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PubMed2005

Comparison of three-dimensional hysterosalpingo-contrast-sonography and diagnostic laparoscopy with chromopertubation in the assessment of tubal patency for the investigation of subfertility.

BACKGROUND: Two-dimensional hysterosalpingo-contrast-sonography, as a screening test for tubal patency for subfertile patients, is limited by the difficulty in visualizing the entire Fallopian tube owing to its tortuosity. This major disadvantage can be overcome by means of the three-dimensional hysterosalpingo-contrast-sonography (3D-HyCoSy). The current study compared the efficacy of 3D-HyCoSy with diagnostic laparoscopy and its feasibility as a screening test for tubal patency. METHODS: Twenty-one consecutive patients scheduled to have laparoscopy were recruited to undergo the 3D-HyCoSy 2 days before the scheduled laparoscopy. Echovist (Schering AG, Berlin, Germany), the ultrasound contrast medium, was injected into the uterine cavity via a Foley's catheter. The flow of the medium in the Fallopian tube was captured by using three-dimensional power Doppler mode and was stored for later analysis. The person analyzing the images, the surgeon performing the laparoscopy, and the patients were blinded to the patients' identity and the sonography findings. The sonography and the laparoscopy findings were compared. The duration for the ultrasound examination, pain score, and patient acceptability were assessed. RESULTS: Thirty-four of 42 (81%) Fallopian tubes were assessed. The sensitivity of 3D-HyCoSy for detecting tubal patency was 100% with a specificity of 67%. The positive and negative predictive values were 89 and 100%, respectively; the concordance rate was 91%. The mean duration (+/- SD) for the 3D-HyCoSy was 13.4 +/- 5.5 min. Fifteen patients (71%) regarded the sonography examination as at least acceptable. CONCLUSIONS: This study confirmed the feasibility of using 3D-HyCoSy as an initial investigation for tubal patency.

Adult↗
PubMed1977

Office gynecology. Diagnostic survey of the infertile couple.

The diagnostic survey of the infertile couple usually takes about three months. After semen analysis, the husband is referred for general and urologic examination. The wife is given a general physical and pelvic examination and returns during the next two months for ovulation studies. Tubal patency tests are also performed and may in themselves be therapeutic.

Fallopian Tube Patency Tests↗
PubMed1987

Improving Falope-Ring application in laparoscopy training.

Laparoscopic Falope-Ring sterilization was performed by residents on 71 women. Immediately following application of the ring, methylene blue was injected through the cervix to assess tubal patency. Unilateral spillage of the dye was demonstrated in four patients (5.6%). In these instances a new ring was applied, or the tube was tied surgically. The high rate of tubal patency was attributed to the surgeons' inexperience. The findings suggest that the use of a patency test as an adjunct to sterilization with the Falope-Ring in training programs is likely to decrease the rate of surgical failures.

Fallopian Tube Patency Tests↗
PubMed2003

Evidence-based medicine for diagnostic questions.

When searching the medical care literature for evidence on a diagnostic test, three questions should be addressed each time a study is found: (1) Is this evidence about a diagnostic test valid? (2) Does the test accurately discriminate between patients who do and patients who do not have a specific disorder? (3) Can the test be applied to this patient who is right now sitting in front of me? We will discuss hysterosalpingography (HSG) as an example of a valid and accurate diagnostic test to be applied in a general population of subfertile couples to assess tubal patency (specificity 0.83). HSG is an unreliable test for diagnosing tubal occlusion however (sensitivity 0.65). If HSG were normal, other investigations could be pursued and diagnostic laparoscopy (LS) only performed if conception had not occurred by a later date. If HSG were abnormal, LS would be needed to confirm or exclude tubal occlusion. Patients with risk factors for pelvic or tubal disease, including an abnormal Chlamydia antibody test (CAT) and those showing abnormalities at pelvic examination, should proceed directly to LS because they are significantly more likely to have pelvic pathology. A completely different issue would be HSG as a prognostic test for the occurrence of pregnancy. In theory, the occurrence of pregnancy may be considered a gold standard; however, in reproductive medicine, with so many causes of subfertility other than tubal pathology, a diagnostic test for one single disorder, if normal, will never be able to accurately predict the eventual occurrence of pregnancy.

