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Hager M, Ott J. The Role of Hysteroscopy in the Assessment of Fallopian Tubal Patency: A Comprehensive Review and Meta-analysis. Geburtshilfe Frauenheilkd 2024; 84:619-628. [PMID: 38993802 PMCID: PMC11233202 DOI: 10.1055/a-2304-5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/09/2024] [Indexed: 07/13/2024] Open
Abstract
Hysteroscopy has been recognized as a reliable method for the evaluation of female infertility for several years. The outpatient setting is particularly convenient, as patients do not require general anesthesia and do not have to stay overnight. In recent years, more and more articles have dealt with the role of diagnostic hysteroscopy in tubal evaluation. Twenty-four articles were included in this comprehensive review and 14 of them were also included in a meta-analysis. This review provides an overview of the different techniques of hysteroscopic tubal evaluation, with a focus on perioperative changes in cul-de-sac volume, the air bubble technique ("Parryscope" technique), the Flow technique and selective hysteroscopic pertubation with methylene blue dye (SHPMBD). In pooled analyses, SHPMBD achieved the highest sensitivity for tubal patency (91.7%, 95% confidence interval, CI: 88.8-94.0), whereas the air bubble technique revealed the highest specificity of all methods (98.4, 95% CI: 95.3-99.6). Furthermore, in a meta-analysis of all methods on the assessment of single tubes, an overall sensitivity of 87.1% and an overall specificity of 79.8% (95% CI: 76.4-82.9) could be shown. In conclusion, the techniques of hysteroscopic tubal evaluation are well-tolerated, clinically relevant, and reliable.
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Affiliation(s)
- Marlene Hager
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
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Magnetic Resonance Imaging Feature Analysis and Evaluation of Tubal Patency under Convolutional Neural Network in the Diagnosis of Infertility. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:5175072. [PMID: 34629993 PMCID: PMC8464418 DOI: 10.1155/2021/5175072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
To explore the diagnostic value of MRI image features based on convolutional neural network for tubal unobstructed infertility, 30 infertile female patients were first selected as the research objects, who admitted to the hospital from May 2018 to January 2020. They all underwent routine MRI examinations and CNN-based MR-hysteron-salpingography (HSG) examinations, in order to discuss the diagnostic accuracy of the two examinations. In the research, it was necessary to observe the patients' imaging results, calculate the diagnosis rate of the two examination results, and analyze the application effect of the CNN algorithm, thereby selecting the best reconstruction method. In this study, the analysis was conducted on the basis of no statistical difference in the baseline data of the included patients. The results of undersampling reconstruction at 2-fold, 4-fold, and 6-fold showed that CNN for data consistency layer (CNN_DC) had a better effect, and its peak signal-to-noise ratio (PSNR) was lower sharply than that of the other two reconstruction methods, while the normalized mean square error (NMSE) and structural similarity index measure (SSIM) were higher markedly than the values of the other two reconstruction methods. The diagnostic rate of routine MRI examination of the fallopian tube and other parts of the uterus was lower than or equal to that of MR-HSG examination by CNN. Routine MRI examinations of fallopian tube imaging artifacts were large, and the definition was reduced, which increased the difficulty of identification. However, MR-HSG examination by CNN indicated that the imaging artifacts were low, the clarity was high, and the influence of noise was small, which was conducive to clinical diagnosis and identification. For endometriosis, the accuracy of MR-HSG was 33.33% and the accuracy of MRI was 46.67%. CNN MR-HSG inspection method was significantly better than the conventional MRI inspection method (P < 0.05). Therefore, the results of this study revealed that MR-HSG examination by CNN had a clear imaging effect and obvious inhibition effect on background signals and rapid image generation without the need for reconstruction with the same spatial resolution, which improved the imaging quality and could provide a reference value for clinical diagnosis and subsequent related studies.
