Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation |
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| Institution: | 1. Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria (Drs. Ott, Hager, Nouri, Marschalek, and Kurz);2. Department of Obstetrics and Gynecology, Semmelweis Frauenklinik der Krankenanstalt Rudolfstiftung, Vienna, Austria (Dr. Hager).;1. Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy (Dr. Di Spiezio Sardo);2. Department of Advanced Medical Sciences, University of Naples Federico II, Naples, Italy (Dr. Gencarelli);3. Department of Gynecology and Obstetrics, ABC Foundation School of Medicine, Sao Paulo, Brazil (Dr. Da Cunha Vieira);4. Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy (Dr. Riemma);5. Coleman Spa, Naples, Italy (Dr. De Simone);6. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida (Dr. Carugno).;1. Endoscopy Unit, Centro Gutenberg, Malaga, Spain (Dr. Alonso);2. Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida (Drs. Ulker, Timmons, and Carugno).;1. Department of Women''s Health, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom (Drs. Oxley and Odejinmi);2. Department of Women''s Health, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, United Kingdom (Dr. Mallick);1. Endoscopy Unit, Centro Gutenberg, Malaga, Spain (Dr. Alonso);2. Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy (Dr. Laganà);3. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida (Drs. Palin and Carugno). |
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| Abstract: | Study ObjectiveTo evaluate whether the presence of a visualizable “flow” effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency.DesignA prospective cohort study.SettingIn 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.PatientsSeventy-two infertile women.InterventionsCombined hysteroscopy and laparoscopy with chromopertubation.ResultsOne-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]).ConclusionsThe 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. |
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