[Abdominal test of tubal patency during surgery. (Report on a practical uterus clamp)].
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Fallopian Tubes↗
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Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.
OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.
Adult↗
Lessons learned from infertility investigations in the public sector.
OBJECTIVES: To determine the main factors causing infertility in an urban, tertiary hospital population. To establish if any such major causal factor could be used to rationalise and improve the service for infertile couples in the public sector. DESIGN: A retrospective analysis of the hospital records of 206 women who had a tubal patency test (hysterosalpingogram) performed and the results of the investigations performed in the couples with infertility. RESULTS: Of the 206 women 38 (18.5%) had normal fallopian tubes on hysterosalpingogram; 33 (16%) had unilateral obstruction and 135 (65.5%) had bilateral tubal obstruction. Of the latter group 81 (60%) had significant hydrosalpinges. Semen analysis results in 148 partners (71.8%) demonstrated a normal count in 85 (62%), normal motility in 70 (51%) and normal morphology in only 25 (18%). Testing for ovulation (mid-luteal phase progesterone) was positive in 91 of 124 women tested (73%). Compliance, technical and logistical problems were encountered with both semen analysis and mid-luteal phase progesterone tests. CONCLUSIONS: Infertility is a major problem in South Africa, with limited resources for investigation and treatment in the public sector. Tubal factor infertility was the most common cause of infertility demonstrated in this study. In the presence of bilateral tubal obstruction with hydrosalpinges the prognosis is so poor that unless assisted reproductive techniques are available and affordable, further infertility investigations do not seem justified. Recommendations on an approach to the infertile couple in the public sector is outlined.
Adult↗
[Rifamycin chromopertubation under laparoscopic control (author's transl)].
There is an inherent danger of infection or promoting the exacerbation of an as yet incompletely healed inflammatory process when retrograde perfusion of the Fallopian tubes is performed, as in the diagnosis of sterility by laparoscopy and chromopertubation. Hence, the intense-red tuberculostatic drug, rifamycin SV (Rifocin) was instilled by means of the Schultz Instillator, either alone or in combination with indigo carmine, in place of the conventional indicator solutions, to test tubal patency in all patients under investigation for sterility, whether there was a history of acute, subacute or chronic salpingitis or not. This procedure was not followed by exacerbation of preceeding infection in a single case, which is particularly noteworthy in two patients shown to have extensive tubal and peritoneal tuberculosis.
Adnexal Diseases↗
A new method of determining tubal patency and tubal ciliary activity.
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Animals↗
Fallopian tissue sampling with a cytobrush during hysteroscopy: a new approach for detecting tubal infection.
OBJECTIVE: To evaluate whether the transcervical approach for fallopian tissue sampling is a practicable and safe method to establish an etiologic diagnosis of salpingitis. DESIGN: Controlled clinical study. SETTING: Academic research environment. PATIENT(S): Twenty women with primary or secondary sterility undergoing hysteroscopy and laparoscopy. INTERVENTION(S): During hysteroscopy, fallopian tissue samples were obtained from the proximal parts of both tubes with a cytobrush inserted through the working channel of the hysteroscope. Diagnostic laparoscopy with assessment of tubal patency was performed in the same session. The specimens were split and used for chlamydial testing by both cell culture and polymerase chain reaction. Serum samples were evaluated for the presence of antichlamydial antibodies. MAIN OUTCOME MEASURE(S): Practicability and safety of the method. RESULT(S): The sampling procedure was performed in all patients without complications. Adequate samples were obtained from both tubes in all 20 patients. The fallopian specimens showed evidence of chlamydial infection in one patient. CONCLUSION(S): Those data indicate that transcervical fallopian tissue sampling with a cytobrush is a reliable and safe technique.
Cervix Uteri↗
Reconstructive microsurgery of the fallopian tube with the carbon dioxide laser - procedures and preliminary results.