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Roy KK, Gajapathy SR, Rai R, Zangmo R, Das A, Singhal S. Assessment of Tubal Patency with Selective Chromopertubation at Office Hysteroscopy versus Modified Minilaparoscopy in Infertile Women. Gynecol Minim Invasive Ther 2021; 10:159-165. [PMID: 34485060 PMCID: PMC8384029 DOI: 10.4103/gmit.gmit_95_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Tubal factor is the leading cause of female infertility. Diagnostic hysterolaparoscopy with chromopertubation plays a pivotal role in its evaluation. Office hysteroscopy (OH) has gained popularity as the outpatient procedure for diagnostic purposes. OH being a less invasive approach, the current study was undertaken to compare the accuracy of assessment of tubal patency with chromopertubation at OH with modified minilaparoscopy in infertile patients. MATERIALS AND METHODS The present study was a pilot study conducted from March 2017 to August 2018. Eighty patients were recruited. OH was done without anesthesia. Diluted methylene blue dye was injected. The eddy current of blue dye, "Visualizable flow" at ostium, and disappearance of blue dye from the uterine cavity through ostium was documented as evidence of patent tubal ostium. In case of tubal occlusion, uterine cavity became blue due to backflow of dye. After OH, minilaparoscopy with chromopertubation was performed under general anesthesia. Both tubes were assessed separately for tubal patency. RESULTS All patients underwent OH followed by minilaparoscopy in the same sitting. OH was 87.5% sensitive with positive predictive value of 95.2%. Compared to minilaparoscopy, OH is 85.6% accurate in predicting tubal patency. The area under receiver operating curve was 0.96 (SE is 0.15 with 95% confidence interval of 0.93-0.99, P < 0.001). It implies that, OH should correctly identify all laparoscopic cases with probability of 0.96. CONCLUSION OH chromopertubation can be used as an alternative to laparoscopy for assessing tubal patency with added advantages of lack of requirement of anesthesia, minimal cost, and better patient acceptance. Moreover, the procedure is less time-consuming and less invasive with high sensitivity and moderate specificity.
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Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Rakhi Rai
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Rinchen Zangmo
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Anamika Das
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N, Arab S, Rubenfeld E, Mills G, Buckett W. Transvaginal Sonography Post-Office Hysteroscopy as a Screening Tool for Tubal Patency: A Reliable and Feasible Technique in an Outpatient Setting. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:978-983. [PMID: 34048954 DOI: 10.1016/j.jogc.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine feasibility and accuracy of post-hysteroscopic transvaginal ultrasonography (TVUS) measurement of pelvic fluid accumulation as a screening method for tubal patency (TP). METHODS We conducted a retrospective cohort study of 85 patients who underwent uterine cavity assessment by office hysteroscopy at our university-affiliated fertility centre from November 2019 to October 2020. During the study period, two-dimensional (2D) TVUS was performed pre- and post-hysteroscopy to evaluate TP. Patient records were reviewed for demographics, diagnosis, and prior/subsequent TP testing. Predictive values for TP were calculated. RESULTS Pelvic fluid accumulation post-hysteroscopy was found in 65.9% of patients (56). Accumulation of fluid was seen with the use of as little as 10-50 mL of saline. Using more fluid did not increase the likelihood of demonstrating TP (P = 0.17). A trend towards more false-negative results for TP was observed when less fluid was used (7.7% with 10-50 mL vs. 3.8% with 60-190 mL and 1.3% with 200-760 mL; P = 0.10). The positive predictive value (PPV) of TVUS post-hysteroscopy in comparison to known patency/occlusion was 100%; negative predictive value (NPV) was 33%; sensitivity was 82.8%; and specificity was 100%. Similar values were seen in a second analysis that included patients with highly suspected patent or occluded tubes (n = 60); presumed predictive values were: PPV 100%, NPV 42%, sensitivity 78.8%, and specificity 100%. The use of more fluid did not increase pain (P = 0.75). This finding remains after accounting for confounders (e.g., pre-medication, endometrial biopsy). CONCLUSION TVUS pre- and post-hysteroscopy is feasible in an outpatient setting, and can serve as a reliable screening tool for TP. When hysteroscopy is performed and TP is not known, TVUS can be added for screening, potentially omitting the need for more invasive examinations. With limited non-urgent ambulatory services, it is of upmost importance to maximize information from a single procedure.
