Assessment of tubal patency: A Prospective comparison of diagnostic hysteroscopy and laparoscopic chromopertubation

Abstract Study objective To evaluate whether the presence of a visualizable “flow” effect in the Fallopian tube ostia in hysteroscopy was predictive of tubal patency. Design Prospective cohort study. Setting In a prospective study, infertile women who underwent surgery due to 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 72 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% 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= 0.028) were associated with a false-normal “flow” result. A hazy hysteroscopic picture was found in 15/21 (71.4%) and 5/51 (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 a 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.