OBJECTIVE: To evaluate the agreement between repeat transvaginal sonographic assessments of tubal patency using a combination of air and saline. MATERIAL AND METHODS: Twenty-nine patients were examined twice by the same investigator (H.S.). There was a three-month interval between the observations, and the investigator was blinded to the results of the first examination. Each patient was evaluated using three categories classified as: 1) bilateral patency, 2) unilateral patency and 3) bilateral occlusion. In addition, the pooled data from individual tubes was examined with respect to the detection of patency or occlusion. Data from the right and left tubes were analyzed separately as well. Agreement between the two examinations was subsequently determined using Cohen's kappa coefficient (kappa). When there were more than two categories, a weighted kappa coefficient was used. RESULTS: There was good (kappa = 0.61) agreement between the two examinations when each patient was evaluated individually. For the pooled data of all tubes (n = 46), the kappa coefficient was 0.53, but increased to 0.66 after correction for prevalence. There was no systematic bias between the successive examinations of tubes. There was more consistency between repeated observations in the right (kappa = 0.70) than in the left (kappa = 0.37) tubes. The prevalence of occlusion was higher in the left tubes. CONCLUSION: Transvaginal salpingosonography was shown to be a reliable method for the assessment of tubal patency.
The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.
Tubal patency was studied in 32 patients who had previously undergone a laparoscopic or laparotomy procedure (salpingostomy, salpingectomy or tubal resection), or who had received a local injection of hypertonic glucose because of tubal pregnancy. Transvaginal salpingosonography (TSSG) was subsequently performed in the follicular phase of the menstrual cycle, and laparoscopic chromopertubation was carried out as a comparative method after TSSG. Of 32 patients (47 Fallopian tubes examined), the affected tube was observed to be patent by TSSG in 68%. The contralateral tube was patent in 93%. Nine patients became pregnant and were thus not subsequently assessed with laparoscopy. Two of these pregnancies ended in a miscarriage and one in a recurrent tubal pregnancy. A concordance of 86% for Fallopian tubes was achieved between the TSSG and laparoscopic chromopertubation methods. When checking the Fallopian tubes separately, the concordance for the results in the affected tubes was 67%, and 100% for the contralateral tube. Therefore TSSG appears to be a practical method for the primary examination of tubal patency in patients treated previously for tubal pregnancy. Guidelines for the treatment of infertility after tubal pregnancy can also be set out according to TSSG findings.
A follow-up analysis was made of 929 infertile couples, with special attention paid to ectopic pregnancy. The conception rate was 46%, and 9% of the pregnancies were ectopic. Previous ectopic pregnancy, an industrial occupation and smoking reduced the fecundity and increased the risk of ectopic pregnancy. Tubal damage as a verified reason for infertility and its treatment also increased the risk of ectopic pregnancy. Stepwise logistic regression analysis showed the strongest association with ectopic pregnancy to exist in the case of women with a previous ectopic pregnancy (9.9-fold risk) rather than women with primary infertility. Treatment of tubal damage by salpingostomy entailed a 6.0-fold risk and treatment by other methods a 2.8-fold risk. Women working in industry had a 3.5-fold risk of ectopic pregnancy compared with those in other professions.
Among 167 women who underwent laparoscopic sterilization in the course of one year, 1.2% were found to have a bicornuate uterus. Of them, 111 were offered follow-up by hysterosalpingography (HSG), and the history of their menstrual pattern as well as reproductive potential was recorded. Evaluation of the HSG exposures revealed 3.6% moderately to severely septate uteri (H/L greater than 0.20), and a total of 15.3% had fundal anomalies (H/L greater than 0.10). In women who had always had normal fertility and menstrual cycles of less than 35 days, the corresponding frequencies of septate uterus were 1.2% and 11.8% respectively. Among women who had had oligomenorrheic periods exceeding one year in duration, the frequency of müllerian anomalies was significantly higher (21.1% at H/L greater than 0.20 and 36.8% at H/L greater than 0.10) than in the above-mentioned groups. A control group of infertile oligomenorrheic women revealed that the material was comparable with previously published populations as regard the occurrence of minor müllerian anomalies. It is concluded that the HSG-diagnosed prevalence of developmental uterine anomalies is in general somewhat higher than usually assumed.