PDF herunterladen
CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(07): 619-628
DOI: 10.1055/a-2304-5018
GebFra Science
Meta-Analysis/Systematic Review

The Role of Hysteroscopy in the Assessment of Fallopian Tubal Patency: A Comprehensive Review and Meta-analysis

Die Rolle der Hysteroskopie bei der Bewertung der Eileiterdurchgängigkeit: eine umfassende Übersicht und Metaanalyse
Marlene Hager
1   Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
,
Johannes Ott 
1   Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Hysteroscopy has been recognized as a reliable method for the evaluation of female infertility for several years. The outpatient setting is particularly convenient, as patients do not require general anesthesia and do not have to stay overnight. In recent years, more and more articles have dealt with the role of diagnostic hysteroscopy in tubal evaluation. Twenty-four articles were included in this comprehensive review and 14 of them were also included in a meta-analysis. This review provides an overview of the different techniques of hysteroscopic tubal evaluation, with a focus on perioperative changes in cul-de-sac volume, the air bubble technique (“Parryscope” technique), the Flow technique and selective hysteroscopic pertubation with methylene blue dye (SHPMBD). In pooled analyses, SHPMBD achieved the highest sensitivity for tubal patency (91.7%, 95% confidence interval, CI: 88.8–94.0), whereas the air bubble technique revealed the highest specificity of all methods (98.4, 95% CI: 95.3–99.6). Furthermore, in a meta-analysis of all methods on the assessment of single tubes, an overall sensitivity of 87.1% and an overall specificity of 79.8% (95% CI: 76.4–82.9) could be shown. In conclusion, the techniques of hysteroscopic tubal evaluation are well-tolerated, clinically relevant, and reliable.

Zusammenfassung

Die Hysteroskopie gilt seit mehreren Jahren als zuverlässige Methode zur Beurteilung weiblicher Infertilität. Praktischerweise kann der Eingriff ambulant erfolgen, da die Patientinnen keine Allgemeinanästhesie benötigen und nicht über Nacht im Krankenhaus bleiben müssen. In den letzten Jahren sind immer mehr Arbeiten erschienen, die sich mit der Rolle der diagnostischen Hysteroskopie zur Prüfung der Eileiterdurchgängigkeit befassen. Insgesamt hat diese umfassende Übersichtsarbeit 24 Artikel einbezogen, davon wurden 14 auch in die Metaanalyse aufgenommen. Diese Überblicksarbeit gibt eine Übersicht über die verschiedenen Techniken zur hysteroskopischen Überprüfung der Eileiterdurchgängigkeit mit besonderem Schwerpunkt auf die perioperativen Veränderungen der Flüssigkeitsmenge in der Douglas-Tasche, die Luftblasen-Technik (auch „Parryscope-Technik“ genannt), die „Flow-Technik“ und die selektive Chromopertubation. In den aggregierten Analysen zeigte die selektive Chromopertubation mit Methylenblau die höchste Sensitivität für die Eileiterdurchgängigkeit (91,7%, 95%-Konfidenzintervall [KI] 88,8–94,0), wohingegen die Luftblasen-Technik die höchste Spezifität aller Methoden aufwies (98,4; 95%-KI 95,3–99,6). Darüber hinaus fand eine Metaanalyse aller Methoden zur Beurteilung einzelner Eileiter eine allgemeine Sensitivität von 87,1% und eine allgemeine Spezifität von 79,8% (95%-KI 76,4–82,9). Zusammenfassend kann festgestellt werden, dass die Techniken zur hysteroskopischen Überprüfung der Eileiterdurchgängigkeit gut verträglich, klinisch relevant und zuverlässig sind.

Keywords

office hysteroscopy - hysteroscopy - infertility - tubal patency - tubal pathology

Schlüsselwörter

ambulante Hysteroskopie - Hysteroskopie - Infertilität - Tubenverschluss - Tubenpathologie

