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

Study ObjectiveTo evaluate the accuracy of the “Parryscope” and “flow” techniques for hysteroscopic assessment of tubal patency.DesignProspective randomized clinical trial.SettingFrom 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.PatientsSixty women with subfertility.InterventionsHysteroscopy with either the “Parryscope” or the “flow” techniques for tubal assessment, directly followed by laparoscopy with chromopertubation.Measurements and Main ResultsHysteroscopic 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).ConclusionUsing 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.     

Accuracy of Tubal Patency Assessment in Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study

Study Objective

To evaluate whether the presence of a visualizable “flow” effect in the fallopian tube ostia in hysteroscopic routine evaluation is predictive of tube patency.

Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

ObjectiveTo assess the diagnostic accuracy of hysteroscopy compared with that of laparoscopic chromopertubation for the detection of fallopian tubal obstruction.Data SourcesAn electronic search from inception to March 31, 2020, was performed in Medline, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials.Methods of Study SelectionThis diagnostic accuracy meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesizing Evidence from Diagnostic Accuracy Tests recommendations. A combination of the following Medical Subject Headings terms and keywords was included in the search strategy: “hysteroscopy[MeSH],” “tubal obstruction,” “tubal patency,” “tubal dysfunction,” and “tubal blockage.” Quality assessment of the included studies was conducted using the Quality Assessment Tool for Diagnostic Accuracy Studies–2 (University of Bristol, Bristol, United Kingdom). Publication bias was evaluated by means of the Deek funnel plot asymmetry test. The following outcomes were analyzed: diagnostic odds ratio, area under hierarchical summary receiver operating characteristic and area under receiver operating characteristic curve, sensitivity, specificity, and positive and negative likelihood ratios.Tabulation, Integration, and ResultsSix studies comparing hysteroscopy with laparoscopic chromopertubation were included in the meta-analysis. After pooling all the studies, the diagnostic odds ratio was 43. The evaluated area under receiver operating characteristic curve was 0.93, correlating with high diagnostic accuracy for the index test. Sensitivity and specificity were 88% and 85%, respectively. In addition, the positive and negative likelihood ratios were 5.88 and 0.16, respectively.ConclusionHysteroscopic techniques are highly accurate and sensitive for detecting fallopian tubal obstruction. Interventional assessment enhances diagnostic accuracy compared with observational assessment, as does the office setting compared with the operating room. Additional studies, along with a refinement of the techniques, could facilitate the widespread use of hysteroscopic techniques for the detection of fallopian tube occlusion.     

Contrast Ultrasonography for Tubal Patency

Evaluation of tubal patency is an essential part of a fertility workup. Laparoscopy with chromopertubation in conjunction with hysteroscopy is the gold standard in evaluation of tubal patency and the uterine cavity. In this review article we describe a newer method for evaluation of the uterus and fallopian tubes, that is, hysterosalpingo–contrast sonography (HyCoSy). Accuracy of HyCoSy for tubal patency has been shown to be comparable to that with hysterosalpingography (HSG) when compared with laparoscopic chromopertubation. Sensitivity ranges from 75% to 96%, and specificity from 67% to 100%. HyCoSy is also accurate when compared with HSG in determining tubal occlusion after hysteroscopic sterilization, with 88% of patients stating they would prefer to undergo the tubal occlusion test in their gynecologist's office. Because HyCoSy also includes evaluation of the uterine cavity with saline solution–enhanced sonohysterography, accuracy in evaluating the uterine cavity is >90% when compared with hysteroscopy. HyCoSy enables the gynecologist to complete a fertility workup in the office in the most minimally invasive way. HyCoSy is well tolerated and has been suggested in the literature to replace HSG for evaluation of tubal disease in the subfertile population.     

Analysis of Tubal Patency After Essure Placement

Study ObjectiveTo evaluate tubal patency after hysteroscopic sterilization using the Essure microinsert (Conceptus Inc, San Carlos, CA).DesignA retrospective longitudinal cohort study.Design ClassificationII-3.SettingPatients undergoing hysteroscopic sterilization in the outpatient clinic of a university-based hospital in Southeast Texas from July 2009 to November 2011.PatientsTwo hundred twenty-nine women (ages 21–44 yrs, 71% Hispanic) desiring sterilization with a history of regular menses, demonstrated prior fertility (≥1 live birth), and the ability to use an alternative contraceptive method for at least 90 days after coil placement were included. Twenty six patients in this cohort were excluded because of failure to perform a hysterosalpingogram (HSG), tubal perforation, severe dyspareunia, a history of ectopic pregnancy, tubal surgery, or cervical intraepithelial neoplasia.InterventionsNot applicable.Measurements and Main ResultsHSGs were assessed for microinsert location and tubal occlusion. Two hundred three patients were included for analysis. After the successful bilateral hysteroscopic placement of Essure microinserts in fallopian tubes, all patients returned for the first follow-up HSG a mean of 103 ± 38 days after the procedure. Patients with fallopian tube patency at the initial HSG returned for second and/or third HSGs as needed at 192 ± 45 and 291 ± 97 days, respectively. Correct device placement was confirmed in 100% of cases at the first HSG. The tubal patency rates at the 90-day and 180-day HSGs were 16.1% (95% confidence interval, 7.4%–31.7%) and 5.8% (95% CI, 1.2%–24.4%), respectively. These rates were estimated by the accelerated failure time model with log normal distribution and interval censored time to event. The 16.1% 90-day tubal patency rate is significantly different from the 8% rate reported by Cooper et al in the 2003 multicenter phase III pivotal trial (p <.001).ConclusionOur data indicate that hysteroscopic sterilization with Essure results in a higher initial tubal patency rate than previously reported. Multivariate analyses are needed to identify factors associated with an increased risk of postprocedure tubal patency.     

Is Chronic Endometritis Associated with Tubal Infertility? A Prospective Cohort Study

Study ObjectiveChronic endometritis (CE), which often presents asymptomatically, is associated with recurrent pregnancy loss, recurrent implantation failure after in vitro fertilization, and endometriosis. Data connecting CE with fallopian tubal occlusion are limited. The aim was to assess a potential association of CE, defined by the presence of syndecan-1 (CD138)–positive plasma cells in endometrial tissue samples, with fallopian tube patency and other factors for infertility, including endometriosis, adenomyosis, and hydrosalpinges.DesignProspective, monocentral pilot study.SettingTertiary care center.PatientsA cohort of 100 women who were infertile was enrolled from July 2019 to December 2020.InterventionsHysteroscopy with endometrial biopsy and laparoscopy with chromopertubation.Measurements and Main ResultsCE was found in 13 women (13.0%) and was associated with endometriosis (p = .034) and unilateral/bilateral fallopian tube blockage (p = .013). In women with endometriosis, the mean number of CD138-positive cells was positively correlated with the revised American Society for Reproductive Medicine score (r = .302, p = .028). In a binary regression model, the presence of a hydrosalpinx on one or both sides (odds ratio 15.308; 95% confidence interval, 1.637–143.189; p = .017) and the finding of CE in the endometrial tissue sample (odds ratio 5.273; 95% confidence interval, 1.257–22.116; p = .023) were significantly associated with fallopian tubal occlusion.ConclusionCE was significantly associated with blockage of the fallopian tubes and endometriosis. Endometriosis stage was associated with the number of CD138-positive cells in endometrial biopsies.     

Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study

Study ObjectiveTo study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy).DesignA case-control study (Canadian Task Force classification II-2).SettingA university hospital.PatientsA total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017.InterventionA retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy.Measurements and Main ResultsThe prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively.ConclusionThe prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.     

Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy

Study ObjectiveTo report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage.DesignA step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III).SettingUniversity Hospital Estaing, Clermont-Ferrand, France.PatientA 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus.InterventionWe decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1.Measurements and Main ResultsA tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed.ConclusionCurettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.     

A Novel Nomogram Based on 3-dimensional Transvaginal Ultrasound for Differential Diagnosis Between Severe and Mild-to-Moderate Intrauterine Adhesions

Study ObjectiveTo develop and validate a nomogram for differentiating severe intrauterine adhesions (IUAs) from mild-to-moderate IUAs preoperatively on the basis of 3-dimensional transvaginal ultrasound (3D-TVUS).DesignRetrospective observational study.SettingUniversity-affiliated hospital.PatientsA dataset of 413 patients who had undergone hysteroscopic adhesiolysis and 3D-TVUS examination before hysteroscopic adhesiolysis between March 2019 and December 2020.InterventionsNot applicable.Measurements and Main ResultsA total of 212 patients with mild-to-moderate IUAs and 201 patients with severe IUAs were enrolled. Intercornual distance, endometrial thickness, number of visible fallopian tubal ostia, echoes of the endometrial-myometrial junction zone, and endometrial blood flow grade differed significantly between the severe and mild-to-moderate IUAs groups. The area under the receiver operating characteristic curve of the nomogram was 0.880 (95% confidence interval, 0.843–0.918) in the training set and 0.878 (95% confidence interval, 0.818–0.939) in the validation set, revealing reliable discrimination. The calibration curve and Hosmer–Lemeshow test showed strong calibration, and decision curve analysis indicated that the nomogram had a high net benefit and a wide range of threshold probabilities.ConclusionThis nomogram, which was developed on the basis of 3D-TVUS, can accurately distinguish severe IUAs from mild-to-moderate IUAs preoperatively.     

Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile

Study ObjectiveTo compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile.DesignA single-center, retrospective cohort study.SettingDepartment of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy.PatientsA total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle.InterventionsAfter the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated.Measurements and Main ResultsThe VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%–100%) and 100% (95% CI, 96.3%–100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%–99.5%) and 100% (95% CI, 75.3%–100%), respectively, with specificities of 100% (95% CI, 96.8%–100%) and 100% (95% CI, 96.6%–100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%–100%), 100% (95% CI, 39.8%–100%), and 100% (95% CI, 75.3%–100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%–100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as “less painful than expected,” 25% (30 of 120 women) “just as expected,” and only 7% (9 of 120 women) as “more painful than expected.”ConclusionVUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.     

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.     

Fallopian tube patency using color Doppler

OBJECTIVE: To evaluate a new test for tubal patency using color Doppler ultrasonography in infertile women. METHOD: Between October 1991 and March 1992 results of our new technique were compared with those of hysterosalpingography (HSG) and laparoscopy in 27 cases. The new technique of evaluating tubal patency using color Doppler has been described in detail. RESULT: There was 92.59% agreement, i.e. patency or occlusion of the fallopian tubes when the results of our test were compared with those of hysterosalpingography and laparoscopic chromopertubation. The HSG and laparoscopy findings were in 100% agreement. CONCLUSION: Color Doppler ultrasonography is now a very important investigation in the assessment of fallopian tube patency and compares favorably with the existing ‘gold standards’ namely HSG and laparoscopic chromopertubation.     

Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment

ObjectiveThis study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy?MethodsThis was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle.ResultsAmong 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure.ConclusionPregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.     

Effectiveness of Hysteroscopic Techniques for Endometrial Polyp Removal: The Italian Multicenter Trial

Study ObjectiveTo compare the effectiveness and safety of different techniques of hysteroscopic polypectomy.DesignMulticenter, prospective observational trial (Canadian Task Force classification II-2).SettingNineteen Italian gynecologic departments (university-affiliated or public hospitals).PatientsConsecutive patients suffering from endometrial polyps (EPs).InterventionsHysteroscopic polypectomy, as performed through different techniques.Measurements and Main ResultsIncluded in the study were 1404 patients (with 1825 EPs). The setting was an ambulatory care unit in 40.38% of the cases (567 women), of whom 97.7% (554) did not require analgesia/anesthesia. In the remaining 59.62% of women (837 women), the procedures were performed in an operating room under mild sedation, local or general anesthesia. Minor complications occurred in 32 patients (2.27%), without significant differences between the techniques used (p = ns). Uterine perforation occurred in 14 cases, all performed in the operating room with some kind of anesthesia, only 1 with a vaginoscopic technique and the remaining during blind dilatation (odds ratio [OR], 19.98; 95% confidence interval [CI], 1.19–335.79; p = .04). An incomplete removal of EPs was documented in 39 patients. Logistic regression analysis showed that a higher risk of residual EPs was associated with the use of a fiber-based 3.5-mm hysteroscope (OR, 6.78; 95% CI, 2.97–15.52; p <.001), the outpatient setting (OR, 2.17; 95% CI, 1.14–4.14; p = .019), and EPs located at the tubal corner (OR, 1.98; 95% CI, 1.03–2.79; p = .039). No association between incomplete EP removal and EP size or number was recorded (p = ns), as well as with the other variables evaluated.ConclusionOutpatient polypectomy was associated with a minimal but significantly higher risk of residual EPs in comparison with inpatient polypectomy. Conversely, inpatient polypectomy was associated with a considerably higher risk of uterine perforation and penetration in comparison with office hysteroscopy. Because of lower intraoperative risks and higher cost-effectiveness, office hysteroscopy may be considered, whenever possible, as the gold standard technique for removing EPs.     