UNLABELLED: In 1974 the carbon dioxide laser was adapted to the operating microscope for reconstructive pelvic surgery. A protocol was designed to test the efficacy of this surgical modality and a new study begun. Complete documentation of laparoscopic findings, surgical technique, and pre- and post-operative hysterosalpingograms are kept on videotape. One hundred cases will be entered into this study. Patency and pregnancy failures will be compared with patency and pregnancy successes to determine, if possible, the reasons for failure. In this paper detailed descriptions of the surgical techniques employed in the first 61 cases are presented. PRELIMINARY RESULTS in terms of patency and pregnancy experience to date are reported. PRELIMINARY RESULTS: Eighty-two couples have been evaluated at the Reproductive Biology Unit. Sixty-one cases have undergone fertility enhancement laser microsurgery and/or interim medical management prior to surgery for infertility. Bilateral patency or patency of the only existing fallopian tube was demonstrated post-treatment in 93% or 57 of the cases. Eliminating those cases who are not at risk of pregnancy due to elective contraception or medical prohibition during Danocrine therapy (28), conception has occurred in 10 of 33 patients. This represents approximately one of every three patients at risk. Considering the limited exposure to pregnancy, these results are very encouraging.
Adult↗
Microsurgery of the fallopian tube with the carbon dioxide laser: eighty-two cases with follow-up.
In 1974 the carbon dioxide laser was adapted to the operating microscope for reconstructive pelvic surgery and the first 15 cases of laser tubal microsurgery were performed. The instrumentation and techniques were refined. A protocol was designed to test the efficacy of this surgical modality, and a new study was begun in 1980. Complete documentation of laparoscopic findings, surgical techniques, and pre- and postoperative hysterosalpingograms are kept on videotapes. Detailed descriptions of the surgical techniques employed in these cases are presented in this paper. Preliminary results are reported in terms of patency and pregnancy rates experienced to date. Eighty-two women experienced fertility enhancement laser microsurgery at the Reproductive Biology Center at F. Edward Hebert Memorial Hospital in New Orleans. Bilateral patency or patency of the only existing fallopian tube was demonstrated postoperatively in 93% of the cases. Eliminating the women practicing contraception, those on postoperative Danazol therapy for endometriosis, male factors, or other reasons for women or their partners being not at risk, conception has occurred 21 times among 20 of 42 patients at risk. Many of the women were referral cases who had had unsuccessful microsurgery or were rejected for microsurgery by their physicians due to extensive disease. These results indicate that the carbon dioxide surgical laser may be a useful adjunct in reconstructive microsurgery for fertility dysfunction.
Adult↗
Combining B-mode ultrasound with pulsed wave Doppler for the assessment of tubal patency.
This study was conducted to determine whether the additional use of pulsed wave Doppler improves the diagnostic capacity in assessing tubal patency by hysterosalpingo contrast sonography (HyCoSy). A total of 210 women with a history of infertility were included in this study. HyCoSy was performed after intrauterine injection of Echovist 200. For the assessment of tubal patency B-mode scanning and pulsed wave Doppler ultrasound were performed in the proximal and distal tubal segments. With the combined sonographic procedure 297 tubes (74%) were rated patent, 35 (8%) incompletely obstructed and 70 (18%) completely obstructed. A total of 252 tubes were additionally examined by laparoscopy for reference purposes. Concordant results for both methods were found in 92% of tubes, nine had been rated false negative and 10 tubes appeared to have been rated false positive. The combined sonographic specificity was found to be 85% with a sensitivity of 95%. Peritubal adhesions detected by laparoscopy were found to be the reason for false positive sonographic results in 60% of cases. In conclusion, the combined B-mode and pulsed wave Doppler examination appears to be a non-invasive and low-cost test for the assessment of tubal patency, which should be performed during diagnostic work-up for infertility.
Adult↗
Abnormal findings on hysterosalpingography: effects on fecundity in a donor insemination program using frozen semen.