Supplementary Material



Publikationsverlauf

Eingereicht: 30. März 2024

Angenommen nach Revision: 09. Mai 2024

Artikel online veröffentlicht:
09. Juli 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Campo R, Meier R, Dhont N. et al. Implementation of hysteroscopy in an infertility clinic: The one-stop uterine diagnosis and treatment. Facts Views Vis Obgyn 2014; 6: 235-239
    PubMedSuche in Google Scholar
  • 2 Parry JP, Isaacson KB. Hysteroscopy and why macroscopic uterine factors matter for fertility. Fertil Steril 2019; 112: 203-210
    CrossrefPubMedSuche in Google Scholar
  • 3 Hager M, Simek IM, Promberger R. et al. The Role of Diagnostic Hysteroscopy in the Evaluation of Fallopian Tube Patency: a Short Review. Geburtshilfe Frauenheilkd 2019; 79: 483-486
    Thieme ConnectPubMedSuche in Google Scholar
  • 4 Vitale SG, Carugno J, Riemma G. et al. Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis. J Minim Invasive Gynecol 2021; 28: 769-778
    CrossrefPubMedSuche in Google Scholar
  • 5 Siristatidis C, Chrelias C, Salamalekis G. et al. Office hysteroscopy: current trends and potential applications: a critical review. Arch Gynecol Obstet 2010; 282: 383-388
    CrossrefPubMedSuche in Google Scholar
  • 6 Hager M, Ott J, Göbl C. et al. Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion. Arch Gynecol Obstet 2021; 304: 1073-1080
    CrossrefPubMedSuche in Google Scholar
  • 7 Habibaj J, Kosova H, Bilali S. et al. Comparison between transvaginal sonography after diagnostic hysteroscopy and laparoscopic chromopertubation for the assessment of tubal patency in infertile women. J Clin Ultrasound 2012; 40: 68-73
    CrossrefPubMedSuche in Google Scholar
  • 8 Parry JP, Riche D, Aldred J. et al. Proximal Tubal Patency Demonstrated Through Air Infusion During Flexible Office Hysteroscopy Is Predictive of Whole Tubal Patency. J Minim Invasive Gynecol 2017; 24: 646-652
    CrossrefPubMedSuche in Google Scholar
  • 9 Yildizhan B, Durmusoglu F, Uygur M. et al. A new technique for the diagnosis of fallopian tube patency by using hysteroscopy with ultrasound compared with hysterosalpingography in infertile women. Arch Gynecol Obstet 2009; 280: 543-547
    CrossrefPubMedSuche in Google Scholar
  • 10 Promberger R, Simek IM, Nouri K. et al. Accuracy of Tubal Patency Assessment in Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study. J Minim Invasive Gynecol 2018; 25: 794-799
    CrossrefPubMedSuche in Google Scholar
  • 11 Ott J, Hager M, Nouri K. et al. Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation. J Minim Invasive Gynecol 2020; 27: 135-140
    CrossrefPubMedSuche in Google Scholar
  • 12 Hager M, Ott J, Holzer I. et al. Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques. J Minim Invasive Gynecol 2020; 27: 1552-1557.e1
    CrossrefPubMedSuche in Google Scholar
  • 13 Török P, Major T. Accuracy of assessment of tubal patency with selective pertubation at office hysteroscopy compared with laparoscopy in infertile women. J Minim Invasive Gynecol 2012; 19: 627-630
    CrossrefPubMedSuche in Google Scholar
  • 14 Whiting PF, Rutjes AW, Westwood ME. et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536
    CrossrefPubMedSuche in Google Scholar
  • 15 Lőrincz J, Jakab A, Török P. A petevezeték-átjárhatóság vizsgálómódszereinek összehasonlító elemzése [Comparison of current methods of tubal patency assessment]. Orv Hetil 2017; 158: 324-330
    CrossrefPubMedSuche in Google Scholar
  • 16 Shen H, Lu Y, Su R. et al. Fertility Improvement of Hysteroscopy with Chromopertubation in the Management of Infertile Women with Hysterosalpingography Evidence of Abnormal Tubal Patency: A Prospective Comparative Study. Int J Womens Health 2022; 14: 1613-1619
    CrossrefPubMedSuche in Google Scholar
  • 17 Mardanian F, Rouholamin S, Nazemi M. Evaluation of Efficacy of Transvaginal Sonography with Hysteroscopy for Assessment of Tubal Patency in Infertile Women Regarding Diagnostic Laparoscopy. Adv Biomed Res 2018; 25: 101
    CrossrefPubMedSuche in Google Scholar
  • 18 Shokeir T. Regarding “Accuracy of Tubal Patency Assessment during Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study”. J Minim Invasive Gynecol 2018; 25: 542
    CrossrefPubMedSuche in Google Scholar