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Affiliation(s)
- Keren Rotshenker-Olshinka
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC.
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Steiner
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC
| | - Suha Arab
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC
| | - Eryn Rubenfeld
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC
| | - Ginevra Mills
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC
| | - William Buckett
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC
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Hager M, Ott J, Göbl C, Holzer I, Seemann R, Kurz C, Parry JP. Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion. Arch Gynecol Obstet 2021; 304:1073-1080. [PMID: 33625597 PMCID: PMC8429386 DOI: 10.1007/s00404-021-05993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022]
Abstract
Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.
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Affiliation(s)
- Marlene Hager
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Christian Göbl
- Clinical Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Iris Holzer
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rudolf Seemann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Christine Kurz
- Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - John Preston Parry
- Parryscope® and Positive Steps Fertility, Madison, MS, USA.,Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
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Ott J, Hager M, Nouri K, Marschalek J, Kurz C. Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation. J Minim Invasive Gynecol 2020; 27:135-140. [DOI: 10.1016/j.jmig.2019.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
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Hager M, Simek IM, Promberger R, Ott J. The Role of Diagnostic Hysteroscopy in the Evaluation of Fallopian Tube Patency: a Short Review. Geburtshilfe Frauenheilkd 2019; 79:483-486. [PMID: 31148848 PMCID: PMC6529226 DOI: 10.1055/a-0826-1326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
The relevance of diagnostic hysteroscopy, especially when performed in an outpatient “office” setting, in the evaluation process of infertility has increased within the last few years. Notably, several articles on a possible role for diagnostic hysteroscopy in the assessment of Fallopian tube patency have been published recently. Three relevant articles were identified. Visualizing a “flow effect” or air bubbles dispersing through the ostia, sonographically assessed shifts in cul de sac volume, and selective Fallopian tubal cannulation are reportedly promising hysteroscopic techniques. In this review, an overview of hysteroscopy, details about diagnostic reliability, and considerations with regard to ease of use and difficulties are summarized. Based on these articles, hysteroscopic evaluation of tubal patency seems to be a promising, clinically relevant field for future clinical research.
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Affiliation(s)
- Marlene Hager
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Inga Malin Simek
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Regina Promberger
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.,Department of Gynecology, Hanusch Krankenhaus, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
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Margaux Becker V, Silver S, Seufert R, Muensterer OJ. The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility. JSLS 2019; 23:JSLS.2018.00099. [PMID: 30846898 PMCID: PMC6400250 DOI: 10.4293/jsls.2018.00099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727). Conclusion Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.
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Affiliation(s)
- Victoria Margaux Becker
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Saskia Silver
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Rudolf Seufert
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Sorak M, Devic A. Analysis of Glycodelin Levels Before and After Hysteroscopic Polypectomy in Infertile Patients. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2017-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Glycodelin (or placental protein 14) is a glycoprotein located in the glandular and thin epithelium of the endometrium. It is considered an important factor in the implantation process, and its traces can be found in elevated concentrations in the uterine flushing obtained at the time of implantation, while in the proliferative phase of the cycle, its levels are low. A certain concentration has been found to inhibit the binding of spermatozoids to the zona pellucida of the oocites therefore, it effects conception. It has a role in angiogenesis and is in high concentrations in the tissues of both benign and malignant gynaecological tumours.
