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PubMed2000

Three-dimensional power Doppler imaging in the assessment of Fallopian tube patency.

OBJECTIVE: The aim of the study was to evaluate the feasibility of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy). METHODS: Women attending the fertility clinic were offered a Fallopian tubal patency test as part of the initial investigation. Hysterosalpingo-contrast sonography using contrast medium Echovist was performed on 67 women. Findings on the two-dimensional (2D) gray-scale scanning and three-dimensional power Doppler imaging were compared. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates flow of medium through the tube. RESULTS: Contrast medium Echovist produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 114 (91%) tubes using the 3D-PDI technique and in 58 (46%) of tubes using conventional HyCoSy. The mean duration of the imaging procedure was less with 3D-PDI, but the operator time which included postprocedure analysis of the stored information was similar. A significantly lower volume of contrast medium (5.9 +/- 0.6 mL) was used for 3D-PDI in comparison with that (11.2 +/- 1.9 mL) used for conventional 2D HyCoSy. CONCLUSION: Color coded 3D-PDI with surface rendering allowed visualization of the flow of contrast through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. Although the design of the investigation did not allow the side effects of the two techniques to be compared, the shorter duration of the imaging and lower volume of the contrast medium used suggested that the 3D-PDI technique might have a better side-effect profile. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy.

Contrast Media↗
PubMed1996

Assessment of tubal patency by transvaginal sonographic hydrotubation with color Doppler flow.

OBJECTIVE: To assess the value of transvaginal sonographic hydrotubation with color Doppler flow (TSH) as a test of tubal patency. METHODS: Thirty-nine women undergoing infertility investigation at Chulalongkorn Hospital participated in this prospective, blind comparative study. Before diagnostic laparoscopy (DL) with chromopertubation, TSH was performed using the SSD 680, 5 MHz vaginal ultrasound probe and 20-50 ml of saline was injected into the uterine cavity. RESULTS: Nine cases could not be evaluated properly. Of the 30 cases, there were complete agreements between TSH and DL in 24 (80%), partial agreement in 5 (16.67%) and non-agreement in 1 (3.33%). TSH had sensitivity 100%; specificity 84.62%, positive predictive value 50%, negative predictive value 100%, false positive rate 15.38%, but no false negative rate. CONCLUSION: TSH is a simple diagnostic procedure for screening of tubal patency. However, other confirmatory test is needed if tubal occlusion is suspected.

Fallopian Tube Patency Tests↗
PubMed1992

Fallopian tubes and ultrasonography: the Sion experience.

OBJECTIVE: To compare the accuracy of three new ultrasonographic methods of detecting tubal patency and pathology with established methods like hysterosalpingography (HSG) and laparoscopy. DESIGN: Sixty-seven cases were evaluated by performing the Sion test using endosonography to check for tubal patency. The Sion procedure includes filling up the pouch of Douglas with approximately 300 mL of sterile normal saline to elucidate not only the patency but visualize the motility, the fimbriae, and peritubal adhesions, if present. We have compared the accuracy of this procedure with HSG and laparoscopy in 24 infertile women. Color-coded duplex Doppler sonography was used in 38 patients to check for tubal patency. RESULTS: Our experience at the Sion Hospital using the three new ultrasonographic techniques for evaluating the status of the fallopian tubes is very encouraging. The accuracy with the three modes shows agreement in > 90% of cases with established investigative modalities such as HSG and laparoscopy. CONCLUSION: These three new investigative modalities are offered not as substitutes for HSG, laparoscopy, hysteroscopy, or salpingoscopy but as office-screening procedures that would be complementary to the armamentarium of infertility investigations already available.

Fallopian Tube Patency Tests↗
PubMed2005

Tubal flushing for subfertility.