OBJECTIVE: We sought to evaluate the effect of abnormal baseline hysterosalpingography (HSG) on subsequent fecundity during the first six cycles of treatment. METHODS: Hysterosalpingography was performed on 208 asymptomatic ovulatory women with no history of pelvic disease who were referred for donor insemination. The findings were categorized into five groups: 1) normal study, 2) uterine anomaly or filling defect with bilateral tubal patency, 3) normal uterine anatomy with unilateral tubal patency, 4) normal uterine anatomy with bilateral tubal blockage, and 5) normal uterine anatomy with hydrosalpinx. Subjects in groups 4 and 5 received inseminations only if patency of at least one fallopian tube was demonstrated with laparoscopy. Life-table analysis was performed to calculate the average monthly fecundity and cumulative conception rates for each group. The Mantel-Haenszel test was used to compare group fecundities. RESULTS: A total of 1460 donor insemination cycles were performed. The number of cycles in each group were as follows: group 1, 1173 (80%); group 2, 153 (10%); group 3, 90 (6.2%); group 4, 16 (1.1%); and group 5, 28 (1.9%). None of the patients in group 4 or 5 conceived. The cumulative conception rates in the first three groups were 46, 34, and 40%, respectively, and were not significantly different from one another (P greater than .05). Although a high incidence of uterine filling defects and unilateral tubal blockage was observed (19.2%), the incidence of an abnormal HSG finding that significantly decreased fecundity was only 2.8%. CONCLUSION: In women with no history of tubal or uterine disease, routine HSG before initiation of donor insemination is of limited value for identifying decreased treatment fecundity.
Adult↗
Tubal sterilization by means of endoluminal coagulation: an in vivo study in rabbits.
This study was conducted to investigate the effectiveness and safety of endoluminal tubal coagulation in obliterating the tubal lumen in rabbits. Forty female rabbits were subjected to laparotomy and hysterotomy. Endoluminal tubal coagulation was induced over a length of 3 cm in the proximal, extramural fallopian tube by using a heated stainless steel cannula or a cylindrical diffusing tip emitting argon laser radiation for one to 5 minutes. Tubal patency was evaluated by observing patterns of injected methylene blue and/or breeding success rates. Postoperative recovery was uneventful in all animals. A negative methylene blue test indicated occlusion in 51 of 52 tubes (tubal occlusion rate 98.1%), and a contraception rate of 100% in all 17 uteri in which the tube had been treated. The described endoluminal tubal coagulation method proved suitable for safe and effective sterilization in rabbits and has potential as a new transcervical tubal sterilization method for humans.
Animals↗
Reconstruction of fallopian tubes in previously sterilized patients.
Restoration of tubal patency after surgical sterilization in which the luminal continutiy is interrupted requires either uterine implantation of the patent distal segment or resection and end-to-end anastomosis of patent adjacent segments. Although it is logical to assume that after most tubal ligations the intramural segment remains normal and end-to-end anastomosis is possible, both segments should be evaluated and tested prior to the plastic reconstruction. The results of 178 operations collected from the literature and the author's 23 attempts at surgical reversal of previous tubal operations for surgical sterilization were described. The over-all pregnancy rate after resection and end-to-end anastomosis was 39.0%; after uterotubal implantation, it was 19.4%. The latter procedure was performed in 60% of the patients. The small series of reports makes it difficult to evaluate conception rates or to judge the merits of specific reconstructive operative techniques.
Adolescent↗
Full robotic assistance for laparoscopic tubal anastomosis: a case report.
Optical magnification and long instrumentation significantly increase surgical tremor, which makes laparoscopic microsuturing difficult. Therefore, laparoscopic tubal anastomosis has not gained wide acceptance among gynecologic surgeons. Robotic assistance facilitates this type of procedure by filtering tremor, reducing the surgeon's fatigue, and scaling the maneuvers. The authors have successfully completed a case of laparoscopic tubal reanastomosis using a "master-slave" robot to perform the standard microsuturing technique. A 33-year-old woman, gravida 2, para 2, requested reversal of her previous tubal ligature. A right isthmic-isthmic tubal anastomosis was performed laparoscopically, with faithful adherence to the authors' standard technique applied at laparotomy. Full robotic assistance was used to anastomose the tube. A chromotubation test showed anastomotic patency without leak. The patient recovered uneventfully after surgery and was discharged within 24 h after the procedure. Laparoscopic microsurgical tubal anastomosis with full robotic assistance is feasible and safe in humans.
Adult↗
Rate of transport of radioactive ovum models through the oviducts of individual rabbits.
