[Use of laparoscopy in the testing of fallopian tube patency].
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Fallopian Tube Patency Tests↗
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[Functional test for fallopian tube patency].
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Adnexal Diseases↗
A randomized, prospective, controlled study of laparoscopic dye studies and selective salpingography as diagnostic tests of fallopian tube patency.
OBJECTIVE: To determine and compare the relative merits of laparoscopic dye (LD) studies and selective salpingography (SS) as diagnostic tests of fallopian tube patency. DESIGN: Randomized, prospective, controlled study. SETTING: University-associated assisted reproduction unit. PATIENT(S): Two hundred seventy-eight women undergoing investigation of infertility. INTERVENTION(S): Allocation to the performance of either LD studies followed by SS or SS followed by LD studies conducted sequentially under general anesthesia. MAIN OUTCOME MEASURE(S): Detection of fallopian tube occlusion, including the site of obstruction and evidence of peritubal or pelvic disease. RESULT(S): When diagnosis was compared by the first test used, 16 (11.9%) of 135 patients had proximal tubal occlusion at LD studies versus 5 (3.6%) of 138 at SS. Twelve (5.6%) of 122 patients had distal tubal occlusion at LD studies versus 14 (10.5%) of 133 at SS. Fifteen (11.1%) of 135 patients had peritubal disease at LD studies versus 3 (2.52%) of 119 at SS. When diagnosis was compared by individual tubes, the results were similar. Among patients who had proximal occlusion and otherwise normal tubes by both methods, endometriosis was present in 72.2%. CONCLUSION(S): Selective salpingography is a better diagnostic test of proximal tubal occlusion than are LD studies. There is no difference between SS and LD studies as a diagnostic test of distal tubal occlusion. Laparoscopic dye studies are a better diagnostic test for assessing peritubal disease than is SS. There may be an association between endometriosis and proximal tubal occlusion. Selective salpingography and LD studies are complementary investigations of the fallopian tubes.
Adult↗
First clinical experience with sonicated human serum albumin (Albunex) as an intrafallopian ultrasound contrast medium.
The safety and preliminary efficacy of a new ultrasound contrast medium. Albunex for evaluating Fallopian tube patency during transvaginal sonography were studied in seven women. All of the women had sought medical attention because of uterine fibroids and excessive menstrual bleeding and were scheduled for a subsequent hysterosalpingectomy 3 weeks after the ultrasound examination. Albunex was injected transcervically in doses ranging from 0.5 to 9 ml, alternating with saline, during concomitant transvaginal ultrasound scanning. There were no serious adverse reactions. Peroperative macroscopic and postoperative microscopic investigations of the endometrium. Fallopian tubes and peritoneal biopsies revealed no pathological changes. Agreement between hysterosalpingo contrast sonography (HyCoSy) and postoperative testing for the evaluation of tubal patency was observed in 12 out of 14 Fallopian tubes. These findings suggest that Albunex may safely be used as an intrafallopian contrast medium in ultrasound investigations.
Adult↗
[Radiologic versus ultrasound fallopian tube imaging. Painfulness of the examination and diagnostic reliability of hysterosalpingography and hysterosalpingo-contrast-ultrasonography with echovist 200].
UNLABELLED: Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. PATIENTS AND METHODS: 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). RESULTS: Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). CONCLUSION: Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.
Contrast Media↗
Tubal pregnancy and tubal patency.
The laparoscopic demonstration of a patent tube usually excludes the present of a tubal pregnancy. In the reported case tubal pregnancy was suspected. Tubal patency was tested because of equivocal laparoscopic findings, and an unexpected tubal pregnancy was diagnosed in the presence of tubal patency.
Adult↗
Investigation of tubal infertility by radionuclide migration.
Investigation of the tubal factor in infertility is limited to an assessment of anatomical structure and tubal patency. No test of ascendant tubal function is currently available. The migration of radionuclide (99mTc-labelled human albumin microspheres) through the genital tract in 96 infertile women was compared with pelvic findings at laparoscopy and chromopertubation. The radionuclide test correlated with laparoscopy in the diagnosis of patency or blockage in 83 cases (86%). In nine patients, where 'blockage' was diagnosed on the radionuclide test but patency found at laparoscopy, a higher prevalence of pelvic abnormality was found, compared to the 78 patients where both tests demonstrated patency (P less than 0.02). The radionuclide test may facilitate detection of diseased but patent tubes and, as an adjunct to laparoscopy and chromopertubation, may provide useful information about tubal function.