BACKGROUND: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay. OBJECTIVES: To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 2 March 2004), MEDLINE (1966 to Mar 2004), EMBASE (1980 to Mar 2004), Biological Abstract (1980 to Mar 2004) and reference lists of articles. SELECTION CRITERIA: All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Eleven randomised controlled trials were identified and included in this review. All trials were assessed for quality criteria. The studied primary outcome was live birth (and ongoing pregnancy), with secondary outcomes pregnancy, miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality. MAIN RESULTS: Tubal flushing with oil-soluble media versus no intervention (three trials including 381 participants) was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95%CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95%CI 2.00 to 5.43). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media (six trials including 1,483 participants), the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95%CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.24, 95%CI 0.97 to 1.57). The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone; three trials including 555 participants) showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.18, 95%CI 0.82 to 1.70) or live birth (Peto OR 1.06, 95%CI 0.64 to 1.77). Adverse event data were only available for the comparison OSCM versus WSCM: OSCM carried a significantly higher chance of intravasation (Peto OR 5.41, 95%CI 2.57 to 11.37) but a significantly lower chance of immediate pain (Peto OR 0.53, 95%CI 0.34 to 0.84), prolonged pain (Peto OR 0.26, 95%CI 0.15 to 0.45) and post-procedure bleeding (Peto OR 0.22, 95%CI 0.15 to 0.31), and no serious adverse events were reported. AUTHORS' CONCLUSIONS: There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing water-soluble media versus no intervention, would be a useful further guide to clinical practice. Further research is merited to ascertain the mechanism of the fertility enhancing effect of oil-soluble media, as to whether this is a 'tubal flushing' phenomenon, an effect on the intraperitoneal environment, or an implantation enhancing effect on the endometrium.

Contrast Media↗
PubMed1999

Hysterosalpingo contrast sonography as a screening test for tubal patency in infertile women.

The most informative method for assessing tubal patency in subfertile women is laparoscopy-and-dye. This investigation, however, puts a large burden on services and a screening test is needed that identifies a high likelihood of occlusion. In our infertility programme we introduced hysterosalpingo contrast sonography for this purpose, operated entirely by ultrasonographers. A series of audits indicated that this innovation speeded the process of investigation by several weeks and reduced the number of laparoscopy-and-dye procedures by 75%. The negative predictive value was 89% and the positive predictive value was 44%. The main limitation of the method was the long period required for training, in those without extensive experience of vaginal ultrasonography.

Contrast Media↗
PubMed1992

Nuclear medicine in problems of fertility and impotence.

Nuclear medicine techniques may be used to test fallopian tube patency and penile vascular inflow and outflow. Radionuclide hysterosalpingography (HSP) is a readily performed method of evaluating fallopian tube patency, and is believed to be more physiologic and functionally informative than the accepted radiologic method of contrast HSP. The test is simple to perform and interpret and offers an accurate alternative to the contrast examination. For scintigraphic evaluation of impotence, blood pool studies are most useful in assessing the integrity of arterial inflow, but may also be used to generate indices of venous leak. Washout of xenon after subcutaneous injection, in the flaccid state, has been used as a measure of baseline penile perfusion, as has intracavernosal injections in the flaccid penis. Intracavernosal xenon washout during erection seems the most useful method of testing venous integrity. Washout using technetium-99m (99mTc)-labeled red blood cells (99mTc-RBC) may emerge as a convenient alternative to the more technically difficult xenon examinations.

Erectile Dysfunction↗
PubMed1978

The tortuous tube: pregnancy rate following laparoscopy and hydrotubation.

256 infertile women whose ovulatory and related male fertility factors were normal were investigated by diagnostic laparoscopy and dye hydrotubation. The tubes were objectively classed into 4 groups--normal, patent with macroscopic tubal adhesions, patent with one tortuosity, and patent with multiple tortuosities. The latter group had a highly significant response to the above procedures and 66% were pregnant within 1 year and 81% within 2 years. No significant effect was found in the other 3 groups. This multiple tortuosity group represents the type of tube that significantly responds to treatment inherent in all tubal patency tests. Its pathogenesis and management are discussed.

Adnexal Diseases↗
PubMed1989

[Status of the fallopian tube following pelviscopic surgery (conventional versus laser) of tubal pregnancy].

From 1984 to 1988, 136 patients with ectopic pregnancy were treated by endoscopic means. In 29 cases the fallopian tube was removed. In 107 patients conservative treatment was undertaken. The salpingotomy was performed with the endocoagulator and with scissors or using lasers. The postoperative status of the tube was controlled in 54 patients by hysterosalpingography (n = 17) or by second-look laparoscopy (n = 37). In 38 cases the patency test was positive. The incidence of postoperative adhesions was minimal after laser salpingotomy (16%). The complication rate was low (2%).