The aim of this study is to analyse and display the glycodelin level changes before and after hysteroscopic polypectomy in infertile patients in the uterine flushing fluid and serum. This survey covers 80 infertile patients, who were divided into two groups. The first group, the experimental group, consisted of 50 infertile patients with endometrial polyps, and a control group of 30 infertile patients without endometrial polyps was also included.
The results primarily indicate the existence of changes in glycodelin levels preoperatively in the flushing and venous blood in infertile patients with endometrial polyps compared with the levels after surgery. In the control group of patients, no significant change in the glycodelin levels was detected in the flushing and venous blood. When comparing these two groups, statistically significant differences in the glycodelin levels in the flushing and venous blood were noted. We conclude that the presence of endometrial polyps in the cavum uteri affects the increase in the glycodelin concentration in the flushing fluid and in the plasma. Increased glycodelin concentrations complicate fertilization and implantation.
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Affiliation(s)
- Marija Sorak
- Department of Gynecology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Ana Devic
- Clinical Hospital Center Zemun, Hospital for Gynecology and Obstretics , Serbia
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Mardanian F, Rouholamin S, Nazemi M. Evaluation of Efficacy of Transvaginal Sonography with Hysteroscopy for Assessment of Tubal Patency in Infertile Women Regarding Diagnostic Laparoscopy. Adv Biomed Res 2018; 7:101. [PMID: 30050889 PMCID: PMC6036783 DOI: 10.4103/abr.abr_71_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Infertility, as one of the most common gynecological disorders, affects many people worldwide. To choose the clinical treatment, correct assessment of tubal patency can provide an important clue; therefore, it is considered as one of the major steps in workup examinations of infertile women. In this study, we aimed to compare the results of transvaginal ultrasonography (TVS) after hysteroscopy (HSC) with laparoscopy, as a gold standard, for assessing the fallopian tubal patency in infertile women. Materials and Methods This is a cross-sectional study which included 49 infertile women referred to Shahid Beheshti Hospital affiliated with Isfahan University of Medical Sciences during the years 2015 and 2016. At first, patients who met the inclusion criteria were examined through HSC in by a specialist in gynecology and obstetrics in operating room because laparoscopy was performed after TVS with HSC, but HSC was performed without anesthesia. TVS was performed before and after of HSC to observe fluid in the pouch of Douglas. The findings of TVS with HSC and laparoscopy were compared. Results There was a strong agreement between TVS after HSC and laparoscopy (kappa coefficient = 0.935, 95% confidence interval [CI]: 0.81, 1.00). The sensitivity of TVS after HSC was 100% (95% CI: 66.37, 100) and specificity was 97.50% (95% CI: 86.84, 99.94) with a positive predictive value of 90% (95% CI: 55.50, 99.75) and negative predictive value of 100% (95% CI: 90.97, 100). Conclusion TVS after HSC is an accurate diagnostic tool for examination of fallopian tubal patency in infertile women.
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Affiliation(s)
- Farahnaz Mardanian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nazemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Carta G, Palermo P, Pasquale C, Conte V, Pulcinella R, Necozione S, Cofini V, Patacchiola F. Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women. HUM FERTIL 2017; 21:106-111. [PMID: 28975815 DOI: 10.1080/14647273.2017.1384856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80-95.90), sensitivity was 85.7% (95% CI 57.20-98.20), positive and negative predictive values were 70.6% (95% CI: 44.00-89) and 94.7% (95% CI: 82.30-99.40), respectively. Pregnancy rate (PR) within six months after performance of hysteroscopy with chromoperturbation was 27%. Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and uterine cavity.
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Affiliation(s)
- Gaspare Carta
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Patrizia Palermo
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Chiara Pasquale
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Valeria Conte
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Ruggero Pulcinella
- b Section of Gynecology and Obstetrics , ' San Donato' Hospital , Arezzo , Italy
| | - Stefano Necozione
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Vincenza Cofini
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
| | - Felice Patacchiola
- a Department of Life, Health and Environmental Sciences , University of L' Aquila , Coppito , Italy
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