O iginal A icle
Tubal lushing e ec o hys e oscopic pa ency es
q
Pé e Tö ök
a,
⇑
, Judi L}
o incz
b
, Ma ianna Dob ai
b
, Róbe Póka
a
a
Depa men o Obs e ics and Gynecology, Medical and Heal h Science Cen e , Uni e si y o Deb ecen, Deb ecen, Hunga y
b
Kenézy Gyula Coun y Hospi al, Depa men o Obs e ics and Gynecology, Hunga y
a icle in o
A icle his o y:
Recei ed 21 Ma ch 2017
Re ised 11 Ap il 2017
Accep ed 11 Ap il 2017
A ailable online xxxx
Keywo ds:
O ice hys e oscopy
Tubal lushing e ec
Fallopian ube
Pa ency
In e ili y
abs ac
In oduc ion: Tubal lushing e ec is a published phenomena o hys e osalpingog aphy in connec ion
wi h ubal pa ency es . The aim o he s udy was o e alua e he lushing e ec o he ou pa ien me hod:
selec i e ch omope uba ion ia o ice hys e oscopy (OHSC-SPT), and compa e i o ha o HSG.
Ma e ials and me hods: Six y in e ile pa ien s ecei ing OHSC-SPT (mean [SD] age: 34.1 [3.2] yea s) and
163 ecei ing HSG (32.7 [4.7] yea s) ook pa in he s udy. As pa o he in e ili y wo k-up, diagnos ic
o ice hys e oscopy was pe o med o e alua e he u e ine ca i y. Pa ien s wi h a leas one pa en ube
had a 12-mon h ollow-up, du ing which hei obs e ical e en s, including success ul concep ion o
p egnancy a e a s e ile pe iod, we e eco ded. The be ween-g oups compa ison was quan i ied by cal-
cula ing a p egnancy p opo ion a io.
Resul s: Ou o he 60 OHSC-SPT subjec s, bo h ubes we e blocked in 24 cases, and a leas one o he
ubes was pa en in 36 cases. Ou o hese 36 cases, 7 (19.4%) spon aneous p egnancies we e concei ed;
in h ee (8.3%) cases, p egnancy was concei ed a e in au e ine insemina ion (IUI) pe o med on male
indica ion. The numbe o p egnancies obse ed in he HSG g oup (163 examined subjec s) was 37 (32
spon aneous, 5 IUI-assis ed) ou o 153 ollowed-up subjec s (24.4%). The p egnancy p opo ion a io
es ima e was 1.15 (90% CI: 0.70–1.90; p = 0.671).
Conclusions: The no el me hod o OHSC-SPT has a ubal lushing e ec ha is non-in e io o ha
obse ed wi h HSG.
Ó2017 Middle Eas Fe ili y Socie y. P oduc ion and hos ing by Else ie B.V. This is an open access a icle
unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
1. In oduc ion
The incidence o ubal dys unc ion as a cause o in e ili y has
inc eased la ely. P io su gical in e en ions and in ec ions a e
o en ound in he medical his o y, as well as endome iosis, he
incidence o which is also on he ise [1]. Fo e alua ing ubal
pa ency, a a ie y o me hods a e used wo ldwide, including hys-
e osalpingog aphy (HSG), saline in usion sonog aphy (SIS), and
lapa oscopy (LSC) [2]. A common ea u e o hese me hods is he
injec ion o a luid h ough he ubes and he de ec ion o i s low.
In cases whe e he ubes a e only blocked by a mode a e amoun o
de i us o a loose ‘‘plug”, he e is a chance o he ubes o be eo-
pened by he injec ed luid. Re e ed o as he ubal lushing e ec ,
his phenomenon has been desc ibed in ela ion o hys e osalpin-
gog aphy using oil-soluble con as media [3]. A e pe o ming he
examina ion o he e alua ion o ubal pa ency in pa ien s wi h an
in e ile pe iod in hei ecen his o y, spon aneous p egnancies
we e obse ed mo e o en han expec ed.
The ubal lushing e ec may also mani es i sel upon selec i e
pe u ba ion ia o ice hys e oscopy o he assessmen o ubal
pa ency [4]. Compa ed o o he , non-selec i e p ocedu es (HSG,
SIS, LSC) [5], he selec i e na u e o he me hod may lead o a mo e
p ominen e ec and esul in Selec i e Tubal Reopening (eSTeR).
In his s udy, obs e ical ou comes o pa ien s who unde wen
selec i e pe u ba ion ia o ice hys e oscopy we e moni o ed.
By quan i ying he equency o subsequen p egnancy, he
e ec s o he no el me hod we e compa ed o hose o
hys e osalpingog aphy.