Endometriosis↗
[Criteria of selection of patients for organ-sparing operations in tubal pregnancy].
Rabbit experiments indicated that resection of a half of the oviduct anastomosed failed to impair its function and reproduction of viable progeny. With greatly varying diameters of sutured pieces, the valuable anastomosis was made by additional cuts of the narrow end of the oviduct. Analysis of 332 case histories and morphological studies of 10 control and 70 pregnant tubes suggested criteria for selection of patients, for organ-preserving surgeries. The latter could be performed nearly in 50% of females with tubal pregnancy in the form of stomatoplasty or anastomosis. The results of the study were tested in 8 females in the clinical setting who all exhibited a full recovery of tubal patency.
Adolescent↗
Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting.
Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The 'gold standard' for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised. The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 25 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4%). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography. Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first-step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy.
Adult↗
Radionuclide evaluation of tubal function.
The tubal capacity to transport radioactively labeled human albumin microspheres deposited in the vaginal fornix and cervical canal and to concentrate them on the ovarian surface was evaluated in a group of 34 patient-volunteers. One millicurie of technetium-99 was used to label human albumin microspheres of 20 mu in diameter, suspended in 1 ml of saline. The distribution of the radioactive material was imaged on a gamma camera at different intervals between 15 and 240 minutes. The radiation dose to the ovaries was estimated to be similar to that of a hysterosalpingogram. The results of the radionuclide evaluation were compared with the surgical findings at the time of laparoscopy or laparotomy performed for diagnostic or therapeutic reasons. The overall correlation was 87.1%. It would appear that as opposed to the traditional hysterosalpingogram, a radionuclide test may give a better understanding of the functional capacity of the tube and may also prove a useful method in the evaluation of the results of tubal microsurgical procedures.
Adult↗
Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization.
The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.
Adult↗
[Fecundify after treatment of tubal pregnancy].
UNLABELLED: This study is a follow-up analysis of 103 patients who desired to preserve their fertile ability after treatment of tubal pregnancy. Among the 103 cases, 58 were treated by unilateral salpingectomy, 15 by salpingostomy and 30 by drug conservative therapy. RESULTS: 67 cases had intrauterine pregnancy and 9 cases repeated ectopic pregnancy. The intrauterine pregnancy rate of the surgical group (71.2%) was higher than that of the nonsurgical group (50.0%). And the pregnancy rate of salpingostomy group (86.7%) was higher than that of salpingectomy group (67.2%). No repeated ectopic pregnancy occurred in the salpingostomy group. After three months of treatment, 45 cases were randomly sampled for tubal patency test. Bilateral tubal patency rate in salpingostomy group was 93.3% and in drug treatment group was 20.0%. These results indicated that tubal patency is an essential factor for normal pregnancy. Prevention of post-operative adhesion and treatment of pelvic inflammatory disease are important for increasing intrauterine pregnancy rate and decreasing repeated ectopic pregnancy rate.
Fallopian Tube Patency Tests↗
Colour Doppler hysterosalpingosonography: a simple and potentially useful method to evaluate fallopian tubal patency.
The diagnostic efficacy of colour Doppler hysterosalpingosonography to evaluate Fallopian tubal patency was studied in 17 women. Of the 17 women, 12 were infertile and the remaining five were fertile and requested elective tubal ligation. Colour Doppler sonography was performed using the transabdominal approach 1-4 weeks after diagnostic laparoscopy during infertility work-up in the former, and 1-2 weeks after bilateral isthmic tubal ligation in the latter group. Sterile saline was used as the contrast agent. Laparoscopic chromopertubation was considered as the gold standard. The sensitivity and specificity of colour Doppler sonography were found to be 93 and 83%, respectively. A kappa value of 0.73 reflected good clinical agreement between the two techniques. Colour Doppler hysterosalpingosonography is concluded to be a relatively accurate and simple procedure to test tubal patency. The other advantages include absence of radiation and avoidance of potential allergic reactions to iodinated contrast agents employed for hysterosalpingography. However, the inability to delineate the inner architecture of the genital canal and to determine the exact location of tubal obstruction, when present, remain the disadvantages of this technique.
