Diagnostic procedures for assessment of tubal patency.
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Culdoscopy↗
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Results for “Fallopian Tube Patency Tests”
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The effect of dexamethasone and promethazine administration on adhesion formation, tubal function, and ultrastructure following microsurgical anastomosis of rabbit oviducts.
In a controlled study, 24 rabbits underwent bilateral division and immediate microsurgical anastomosis of the oviducts. Dexamethasone and promethazine were administered to 13 rabbits in a dose and route of administration similar to those used in clinical practice. Eleven control rabbits received a saline vehicle. Morbidity and mortality were encountered only in the dexamethasone and promethazine-treated group. Dexamethasone and promethazine did not appear to influence the formation of intraluminal and peritubal adhesions, histology, ultrastructure, patency, implantation, or pregnancy rates. The presence of intraluminal adhesions, as seen by scanning electron microscopy, was associated with relatively more efficient tubal function as measured by the ability of the oviducts to convey ova to intrauterine implantation sites. Collagen accumulation in the muscularis, as demonstrated by trichrome staining, was associated with relatively decreased tubal function.
Animals↗
Comparison of tubal surgery with the CO2 laser and the unipolar microelectrode.
The uterine horns of 40 New Zealand White female rabbits were resected and anastomosed to compare microsurgical anastomosis of the horns excised with microscissors, with a laser, and with a microelectrode. The rabbits were divided into four groups. In the first group of ten rabbits, 3 cm of tissue was resected by microscissors from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using the operating microscope. In the second group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed in one layer with 8-0 Vicryl. In the third group of ten rabbits, 3 cm of tissue was resected by laser from each uterine horn; the cut ends were then anastomosed by "welding" the tissues with the laser. In the fourth group of ten rabbits, 3 cm of tissue was resected by a microelectrode; the cut ends were then anastomosed in one layer with 8-0 Vicryl sutures using loupe magnification. All the rabbits in the first and fourth groups became pregnant, only four became pregnant in the second group, and none became pregnant in the third group. It is concluded that the CO2 laser beam as used in this study has no place in tubal resection and reconstruction.
Animals↗
Use of corticosteroids as an adjuvant in terminal salpingostomy.
Between the years 1977 and 1980, 26 women underwent terminal salpingostomy with a standard operative procedure at Vanderbilt University Medical Center. The term pregnancy rate was 23%, and the ectopic pregnancy rate was 13%. Fourteen patients received dexamethasone perioperatively; and of these, 3 had term pregnancies (21%). Of the 12 patients not receiving dexamethasone, there were also three term pregnancies (25%). It is concluded from this small series that perioperative corticosteroids do not improve the term pregnancy rate for terminal salpingostomy.
Adult↗
Laparoscopic salpingostomy utilizing the CO2 laser.
A new technique for performing a terminal salpingostomy using the CO2 laser via laparoscopy has been developed. This operative procedure is described, and the clinical results of the first 22 patients are reported. A hysterosalpingogram-documented tubal patency rate of 75% was noted 2 months postoperatively. Within the first 12 months postoperatively, there have been five pregnancies, including one ectopic gestation and one spontaneous abortion. Operative laparoscopy with the CO2 laser for distal salpingostomy may provide an acceptable alternative to laparotomy in selected patients.
Carbon Dioxide↗
Conventional and simplified microsurgical isthmic tubal anastomosis compared in the rabbit.
Because the fallopian tube has potential for spontaneous recanalization, a simplified technique for isthmic anastomosis has been previously proposed. This study compares the simplified technique, which uses only one suture to approximate the tube, with a conventional isthmic anastomosis. The nidation index and patency rate subsequent to these procedures on the rabbit oviduct were evaluated. The conventional anastomosis gave a significantly better nidation index (P less than 0.01) and a patency rate (P less than 0.05). Even when tubal patency was established with the simplified technique, the nidation index may have been less than with conventional anastomosis (P less than 0.07). Gynecologic microsurgeons should continue to strive for the best anatomic repair possible when performing isthmic anastomosis and not rely on the fallopian tube's potential for spontaneous recanalization.
Animals↗
Transvaginal fluoroscopic recanalization of a proximally occluded oviduct.
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Adult↗
Pregnancy after fimbriectomy reversal: results of microsurgery augmented by gamete intrafallopian tube transfer and embryo transfer.
In this study, fimbriectomy reversal resulted in a 43% intrauterine PR and a fecundability of 6.6%. The cumulative PR and the fecundability were 57% and 7.8%, respectively, when microsurgery was augmented by GIFT and embryo cryopreservation during the same treatment cycle and by subsequent embryo thaw and transfer.
Adult↗
Treatment of unruptured tubal pregnancy by local injection of methotrexate and prostaglandin F2 alpha in 52 patients.
