achieve pregnancy. 3D US plays an important role for diagnosis of PCO, to assess ovarian reserve and response and thus to decide optimum stimulation protocols. It adds to the information on follicular maturity and endometrial receptivity, thus improving the chances to achieve pregnancy for patients under treatment for fertility. 3D hystero-contrast-salpingography (HyCoSy) has also proved itself to be one of the best modalities for assessment of tubal patency. In this article, the role of 3D and 4D US is discussed for the following. I. Pretreatment assessment of the females desiring fertility which includes assessment of uterus and fallopian tubes. II. Monitoring of infertile females undergoing treatment. III. Assessment of very early pregnancy - especially in abnormal locations.

Preimplantation 3D ultrasound: current uses and challenges.

The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approach for 3D US examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness. Uterine anatomy is explored in the coronal plane by simultaneous visualization of the uterine cavity, the external surface of the fundus and cervix. Saline infusion sonogram (SIS) is recommended for patients with increased endometrial volume, abnormal endometrial pattern and irregular uterine cavity shape suggestive of Müllerian duct anomalies or acquired intracavitary abnormalities. Myometrial lesions should be recognized and proper dimensions and locations should be ascertained. Ovarian dimensions and volume are measured and the antral follicle count is recorded. Adnexa are carefully assessed for masses, endometriosis and dilated tubes. Color power Doppler US may be applied to evaluate vascularity of the ovaries and pelvic lesions. Hysterosalpingo-contrast-sonography (Hy-Co-Sy) should be optimally utilized for assessment of tubal patency. Accessibility and mobility of the ovaries should be checked in real time for better planning of the ultrasound-guided oocyte retrieval. The cul-de-sac is assessed for the presence of free fluid or masses.