The transport of radioactive ovum models of 100, 200, 400, 800, and 1,000 mu diameter through the oviducts was measured. Four surrogates of a given size were transferred into each oviduct 6 hours after injection of human chorionic gonadotropin (HCG). The surrogates were located in the oviducts 24, 48, 60, 66, and 72 hours after HCG injection with a collimated end-window Geiger-Mueller tube. Thus the time-course of the transport of each surrogate, from ampulla to uterus in the same animal, was plotted. The time-course of surrogate transport was directly related to surrogate size. Our data suggest that normal tubal patency and ovum transport function can be tested by introducing radioactive ovum surrogates of appropriate size into the oviducts and monitoring their time of arrival at the uterus.
Animals↗
[The significance of tubal patency tests for diagnostic technics in treatment of "infertility" (II). With special reference to statistics for the past six years (author's transl)].
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Adult↗
Office hydrolaparoscopy for the diagnosis of endometriosis and tubal infertility.
Transvaginal hydrolaparoscopy has been described as an office procedure that is particularly suitable for the diagnosis of endometriosis and adhesions. It is recommended as a first line procedure in patients with infertility. The procedure is performed under local anaesthesia or sedation in an office setting. The abdominal distension is achieved by transvaginal instillation of warm saline using a combined Veress needle-trocar system. The exploration under fluid allows the inspection of the tubo-ovarian structures in their natural position and the easy identification of endometriotic lesions and adhesions in the posterior pelvis. The limitation of the inspection to the posterior pelvis is not a major problem for the diagnosis of endometriosis because exclusively anterior pelvis endometriosis is rare and of doubtful significance in infertility. Transvaginal hydrolaparoscopy can be performed in the office setting in combination with minihysteroscopy, tubal patency test and salpingoscopy, offering major advantages for the diagnosis of pelvic disease in patients with infertility.
Ambulatory Surgical Procedures↗
Diode laser assisted transcervical tubal sterilization: an in vivo study in rabbits.
BACKGROUND AND OBJECTIVE: To investigate the sterilization effectiveness of endoluminal tubal photocoagulation on tubal lumen obliteration. STUDY DESIGN/MATERIALS AND METHODS: Twenty-four female rabbits were subjected to laparotomy and hysterotomy. Endoluminal tubal photocoagulation was induced over a length of 3 cm in the proximal, extramural fallopian tube by using a cylindrical diffusing tip that emitted diode laser radiation at 805 and 980 nm wavelengths. Tubal patency was evaluated by observing patterns of injected methylene blue and/or breeding success rates. RESULTS: Postoperative recovery was uneventful in all animals. Evidence of occlusion of the tubal lumen included a negative methylene blue test in all 12 tubes treated (tubal occlusion rate 100%) and failure to conceive in 17 of 18 uteri (contraception rate 94.5%). Although identical power settings were used, distinctly lower tubal surface temperatures (about 10 degrees C) were obtained with the 805 nm diode laser as compared to the 980 nm diode laser. CONCLUSIONS: The described endoluminal tubal photocoagulation method using a diode laser emitting longer wavelengths (e.g., 980 nm) is suitable for safe and effective sterilization in rabbits and has potential as a new transcervical tubal sterilization method for humans.
Animals↗
[Hysterosonosalpingography and hysterosalpingography in the diagnosis of tubal patency in infertility patients].
OBJECTIVES: To compare the hysterosonosalpingography(HSS) to the hysterosalpingography(HSG) in the evaluation of the tubal factor in infertility patients. MATERIAL AND METHODS: A transversal study with 30 patients in infertility investigation, with age minor than 38 years was performed. The patients were submitted to HSS, HSG and laparoscopy (LPC) in the first cycle menstrual phase. The evaluation of tubal patency of HSS and HSG, with LPC like gold-standard was compared. It was calculated the negative predictive value (PV-) of the exams. The HSS used Ecovist like contrast agent, the HSG used water soluble contrast media and the LPC used tubal insufflation with methylene blue. It was considered significative a p< 0.05 RESULTS: The final sample was of 26 patients (4 leave the investigation). The mean age was of 30,6 years. The HSS showed tubal patency in at least one of the tubes in 24 patients (92,3%). The HSG showed tubal patency in one of the tubes in 25 patients (96,2%), and the LPC in 25 patients (96,2%). The PV- of the HSS was of 92% and the PV- of HSG was of 100%. The differences were not statistically significant (p=0.996, Yates test). CONCLUSIONS: The HSS is an alternative method in the evaluation of tubal patency in infertility patients.
Adult↗