Hysteroscopic Access and Uterine Cavity Evaluation 12 Months after Endometrial Ablation with the Cerene Cryotherapy Device

Study ObjectiveTo evaluate whether physical access and the ability to systematically assess the postablation uterine cavity were preserved at 12 months after endometrial ablation with the Cerene cryotherapy device (ChannelMedsystems, Emeryville, CA).DesignA prospective, multicenter, single-arm study.SettingIn the clinic at 8 US sites and outpatient hospital setting at 2 sites in Canada and 1 site in Mexico.PatientsA total of 230 (of 242) subjects continued in the study at the Month 12 visit after ablation. Two hundred twenty-three subjects were available for a diagnostic hysteroscopic evaluation.InterventionsSubjects who had previously been treated with a 2.5-minute cryoablation of the endometrium utilizing the Cerene device underwent a diagnostic hysteroscopy at the Month 12 follow-up visit.Measurements and Main ResultsThe uterine cavity was accessible in 220 of 223 subjects (98.7%) and not accessible in 3 (1.3%) because of pain (n = 2) and cervical stenosis (n = 1). Visualization of the uterine cavity was possible in 204 of 220 subjects (92.7%) with one or both tubal ostia identified in 89.2% (182 of 204) of subjects. Both tubal ostia were visible in 160 of 204 subjects (78.4%) and one ostium in 22 of 204 subjects (10.8%). The cavity was not visualized in the remaining 16 of 220 subjects (7.2%) because of intrauterine adhesions (n = 14), technical difficulties (n = 1), or menstruation (n = 1). In 95.6% (195 of 204) of subjects where the cavity was visualized, the hysteroscopic view was judged adequate to evaluate the uterine cavity for pathologic change. No significant complications occurred during the hysteroscopic evaluations.ConclusionThis is the largest study to date conducted to hysteroscopically evaluate the postablation uterine cavity. Uterine cavity assessment with in-office hysteroscopy 1 year after the use of the Cerene cryotherapy device is attainable, enabling both diagnostic and therapeutic procedures within the endometrial cavity.     

Proximal Fallopian Tubal Embolization by Interventional Radiology prior to Embryo Transfer in Infertile Patients with Hydrosalpinx: A Prospective Study of an Off-label Treatment

Study ObjectiveTo evaluate in vitro fertilization (IVF) outcomes of proximal fallopian tube embolization by interventional radiology compared with laparoscopic salpingectomy before embryo transfer (ET) in patients with hydrosalpinx.DesignA single-center, off-label, nonrandomized prospective study.SettingAcademic university hospital.PatientsOne hundred fifty-five patients with hydrosalpinx were identified on ultrasound or hysterosalpingography desiring IVF between April 2016 and December 2017.InterventionsRadiologically guided tubal occlusion with embolization microcoils (RTO-EM) and laparoscopic salpingectomy.Measurements and Main ResultsOf the 155 analyzed patients, 42 were treated with RTO-EM and 113 with laparoscopic salpingectomy. The subsequent IVF outcomes, including implantation, clinical pregnancy, miscarriage, ectopic pregnancy, and ongoing pregnancy (i.e., a fetal heartbeat on ultrasound beyond 10 weeks) were compared between the 2 groups. Implantation and clinical pregnancy per ET cycle in the RTO-EM group were similar to that of the salpingectomy group (26.7% vs 30.2% [p = .51] and 39.0% vs 45.3% [p = .40], respectively), with a similar miscarriage rate. There was no statistically significant difference in ectopic pregnancies between the 2 groups. Moreover, no difference was detected in ongoing pregnancy per cycle between the 2 groups (33.9% vs 41.2%; p = .32). The ongoing-pregnancy rate per patient following RTO-EM was 47.6% (20 of 42) compared with 61.9% (70 of 113) following salpingectomy (odds ratio, 0.56; 95% confidence interval, 0.27–1.14; p = .11).ConclusionPregnancy in the RTO-EM group was comparable to the salpingectomy group in patients with hydrosalpinx before ET treatment. RTO-EMs may be an alternative to salpingectomy for patients with hydrosalpinx planning for IVF-ET.     