Uncomplicated tubal pregnancies were treated by local injection of methotrexate (25 to 50 mg) and PGF2 alpha (5 to 10 mg). Trophoblastic resorption occurred in 50 (96.1%) of 52 patients within 20 days after treatment and without side effects. Three months after treatment, the affected tube was patent in 43 (91.4%) of 47 patients continuing in the study, and the subsequent intrauterine pregnancy rate was 40.4%. The combined use of methotrexate and PGF2 alpha appears to be a promising treatment for tubal pregnancy and should be evaluated further.
Dinoprost↗
Transvaginal hysterosalpingo-contrast sonography for the assessment of tubal patency with gray scale imaging and additional use of pulsed wave Doppler.
OBJECTIVE: To determine whether the additional use of pulsed wave (PW) Doppler can improve the tubal diagnosis reached with gray scale imaging in doubtful cases. DESIGN: The study is an open, uncontrolled clinical trial of women of childbearing age. SETTING: Clinical environment. PATIENTS: Seventeen female patients (23 to 37 years of age) with diagnosed sterility problems. INTERVENTIONS: The contrast agent SH U 454 was administered transcervically during transvaginal gray scale and PW Doppler sonography. MAIN OUTCOME MEASURES: Hysterosalpingo-contrast sonography by gray scale and by PW Doppler and follow-up chromolaparoscopy (n = 16) or hysterosalpingography (HSG, n = 1) were performed. The diagnostic efficacy of gray scale and PW Doppler were compared with each other and against a conventional control procedure (chromolaparoscopy or HSG). RESULTS: The gray scale findings were confirmed by PW Doppler in 5 cases on one side; confirmed by PW Doppler in 7 cases on both sides; corrected by PW Doppler in 4 cases on one side; and corrected by PW Doppler in 1 case on one side and confirmed on the other side by PW Doppler. In all 17 cases, the tubal findings after PW Doppler were confirmed by chromolaparoscopy or HSG. CONCLUSION: The additional use of PW Doppler in hysterosalpingo-contrast sonography is recommended as a supplement to gray scale imaging (1) in cases of suspected tubal occlusion and (2) in the event of intratubal flow demonstrable only over a short distance.
Adult↗
Evaluation of tubal patency by transvaginal sonosalpingography.
OBJECTIVE: To evaluate tubal patency by transvaginal sonosalpingography. DESIGN: Comparative study of transvaginal sonosalpingography with chromolaparoscopy in subjects with unknown tubal function. SETTING: Outpatient infertility clinic at Zeynep Kamil Maternity Hospital in Istanbul, Turkey. PATIENTS: Forty-two cases of unknown tubal function with infertility complaints were included. INTERVENTIONS: Isotonic saline was injected into the uterine cavity through a catheter. MAIN OUTCOME MEASURES: Transvaginal sonosalpingography is a safe, easy, and cost-effective procedure for screening tubal status. RESULTS: The results obtained from transvaginal sonosalpingography and laparoscopy were completely consistent for 29 cases (76.32%) and partially consistent for 8 cases (21.05%). Transvaginal sonosalpingography accurately showed patency in 26 patients and bilateral nonpatency in 3 patients. CONCLUSIONS: Transvaginal sonosalpingography, with its accuracy and safety, is a promising screening and diagnostic technique in the evaluation of tubal patency on ambulatory basis.
Adult↗
Color Doppler ultrasonography assessment of tubal patency: a comparison study with traditional techniques.
OBJECTIVE: To compare the results of color Doppler ultrasonic hysterosalpingography (color US-HSG) and x-ray-HSG with chromoperturbation at the time of laparoscopy. DESIGN: Open, uncontrolled study of women seeking evaluation for infertility from August 1989 to July 1991. SETTING: Clinical environment. PATIENTS: Two hundred thirty-eight infertile women. INTERVENTION: Saline was administered transcervically during transvaginal color Doppler sonography in 238 women. Traditional x-ray-HSG was performed in 89 women. Laparoscopy with chromoperturbation was done in 121 women. Forty-nine women had all three procedures performed. MAIN OUTCOME MEASURES: The frequency of diagnosis of bilateral tubal patency, bilateral tubal occlusion, and unilateral tubal patency after color US-HSG and x-ray-HSG was compared with chromoperturbation. The diagnostic efficacy of color US-HSG and x-ray-HSG was compared with chromoperturbation. RESULTS: Correlation between color US-HSG and x-ray findings with chromoperturbation occurred in 81% versus 60% (P = 0.0008) of all women studied. In 49 women who had all three procedures performed, color US-HSG results correlated with chromoperturbation more often than x-ray-HSG (82% versus 57%, P = 0.0152). CONCLUSION: Color US-HSG is an alternative technique to x-ray-HSG in diagnosing tubal occlusion as a cause of infertility.
Fallopian Tube Patency Tests↗
Term pregnancy after fallopian tube transposition.
A 28-year-old woman suffered from pelvic pain and secondary infertility. She previously had right salpingo-oophorectomy because of ruptured right cornual EP. She was found to have a normal appearing left fallopian tube that entered into a noncommunicating residual horn of the uterus. Microsurgical transposition of the left tube and tubouterine implantation was performed successfully. For cases in which tubocornual anastomosis of the transposed tube is impossible because of previous cornual resection, our technique remains an option.