Adult↗
PubMed1994

Colour-coded duplex sonography for the assessment of fallopian tube patency.

Tubal patency was studied in 53 infertile women by means of colour-coded duplex sonography (CCDS) with transcervical injection of normal saline. In 47 women the patency was studied using a 2.5 MHz transabdominal transducer while in the last six cases, a 5.0 MHz vaginal probe was used. The results were compared with a conventional hysterosalpingogram (HSG) and laparoscopic chromopertubation. When the results of CCDS were compared with those of HSG and laparoscopy, there was a 92.5% agreement, that is, there was patency or occlusion of the Fallopian tubes. In addition, CCDS demonstrated all the soft tissues and their mobility. The colour signals generated by the air bubbles make it possible to demonstrate tubal patency on both sides separately. Vaginal CCDS offers a much better resolution with the advantage of lesser volume of normal saline being utilised. Tubal patency can be demonstrated in the presence of anatomical complications and requires only a small quantity of normal saline. This new tubal patency test is offered, not as a substitute for HSG, laparoscopy, hysteroscopy or salpingoscopy, but as a screening technique in the armamentarium of infertility investigations.

Adolescent↗
PubMed1988

Bacteriological contamination during laparoscopy with dye injection.

Peritoneal contamination with bacteria during the laparoscopy and dye procedure was studied in 38 subfertile women by culturing samples of peritoneal fluid, aspirated before, and after, injection of dye solution. Bacteria were carried with the dye into a previously sterile peritoneal cavity in 34 women (90%). These vaginal organisms were present in low concentrations, not exceeding 10(5) organisms/ml. These findings explain the low incidence of acute salpingitis after tubal patency tests, but the selective use of antibiotic prophylaxis is recommended.

Coloring Agents↗
PubMed2006

[Hysterosalpingography in the assessment of tubal patency].

UNLABELLED: A major cause of infertility in women is occlusion of fallopian tubes. Hysterosalpingography (HSG) and laparoscopic chemoperturbation are the two traditionnal diagnostic options for tubal assessment. Recently hysterosalpingo-contrast sonography (HyCoSy), an ultrasound-based technique that uses as a contrast agent fluid injected into the fallopian tubes via the uterine cavity, is gaining importance as an alternative procedure. The aim of this study is the analysis of several technic and semiologic aspects of HyCoSy. RESULTS: advantges and limits are discussed throughout a review of literature. HyCoSy is a well tolerated outpatient technique. When performed by experienced operators, it servs as a valable first line screening test of tubal patency in low fertility women. It can confirme that tubes are patent and permits to select patients who need more invasive procedures.

Contrast Media↗
PubMed1995

[Variations in fertility studies in The Netherlands].

OBJECTIVE: To determine how a standard infertility investigation is conducted and to determine the use of fertility tests used in such investigations in relation to WHO guidelines. DESIGN: Questionnaire survey. SETTING: Dutch medical schools. METHOD: A questionnaire survey among the heads of all 8 university and 20 non-university teaching departments of obstetrics and gynaecology or their fertility units was conducted. One non-university department failed to respond. RESULTS: The examinations recommended by the WHO (general physical examination, andrological and gynaecological examination, semen analysis, ovulation detection, tubal patency testing) in general were carried out, but general physical examination of the male as a rule was only carried out if indicated. Popular routine examinations not recommended by the WHO were the postcoital test and hysterosalpingography. Regarding the postcoital test, there was variation in the time interval after coitus and the standards for spermatozoal motility. CONCLUSION: Standard fertility investigations are usually based on empiricism and tradition, including the testing recommended by the WHO.

Fallopian Tube Patency Tests↗
PubMed2005

An audit of patients investigated by Hysterosalpingo-Contrast-Sonography (HyCoSy) for infertility.