Color↗
The value of Chlamydia trachomatis antibody testing as part of routine infertility investigations.
Laparoscopy is considered the gold standard for the evaluation of tubal disease but it is an invasive and costly procedure. Chlamydia trachomatis antibody testing is simple and inexpensive and causes minimal inconvenience to the patient. Using the micro-immunofluorescence technique we assessed the significance of positive serology. There was a marked association between the titre and the likelihood of tubal damage. In the group with low titres (1 in 32) there was only a 5% incidence of tubal damage; however, there was a progressive increase in the incidence of tubal damage in those with higher titres. Twenty out of 57 patients with titres higher than 1 in 32 had tubal damage (35%). The difference between the two groups was statistically significant (P < 0.0001, chi(2) test). By using C. trachomatis antibody testing more widely it may be possible to reduce the number of laparoscopies performed. It should therefore become an integral part of the fertility work-up.
Anti-Bacterial Agents↗
A clinical comparison of sonographic hydrotubation and hysterosalpingography.
OBJECTIVE: To assess the value of vaginal sonographic hydrotubation as a preliminary test of uterine configuration and tubal patency in infertility investigation, and to compare this new test with hysterosalpingography. DESIGN: A prospective blind comparison of the two tests in an unselected group of infertile women. SETTING: Hillbrow Hospital, Johannesburg, South Africa. SUBJECTS: Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals. INTERVENTIONS: Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter. MAIN OUTCOME MEASURES: The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas. RESULTS: The sonographic and hysterosalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation. CONCLUSIONS: Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.
Diagnosis, Differential↗
[Hormonal treatment of proximal tubal pathology with the GnRH analogue leuprorelin].
In proximal tubal occlusions (PTO) the microsurgical anastomosis or in case of extensive tubal damage the in vitro-fertilisation (IVF) are the treatment modalities of choice. Aim of our study was to evaluate the effectivity of GnRH-analogues in the treatment of PTO. In 23 patients with repeatedly proven proximal tubal occlusion the GnRH-analogon Leuprorelin was applied for a 3 month period. 20 out of 23 patients completed the entire study including a further tubal patency test. 10 patients showed open tubes on both sides and in 2 cases one oviduct was patent. In 8 patients no effect of the hormonal treatment was found. Following the therapy 4 pregnancies occurred, 2 were located ectopically. Regarding tubal patency we could demonstrate a significant effect of hormonal treatment in proximal tubal occlusions (PTO). However, in respect to the pregnancy rate the results were not satisfactory. Therefore, the hormonal treatment of PTO by GnRH-analogues is limited to certain cases and doesn't represent a standard therapy.
Adult↗
Effects of an antiprostaglandin drug on human fallopian tubes in vivo.
The Authors studied 17 patients with patent tubes, normal ovulation and Rubin's test results. In the following cycle, this test was repeated divided into two phases. The first followed the normal procedure; the second started 10' after the e.v. administration of 50 mg of an antiprostaglandin drug (Ketoprophen). The results highlighted the capability of this drug to alter the activity of human tubes. A general increase was observed in the amplitude and frequency of tubal contractions. The Authors finally analyse the possible clinical use of this drug in the treatment of the tubal pathology.
Adult↗
Radionuclide migration through the genital tract in infertile women with endometriosis.
The migration of radionuclide through the genital tract was observed, comparing 20 patients with endometriosis and infertility with a control group of 23 infertile patients who had a normal pelvis. All patients had patent tubes at laparoscopy and chromopertubation, performed in both groups for the investigation of infertility and to diagnose the presence and extent of endometriosis. A radionuclide tubal test, using human albumin microspheres labelled with 99m-technetium (99mTc) was subsequently undertaken to observe the extent of genital tract migration of radionuclide to uterus, Fallopian tube and peritoneal cavity. The results show that radionuclide migration to the peritoneal cavity was impaired in patients with endometriosis, compared with the control group (30 versus 83%, respectively; P < 0.001). There was no relationship between migration and the severity of endometriosis. We conclude that impaired tubal function may be a cause of infertility in some patients with endometriosis.
Adult↗