Assessment of tubal patency with selective chromopertubation at office hysteroscopy versus modified minilaparoscopy in infertile women

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.

Intraoperative dyes, fluorescence and enhanced imaging in benign gynaecologic surgery

“…Two to 10 ml of dye is slowly injected into the tubal ostium. Tubal patency is confirmed with the absence of retrograde spill around the catheter and into the uterine cavity [15]. A meta-analysis of six studies recently suggested again that this hysteroscopic technique is highly accurate and sensitive for detecting fallopian tube obstruction [16 && ].…”