  • 19 Devine K, Dolitsky S, Ludwin I. et al. Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology. Fertil Steril 2022; 118: 19-28
    CrossrefPubMedSuche in Google Scholar
  • 20 La Sala GB, Sacchetti F, Degl’Incerti-Tocci F. et al. Complementary use of hysterosalpingography, hysteroscopy and laparoscopy in 100 infertile patients: results and comparison of their diagnostic accuracy. Acta Eur Fertil 1987; 18: 369-374
    PubMedSuche in Google Scholar
  • 21 Roma Dalfó A, Ubeda B, Ubeda A. et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. AJR Am J Roentgenol 2004; 183: 1405-1409
    CrossrefPubMedSuche in Google Scholar
  • 22 Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N. et al. Transvaginal Sonography Post-Office Hysteroscopy as a Screening Tool for Tubal Patency: A Reliable and Feasible Technique in an Outpatient Setting. J Obstet Gynaecol Can 2021; 43: 978-983
    CrossrefPubMedSuche in Google Scholar
  • 23 Roy KK, Gajapathy SR, Rai R. et al. Assessment of Tubal Patency with Selective Chromopertubation at Office Hysteroscopy versus Modified Minilaparoscopy in Infertile Women. Gynecol Minim Invasive Ther 2021; 10: 159-165
    CrossrefPubMedSuche in Google Scholar
  • 24 Lörincz J, Molnár S, Herman T. et al. Predictive value of bubble sign for tubal patency during office hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2020; 253: 58-60
    CrossrefPubMedSuche in Google Scholar
  • 25 Panda SR, Kalpana B. The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients. Cureus 2021; 13: e12526
    CrossrefPubMedSuche in Google Scholar
  • 26 Parry JP, Riche D, Rushing J. et al. Performing the Parryscope technique gently for office tubal patency assessment. Fertil Steril 2017; 108: 718
    CrossrefPubMedSuche in Google Scholar
  • 27 Carta G, Palermo P, Pasquale C. et al. Office hysteroscopic-guided selective tubal chromopertubation: acceptability, feasibility and diagnostic accuracy of this new diagnostic non-invasive technique in infertile women. Hum Fertil (Camb) 2018; 21: 106-111
    CrossrefPubMedSuche in Google Scholar
  • 28 Aldred J, Riche DM, May W. et al. Air infused saline for predicting tubal patency with flexible office hysteroscopy is correlated with post-hysteroscopy changes in cul-de-sac fluid volume. Fertil Steril 2016; 106: e220
    CrossrefPubMedSuche in Google Scholar
  • 29 Török P. A novel method of selective chromopertubation at office hysteroscopy. J Gynecol Res Obstet 2016; 2: 31-32
    CrossrefPubMedSuche in Google Scholar
  • 30 Ott J, Boegl MS, Hager M. Does detection of hysteroscopic fluid in the pouch of Douglas increase the accuracy of the hysteroscopic bubble technique for bilateral Fallopian tube occlusion? A retrospective cohort study. GREM 2024; 5: 55-59
    CrossrefPubMedSuche in Google Scholar
  • 31 Ludwin I, Ludwin A, Wiechec M. et al. Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye. Hum Reprod 2017; 32: 758-769
    CrossrefPubMedSuche in Google Scholar
  • 32 Lo Monte G, Capobianco G, Piva I. et al. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point!. Arch Gynecol Obstet 2015; 291: 19-30
    CrossrefPubMedSuche in Google Scholar
  • 33 Alcázar JL, Martinez-Astorquiza Corral T, Orozco R. et al. Three-Dimensional Hysterosalpingo-Contrast-Sonography for the Assessment of Tubal Patency in Women with Infertility: A Systematic Review with Meta-Analysis. Gynecol Obstet Invest 2016; 81: 289-295
    CrossrefPubMedSuche in Google Scholar
  • 34 Cholkeri-Singh A, Sasaki KJ. Hysteroscopy safety. Curr Opin Obstet Gynecol 2016; 28: 250-254
    CrossrefPubMedSuche in Google Scholar
  • 35 De Silva PM, Stevenson H, Smith PP. et al. A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy. J Minim Invasive Gynecol 2021; 28: 1148-1159.e2
    CrossrefPubMedSuche in Google Scholar
  • 36 D’Hooghe TM, Debrock S, Hill JA. et al. Endometriosis and subfertility: is the relationship resolved?. Semin Reprod Med 2003; 21: 243-254
    Thieme ConnectPubMedSuche in Google Scholar
  • 37 Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne) 2022; 13: 1020827
    CrossrefPubMedSuche in Google Scholar
  • 38 Seifer BJ, Su D, Taylor HS. Circulating miRNAs in murine experimental endometriosis. Reprod Sci 2017; 24: 376-381
    CrossrefPubMedSuche in Google Scholar