Indications for Distal Salpingoscopy

Abstract

Internal and external tubal pathology are the decisive factors for evaluating tubal function. Salpingoscopy is the most reliable method to determine the mucosal status as the correlation of external and internal pathology is low. We performed distal salpingoscopies according to the method and classification described by Brosens et al on 253 tubes in 159 women and compared external pathology with intratubal findings. In 126 tubes without external pathology, only 2 cases showed moderate mucosal damage (class III), whereas 124 tubes had an intact mucosa (119 class I) or minor pathology (5 class II). Of 127 tubes with external pathology, the mucosa was determined to be class I in 51 cases, class II in 17, class III in 30, class IV (severe damage) in 22, and class V (severe damage) in 7. The correlation of external and internal damage is low. For example, we found that from 10 thin-walled hydrosalpinges, that was formerly a strong indication for microsurgical intervention, 4 showed severely damaged mucosa and were sent for in vitro fertilization (IVF), 3 showed moderate damage (mucosa class III), and only 3 had minor damage (mucosa class II). For complications, we observed four cases with slight bleeding from the fimbriae, two with slight damage of the mucosa, and one incomplete perforation of the tubal wall. We conclude that salpingoscopy should be performed whenever external pathology is detected in an infertility workup. It leads to better evaluation for either microsurgery or IVF. Microsurgical intervention can be avoided in cases with a poor prognosis. If no external pathology of the tube is detected salpingoscopy is not necessary.