2. Ma e ials and me hods
Be ween Janua y 2013 and May 2014, selec i e pe u ba ion ia
o ice hys e oscopy (OHSC-SPT) was pe o med on pa ien s as pa
o hei in e ili y wo kup. In e ili y was de ined as one yea (six
mon hs o e 35 yea s o age) o unp o ec ed in e cou se wi hou
concei ing p egnancy. In all cases pa ne s examina ion was
pe o med. All OHSC-SPT examina ions we e ca ied ou in an
h p://dx.doi.o g/10.1016/j.me s.2017.04.005
1110-5690/Ó2017 Middle Eas Fe ili y Socie y. P oduc ion and hos ing by Else ie B.V.
This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
Pee e iew unde esponsibili y o Middle Eas Fe ili y Socie y.
⇑
Co esponding au ho a : Depa men o Obs e ics and Gynecology, Clinical
Cen e , Uni e si y o Deb ecen, 4032 Deb ecen, Hunga y.
E-mail add ess: [email p o ec ed] (P. Tö ök).
Middle Eas Fe ili y Socie y Jou nal xxx (2017) xxx–xxx
Con en s lis s a ailable a ScienceDi ec
Middle Eas Fe ili y Socie y Jou nal
jou nal homepage: www.sciencedi ec .com
Please ci e his a icle in p ess as: P. Tö ök e al., Tubal lushing e ec o hys e oscopic pa ency es , Middle Eas Fe il Soc J (2017), h p://dx.doi.o g/
10.1016/j.me s.2017.04.005
ou pa ien se ing a he Depa men o Obs e ics and Gynecology,
Uni e si y o Deb ecen Clinical Cen e , Hunga y. W i en in o med
consen was ob ained om pa ien s. The p ocedu e was pe o med
be ween he 5 h and 10 h pos mens ual days o ensu e op imum
isibili y condi ions. No anes hesia was used [6]. Du ing O ice
Hys e oscopy guided selec i e ch omope uba ion (OHSC-SPT)
e alua ion o u e ine ca i y pe o med, ollowed by e alua ing
ubal pa ency using anspa en plas ic ca he e . Me hod p e i-
ously desc ibed and compa ed o he gold-s anda d lapa oscopic
p ocedu e [4]. Pa ien s wi h nega i e hys e oscopic indings and
wi h a leas one pa en ube we e en olled o ollow-up. P egnan-
cies e i ied by sonog aphy we e eco ded o e he 12 mon hs ol-
lowing he examina ion. The end poin was de ined as clinical
p egnancy, de ec ion o a iable emb yo by sonog aphy, and quan-
i ied as he p opo ion o subjec s eaching a posi i e end poin .
A e e ence g oup was comp ised o pa ien s who unde wen
HSG in Kenézy Hospi al, Deb ecen, Hunga y, in he same pe iod
and on he same indica ion, using wa e -soluble con as media.
Inclusion and e alua ion c i e ia and p ocedu es we e iden ical
o hose o he OHSC-SPT g oup. The end poin was he same as
in OHSC-SPT g oup, clinical p egnancy de ec ed by sonog aphy.
P egnancy a es o bo h g oups we e compa ed.
The ollow-up g oups we e desc ibed using app op ia e sum-
ma y s a is ics and compa ed in e ms o posi i e end poin e-
quency by es ima ing he p opo ion a io wi h a 90% con idence
in e al (CI) and Fishe ’s exac p- alue. Equi alence was de ined
as he inclusion o he CI wi hin he ange 0.70–1.43.
3. Resul s
Hys e oscopic examina ion was pe o med on 60 pa ien s; HSG
was pe o med on 163 pa ien s. The numbe o subjec s quali ying
o ollow-up in each g oup, hei demog aphic cha ac e is ics, and
ou comes a e summa ized in Table 1. Pa ien s we e simila in
e ms o age. Ou o he 10 p egnancies in he OHSC-SPT g oup,
se en we e concei ed spon aneously, and h ee equi ed in au e -
ine insemina ion (IUI) wi hou s imula ion, due o he p esence o
a male indica ion, while he 37 p egnancies in he HSG g oup we e
composed o 32 spon aneous and 5 IUI-assis ed concep ions. The
p egnancy p opo ion a io (OHSC-SPT e sus HSG) was es ima ed
o be 1.15 (90% CI: 0.70–1.90; p = 0.671), sa is ying he equi alence
c i e ion a he low end bu exceeding he ange a he high end.
P egnancies concei ed du ing he ollow-up pe iod esul ed in
se en spon aneous deli e ies and h ee cesa ean sec ions in he
OHSC-SPT g oup.