Adult↗
Transvaginal salpingosonography for the assessment of tubal patency in infertile women: methodological and clinical experiences.
OBJECTIVE: To evaluate the advantages and accuracy of transvaginal salpingosonography in the assessment of tubal patency with regards to laparoscopic chromopertubation. SETTING: Infertility policlinic of the hospital. DESIGN: Thirty-one women suffering from infertility were examined with transvaginal salpingosonography using air and saline as a contrast medium. The results were compared with those obtained with laparoscopic chromopertubation. RESULTS: Altogether 61 fallopian tubes were examined with both transvaginal salpingosonography and laparoscopic chromopertubation. Concordance was 85%. Of the tubes investigated by transvaginal salpingosonography, 45 were found to be patent and 16 were found to be occluded. In chromopertubation, 50 of 61 tubes were patent and 11 were occluded. Bilateral tubal patency was found by transvaginal salpingosonography in 17 cases and by laparoscopy in 22 cases. Unilateral tubal patency was found in 11 and 6 cases, respectively. Bilateral occlusion was found in three cases using either technique. CONCLUSION: Transvaginal salpingosonography with the combination of air and saline is a low-cost, reliable, safe, and comfortable examination method. It can be used for the primary investigation of infertility on an outpatient basis.
Adult↗
Color Doppler hysterosalpingography in the diagnosis of tubal patency.
OBJECTIVE: To assess tubal patency by color Doppler hysterosalpingography (HSG). DESIGN: Comparative study of color Doppler HSG with roentgenogram HSG and chromolaparoscopy in infertile women of childbearing age. SETTING: Clinical environment. PATIENTS: Sixty female patients (22 to 39 years) with long-lasting infertility problems. INTERVENTION: Sterile saline was transcervically injected into the uterine cavity through a catheter and color Doppler HSG was performed. All the patients were submitted to roentgenogram HSG and chromolaparoscopy. MAIN OUTCOME MEASURES: The diagnostic efficacy of color Doppler HSG and its concordance with "gold standard" chromolaparoscopy were analyzed. RESULTS: Correlation between color Doppler HSG and roentgenogram HSG with chromolaparoscopy occurred in 86% versus 93% of all women studied. CONCLUSIONS: Color Doppler HSG with its accuracy and safety results a promising alternative technique to roentgenogram HSG in diagnosing tubal status in infertile patients.
Adult↗
Cornual fibroids: a conservative approach to restoring tubal patency using a gonadotropin-releasing hormone agonist (goserelin) with successful pregnancy.
The administration of GnRH agonists to shrink fibroids, albeit temporarily, may be of benefit to those patients in whom tubal blockage by the fibroids has given rise to infertility. Tubal patency has been restored in two of our patients, resulting in pregnancy in one.
Adult↗
Microsurgical reversal of tubal sterilization: a report on 1,118 cases.
OBJECTIVE: To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes. DESIGN: Retrospective clinical study. SETTING: Tertiary care academic center. PATIENT(S): In the 134-month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization. MAIN OUTCOME MEASURE(S): Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome. RESULT(S): Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients (n = 505) were younger and had a longer postoperative tube than the nonpregnant patients (n = 417); these differences were statistically significant. CONCLUSION(S): The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length.
Fallopian Tube Patency Tests↗
Quinacrine sterilization (QS) in Iran and the use of HSG as a measure of success.
OBJECTIVES: To establish the safety, effectiveness and acceptability of quinacrine sterilization (QS) in Iran. To determine whether the hysterosalpingogram (HSG) performed under low pressure can be used to demonstrate success of the QS procedure rather than waiting for a pregnancy to occur in order to demonstrate failure. METHODS: This study was initiated in September 1990 in a private family planning clinic in Tehran, Iran. Patient intake for this analysis was completed 31 December 1998 and the cut-off date for follow-up data to be included in this analysis was 30 July 2002. During this period, 268 women received QS. From inception until April 1994, 160 women entered the study. The first 62 women received 3 insertions and the remainder received 2. Short-term side effects were closely followed in these 160 women. From 18 February 1994 until the patient intake cut-off date, 131 women entered the study and 46 of them received an HSG. RESULTS: With 4 to 12 years of follow-up there have been 7 pregnancies for a gross pregnancy rate of 2.6%. However, the use of the HSG tripled the risk of pregnancy for women who underwent the procedure. Furthermore, HSG, even when performed under minimal pressure, indicated failure of the QS procedure about 6% of the time when in fact both tubes would have closed had there been no intervention. Side effects were minor when compared to the complications of surgical sterilization. CONCLUSIONS: QS was found to be safe, effective and preferred over surgical sterilization by Iranian women. HSG understated the number of patients with bilateral tubal closure, or with tubes that would have closed given a little more time.
Adult↗