Fallopian Tube Patency Tests↗
PubMed1992

The Sion test.

Endosonography as a tool for checking the patency of Fallopian tubes was an expected development in the progress the field of gynaecology was taking. We at Sion Hospital have used transvaginal sonography in evaluating the patency of Fallopian tubes with a technique which encompasses a thorough pelvic scan as well. We offer The Sion Test not as a substitute for hysterosalpingography, laparoscopy or hysteroscopy but as a screening technique in infertility investigation. The Sion Test can be performed in the gynaecologists' office at the same time as the pelvic examination. A series of 50 infertile patients had a diagnostic laparoscopy and hysterosalpingography after our test was done. We have compared the accuracy of the 3 methods of evaluating tubal patency and have found our test an excellent screening technique for investigations in infertility.

Fallopian Tube Patency Tests↗
PubMed1991

Fallopian tube catheterization and recanalization under ultrasonic observation: a simplified technique to evaluate tubal patency and open proximally obstructed tubes.

OBJECTIVE: To test a sonoscopic technique developed for transvaginal catheterization and recanalization of the fallopian tube. DESIGN: In a feasibility study, catheterization was performed with the use of laparoscopic control. Patients with bilateral proximal tubal obstruction underwent fallopian tube recanalization under ultrasonic observation. SETTING: This study represents patients evaluated for primary or secondary infertility at Humboldt University Hospital. PATIENTS, PARTICIPANTS: Proximal tubal obstruction had been diagnosed on previous hysterosalpingogram and with laparoscopy. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Tubal patency was assessed by hydrotubation under ultrasonic observation. RESULTS: Transvaginal catheterization was successful in 31 (91.2%) of the 34 tubes. In 19 patients with proximal tubal obstruction, patency of both or at least one tube was achieved in 16 (84.2%) women. Five (31.6%) of 16 patients successfully recanalized were found to have an intrauterine pregnancy at a 6-month follow-up interval. CONCLUSION: This catheterization technique should be investigated for possible use in diagnostic schedule early in the evaluation of the infertile patient. Also, the transvaginal recanalization of proximally obstructed tubes calls into question the application of microsurgical treatment of a selected group of patients.

Adult↗
PubMed1979

The use of the starch grain and phenolsulphonphthalein tests to investigate infertile cows.

The starch grain and phenolsulphonphthalein (PSP) tests were used to investigate the patency of the fallopian tubes in five "repeat breeder" cows. Evidence of tubal lesions was determined in three cows on rectal palpation. Using the starch grain test, bilateral occlusion was determined in three animals, left sided occlusion was determined in one and right sided occlusion in another. Using the PSP test there was evidence of bilateral occlusion in two of the four coes which were tested. In four cows the genital organs were examined visually and by palpation at laparotomy and in two cows tubal occlusion was confirmed when they were flushed with saline, and patency restored. In one animal both ovaries were almost completely encapsulated, while in the fourth adhesions involving the fimbriae occluded the ostia. There were broken down and this cow was the only one which subsequently conceived.

Animals↗
PubMed1983

The Rubin test.

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Fallopian Tube Patency Tests↗
PubMed1975

[The effect of Bactrim and Tandearil on abnormal tubal patency in cases of infertility (author's transl)].

In 257 patients with primary or secondary infertility, tubal occlusion or impeded tubal patency was found. The patients received Bactrim or Tandearil and the tubal patency was retested. In a control group of 74 cases, 2 tubal patency tests were done without treatment. Following treatment with Bactrim, 40,4% of the previously occluded fallopian tubes were patent. Following treatment with Tandearil, 34% of the previously occluded tubes were patient. In the non-treated group, 25% of the cases showed tubal patency at the second patency test. The results were more striking for the cases with impeded tubal patency. The success rate was 73,3% following treatment with Bactrim, 50% following treatment with Tandearil and 26,7% in the untreated control group.

Drug Combinations↗