We reviewed 171 case notes of patients investigated by HyCoSy for sub-fertility in South Manchester University Hospital to assess HyCoSy as a screening test for tubal occlusion, in low risk infertile women and to evaluate the performance of HyCoSy in our unit by confirming its results with the results of laparoscopy & dye test in those patients who had both procedures. We also assessed the prognostic significance of HyCoSy, for fertility outcome over a follow-up period ranging from 12 to 63 months. An audit proforma was designed to collect data on maternal age, type of infertility (primary or secondary), duration of infertility and parity. History suggestive of ovulatory factors (PCO), pelvic inflammatory disease and endometriosis was noted. Findings of standard trans-vaginal scan, hysterosalpingography and HyCoSy were recorded. In total 333 tubes were examined in 171 patients. There were 121/171 diagnoses of bilateral patent tubes, 24/171 bilateral blocked tubes and 26/171 findings of one patent tube. In 15 (8.8%) women, laparoscopy and dye test was performed after HyCoSy and 19 patients had laparoscopy and dye test before HyCoSy. The findings in both investigations were similar. 70 additional uterine and adnexal pathologies were detected. Out of 171 40.9% (n=70) women conceived, 62 of these women had both tubes patent and 8 had one patent tube. In conclusion we have found that HyCoSy is a valuable cost effective screening test for low risk couples. Its results in our hands are as good as demonstrated by other studies. HyCoSy can be offered as a screening test for low risk infertile women as it is an effective alternative for laparoscopy and dye test.

Adolescent↗
PubMed1989

Tubal patency after local methotrexate injection for tubal pregnancy.

Tubal patency was investigated by hysterosalpingography in 21 of 37 patients with unruptured tubal pregnancy treated by local methotrexate injection at laparoscopy. 18 of the 21 patients had bilateral tubal patency, and the only tube of a patient with a single fallopian tube was also patent. 6 subsequent intrauterine pregnancies have so far been recorded. Local methotrexate injection into the tubal pregnancy may provide an efficient and safe alternative to surgery in early unruptured ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1998

Chlamydial and gonococcal serology in women with tubal infertility.

Sera from 81 infertile women with tubal pathology and 40 controls were tested for the presence of antibodies against Chlamydia trachomatis & Neisserria gonorrhoeae. Indirect immunoperoxidase test (Ipazyme kit) & Enzyme linked immuno sorbent assay (ELISA kit) were used for detection of chlamydial & gonococcal antibodies respectively. Antibodies to Ch. trachomatis were found in 74.07% of the infertile women and 5% in control group. Only a very low prevalence (4.93%) of antibodies to N. gonorrhoeae was found is infertile women as compared to nil in control group. Antibodies detection is a sensitive, specific and noninvasive test for diagnosing infertility.

Chlamydia trachomatis↗
PubMed2003

Diagnosing infertility in a district general hospital: a case-note and cost analysis.

This study aimed to observe diagnostic work-up and cost evaluation of infertile couples to identify opportunities for improvement. One hundred and seventy-four new referrals to the gynaecology clinic in a District General Hospital during 1996 and 1997 provided the cohort for analysis. Data from case notes were transferred on to data collection sheets. Data were inputted into SPSS for analysis. Primary infertility accounted for 62% of couples. One hundred and forty-two couples (81.6%) had a definitive diagnosis, and the analyses relate to these couples only. There was no single investigation performed on the whole cohort studied. Semen analysis was undertaken in 80.3% of the couples; couples with suspected male infertility were over four times more likely to have had more than two semen tests (P = 0.0005); 77.5% of couples had FSH and LH tests; and midluteal progesterone was tested in 76.1%. An increased intensity of FSH-LH hormone testing was associated with couples with anovulation (chi(2) = 6.79, P = 0.03). Serial repeat progesterone tended to be given to women with irregular or prolonged cycles (35 days or more), although this tendency was not statistically significant. The most common test for tubal patency was hysterosalpingography. Higher costs are generally associated with diagnosing endometriosis and tubal factor because of the relatively high cost of laparoscopy. The average cost of diagnosis for each patient was pound 365 and ranged from pound 64 to pound 851. In conclusion, a standard protocol of basic investigative procedures should be offered in secondary centres to all couples. Avoiding duplication and unnecessary investigations (for example, serial progesterone) may reduce costs, although offering all couples a standard protocol of tests would probably offset this observation.

Anovulation↗