Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques

Abstract

To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. Design: Prospective randomized clinical trial. Setting: From May to October 2019, women with subfertility undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate in the study. The primary outcome was accuracy of Fallopian tube patency relative to the gold standard of laparoscopic chromopertubation. Patients: Sixty women with subfertility. Interventions: Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. Measurements and Main Results: Hysteroscopic prediction of fallopian tube patency was possible in a statistically significant manner in both study groups (p <0.05). The Parryscope technique achieved higher sensitivity (90.6%, 95% CI: 61.7 −98.4) and specificity (100%, 95% CI: 90.0−100.0) than the flow technique (sensitivity: 73.7%, 95% CI: 48.8−90.9 and specificity: 70.7%, 95% CI: 54.5−83.9). Conclusion: Using the Parryscope technique to determine if air bubbles traverse the ostia can provide valuable additional information during hysteroscopy and is more accurate in predicting fallopian tubal occlusion than the flow method.

Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

“…Concerning study design, all 6 studies used crossover comparison in which hysteroscopic assessment was compared with laparoscopic chromopertubation [22−27]. A single randomized controlled trial (RCT) was identified that additionally compared observational assessment (the swirl test) with interventional assessment (the air bubble infusion technique), during which all participants received general anesthesia [27] (Table 1).…”

“…selective hysteroscopic chromopertubation with methylene blue dye [23,26], 1 performed the air bubble infusion technique [23], and 2 studies were observational [24,25]. In the Hager et al [27] RCT, in 1 group of women the air bubble infusion technique was performed, whereas the other study arm had an observation assessment of the swirl test.…”

“…Regarding the observational approach, the visible flow effect was determined by operator visualization of a clear flow of the saline distension medium, mucus, blood, or other naturally present contrasting material (not deliberately introduced) through the tubal ostium. In cases where the contrasting substance swirled adjacent to the tubal ostium without entering, it was considered suggestive of tubal occlusion [24,25,27].…”

“…If a single large air bubble or a stream of small bubbles crossed the tubal ostia, entering the fallopian tube, it was deemed indicative of tubal patency, but a single small bubble in isolation was not considered sufficient. Data suggest that using a less −than−3-mm flexible hysteroscope compared with larger, rigid hysteroscopes reduces patient pain and uterine spasm [27], potentially enhancing accuracy for office-based procedures [22,27].…”

The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility

“…However, in order to improve the assessment of tubal patency, in addition to the 2 traditional methods of LDT and HSG, innovative research has continued across the world. Some researchers have focused on diagnostic hysteroscopy (4), in which the evaluation is based on a straightforward view of a "flow" effect of hysteroscopic fluid in the fallopian tube ostia (5,6). A prospective cohort study reported a sensitivity of 85.3% (95% CI: 76−92%) and a specificity of 66.1% (95% CI: 52−78%) in predicting patency (P<0.001) (7).…”