Volume 108, Issue 4, Page 718
J. Preston Parry, M.D., M.P.H., Daniel Riche, Pharm.D., John Rushing, M.D., Brittany Linton, R.N., Vicki Butler, R.N., Steven R. Lindheim, M.D., M.M.M.
To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG).
Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its University of Mississippi Medical Center Institutional Review Board protocol number is 2013-0230.
Women undergoing office hysteroscopy and ultrasound, with a subset also having HSG.
Air infusion into saline during office hysteroscopy.
Main Outcome Measure(s)
The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG.
When performed as described, this office technique has 98.3%–100% sensitivity to tubal occlusion and 83.7% specificity. The gentle technique is central to accurate outcomes, which is facilitated through use of a small-caliber (<3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG (relative risk = 110; P < .0001). Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique.
Air-infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility.