The Role of Diagnostic Hysteroscopy in the Evaluation of Fallopian Tube Patency: a Short Review

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To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency. Design: A prospective cohort study. Setting: In 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. Patients: Seventy-two infertile women. Interventions: Combined hysteroscopy and laparoscopy with chromopertubation. Results: One-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]). Conclusions: The 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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confidence: 99%

Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation

Ott

Hager

Nouri

et al. 2020

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“…As previously described for the office [7,10], combining disposable supplies with equipment depreciation amounted to $25 per procedure, which is comparable with the cost of catheters used for sonosalpingography and HSG. Another limitation to the present study relates to not precisely quantifying the laparoscopic pressures necessary to achieve tubal patency, particularly given that high-pressure patency is associated with lower fecundity than when it is observed with lower pressure [6,18]. However, this constraint is common to almost all publications on tubal patency.…”

Section: Discussionmentioning

confidence: 94%

“…Several approaches to hysteroscopic assessment of fallopian tubal patency exist and have been recently reviewed [6]. The 2 approaches with the highest potential seem to be the Parryscope and flow techniques, based on speed, cost, ease of learning, and gentleness (as they can be performed without an operative channel, allowing for smaller hysteroscopes).…”

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confidence: 99%

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

Hager¹,

Ott²,

Holzer³

et al. 2020

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To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. Design: Prospective randomized clinical trial. Setting: From 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. Patients: Sixty women with subfertility. Interventions: Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. Measurements and Main Results: Hysteroscopic 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). Conclusion: Using 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.

“…Hager et al [30] considered the use of diagnostic hysteroscopy in tubal patency evaluation extremely promising. In their conclusions, the authors raised a doubt about which technique should be considered the most accurate.…”

Section: Discussionmentioning

confidence: 99%

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

Vitale

Carugno

Riemma

et al. 2021

To assess the diagnostic accuracy of hysteroscopy compared with that of laparoscopic chromopertubation for the detection of fallopian tubal obstruction. Data Sources: An 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 Selection: This 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 Results: Six 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. Conclusion: Hysteroscopic 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.