A novel use of vaginoscopic office hysteroscopy for prediction of tubal patency and peristalsis among infertile women: a preliminary study

The objective of this study is to test whether vaginoscopic office hysteroscopy (OH) can predict proximal tubal patency as compared with hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and concomitantly tubal peristalsis in infertile women. This is a prospective cross sectional study. The setting is in the endoscopy unit of a tertiary hospital. A total of 85 infertile patients scheduled for laparoscopy are used as the sample of this study. The method used is the vaginoscopic OH in the outpatient infertility clinic to assess proximal tubal patency. The patency results will be compared to HSG and DL reports. Diagnostic accuracy of OH alone or in combination with HSG for assessment of proximal tubal patency in comparison to HSG and DL is the mean outcome measure. Office hysteroscopic bubble suction test was feasible in 78 cases (91.7 %). Patent tubes were diagnosed in 91 and 88.5, 92.3 and 91, and 93.6 and 93.6 % using OH, HSG, and DL on right and left sides, respectively. The percentage of agreement between OH and DL was 78 % while it was 84 % between HSG and DL regarding tubal patency testing. Diagnostic indices of OH were very close to those of HSG. Adding OH to HSG did not improve diagnostic accuracy. Positive osteal peristalsis was reported in 32 cases (42 %) and 28 cases (36.8 %) for right and left ostea, respectively. Hysteroscopic bubble suction test is a good initial screening test for tubal patency nearly comparable to HSG and DL. It should be attempted in every case of OH prior to referral for more invasive HSG or laparoscopic chromopertubation test. Hysteroscopic documentation of peristalsis of the proximal part of the tube is an interesting cofinding but requires more confirmatory studies.     

输卵管阻塞性不孕症宫、腹腔镜术后治疗方法的探讨

目的:探讨输卵管阻塞性不孕症宫、腹腔镜术后阻止再次粘连和阻塞的诊疗方法。方法:将宫、腹腔镜术后至少一侧输卵管通畅的不孕症患者随机分为治疗组和对照组,治疗组和对照组分别术后第1次月经干净后3~7 d应用欣可聍或注射体积分数20%甲硝唑氯化钠注射液进行彩色B超监测下宫腔镜输卵管插管通液;观察术后1年的妊娠情况,术后1年未孕者,于月经干净后3~7 d行子宫输卵管碘佛醇造影检查,了解输卵管通畅度。结果:术后1年治疗组妊娠率(68.75%)高于对照组(51.25%),差异有统计学意义(χ2=5.104,P=0.024);异位妊娠差异无统计学意义(P0.05);未孕者治疗组双侧输卵管通畅率(40.9%)高于对照组(14.2%),差异有统计学意义(χ2=5.168,P=0.023)。结论:输卵管阻塞性不孕症宫、腹腔镜术后第1次月经干净后3~7 d用欣可聍注射液进行彩色B超监测下宫腔镜输卵管插管通液,可以降低盆腔的再次粘连,维持输卵管的通畅,提高受孕率,值得临床推广应用。     

Combined laparoscopy and hysteroscopy in the investigation of the ovulatory infertile female

A previous study had demonstrated the superiority of hysteroscopy over hysterosalpingography for the detection of intrauterine lesions in infertile patients. One hundred and sixty-nine patients were examined by a combined laparoscopic and hysteroscopic technique as the means of detecting tubal, peritubal, peritoneal, or intrauterine causes of infertility. Laparoscopy was successful in 168 and hysteroscopy in 162. The rate of diagnosis by laparoscopy of 49.4% was increased to 66% when the hysteroscopic findings were included. Only one serious complication was recorded, the inadvertent visualization of an intrauterine pregnancy. Arguments are advanced for the replacement of hysterosalpingography with combined laparoscopy and hysteroscopy as the primary means of investigating the ovulatory infertile female.     

Narrow-Band Imaging in Diagnosis of Endometrial Cancer and Hyperplasia: A New Option?

Study ObjectiveTo estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia.DesignProspective study (Canadian Task Force classification: II-2).SettingDepartment of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy.Patients209 consecutive patients with abnormal uterine bleeding.InterventionsWhite-light hysteroscopy and NBI hysteroscopy followed by direct biopsy.Measurements and Main ResultsThe sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27–89.15) and 99.47% (95% CI, 98.49–100.0), and 64.86% (95% CI, 58.39–71.34) and 98.77% (95% CI, 97.27–100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71–97.76) and 97.89% (95% CI, 95.95–99.84), and 78.38% (95% CI, 72.8–83.96) and 97.67% (95% CI, 96.63–99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen κ) was, respectively, 88.80% (95% CI, 86.2%–96.3%) and 91.78% (95% CI, 89.6%–98.2%), a difference of 2.98% (95% CI, 0–9) in favor of NBI.ConclusionNarrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.