4. Discussion
E alua ing ubal pa ency is co ne s one o in e ili y wo k-up in
iden i ying he op imum he apeu ic app oach [2]. As a side-e ec
o pa ency es s, ubal lushing has been desc ibed as a he apeu ic
impac [3]. Due o his e ec , a ise in spon aneous concep ion can
be obse ed a e he diagnos ic p ocedu e. The eme ging use o
OHSC-SPT has c ea ed a need o ind ou abou he ex en o which
his bene icial side-e ec exis s wi h his new me hod o ubal
es s.
A ubal lushing e ec associa ed wi h OHSC-SPT was obse ed
on ou sample o pa ien s wi h a his o y o in e ili y. The ex en o
he e ec was compa able wi h ha seen in a pa allel sample o
HSG ecipien s, wi h he non-in e io i y c i e ion sa is ied, and an
indica ion ha a po en ial exis ence o supe io i y in e ms o e-
quency o subsequen p egnancy canno be uled ou .
Because he pa ien g oups we e no andomized bu con e-
nience sampled om wo di e en heal h ca e p o ide ins i u es,
he issue o selec ion bias a ises. The uni e si y depa men whe e
OHSC-SPT ook place is pa o one o ou medical uni e si ies in
Hunga y, wi h a se ice a ea comp ised mos ly o he ci y o Deb e-
cen and i s su ounding coun y a eas, inhabi ed by abou 133,000
emales aged 15–49 [7]. The hospi al hos ing he HSG a m o he
s udy is also loca ed in Deb ecen, se es he same geog aphic a ea,
and p o ides a simila obs e ics and gynecology se ice p o ile
comple e om p e-p egnancy o pos -pa um ca e. The wo p o i-
de s a e eely selec able based on pa ien s’ indi idual p e e ence;
he choice is ypically down o pe sonal doc o -pa ien ela ions.
The in e ili y wo kup p o ocols a e equi ed by na ionwide guide-
line egula ions o be iden ical, and include a gynecological exam-
ina ion, ul asound s udy, and ological e alua ion o he pa ne ,
and ubal pa ency assessmen . In summa y, he e is no ob ious
sys ema ic di e ence be ween he sou ce popula ions a he wo
s udy si es o s and as a s ong candida e o in oduce selec ion
bias. Howe e , he indings o his i s -explo a ion esea ch should
be co obo a ed by mo e subs an ial e idence om a andomized
s udy be o e inal conclusions can be made.
Re e ences
[1] JA. Hamil on, AJ. La son, AM. Lowe , E alua ion o he pe o mance o
hys e osalpingo con as sonog aphy in 500 consecu i e unselec ed in e ile
women, Hum Rep od. 13 (6) (1998) 1519–1526.
[2] S. Papaioannou, P. Bou d ez, R. Va ma, Tubal e alua ion in he in es iga ion
o sub e ili y: a s uc u ed compa ison o es s, BJOG 111 (12) (2004)
1313–1321.
[3] L. Mohiyiddeen, A. Ha diman, C. Fi zge ald, Tubal lushing o sub e ili y,
Coch ane Da abase Sys . Re . 1 (5) (2015).
[4] P. Tö ök, T. Majo , Accu acy o assessmen o ubal pa ency wi h selec i e
pe u ba ion a o ice hys e oscopy compa ed wi h lapa oscopy in in e ile
women, J. Minim. In asi e Gynecol. 19 (5) (2012) 627–630.
[5] D. Nugen , A.J. Wa son, S.R. Killick, A andomized con olled ial o ubal
lushing wi h lipiodol o unexplained in e ili y, Fe il. S e il. 77 (1) (2002)
173–175.
[6] R. Campo, Y. an Belle, L. Rombau s, e al., O ice mini-hys e oscopy, Hum.
Rep od. Upda e 5 (1) (1999) 73–81.
[7] h p://www.s a in o.ksh.hu.
Table 1
OHSC-SPT g oup HSG g oup
Ini ially examined (n) 60 163
A leas one pa en ube (n) 36 153
Age (yea s; mean [SD]) 33.1 [3.26] 32.7 [4.72]
P egnancies wi hin 12 mon hs (n [%]) 10 [27.8] 37 [24.2]
2P. Tö ök e al. / Middle Eas Fe ili y Socie y Jou nal xxx (2017) xxx–xxx
Please ci e his a icle in p ess as: P. Tö ök e al., Tubal lushing e ec o hys e oscopic pa ency es , Middle Eas Fe il Soc J (2017), h p://dx.doi.o g/
10.1016/j.me s.2017.04.005