Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

SUMMARY OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

RESUMO OBJETIVO Este estudo tem como objetivo investigar as causas do diagnóstico equivocado na avaliação da patência tubária por meio da ultrassonografia de contraste histerosalpingo em tempo real transvaginal (TVS RT-3D-HyCoSy), a fim de melhorar a eficiência diagnóstica das TVS RT-3D-HyCoSy. MÉTODOS Um total de 162 ovidutos em 83 pacientes da infertilidade foi examinado por TVS RT-3D-HyCoSy. Esses resultados foram comparados com o padrão ouro para estudos de tintura laparoscópica, e os casos diagnosticados erroneamente foram analisados. RESULTADOS TVS RT-3D-HyCoSy revelaram que 68 ovidutos foram desobstruídos e 94 ovidutos foram obstruídos. Os resultados para os 144 ovidutos estavam em consonância com o padrão ouro, enquanto que aqueles para os 18 ovidutos, não. A taxa de acurácia do TVS RT-3D-HyCoSy foi de 88,9%, e a taxa de erro de diagnóstico foi de 11,1%. As principais causas de erro de diagnóstico incluíram contraponto e difusão do meio de contraste, espasmo do oviduto, forma ou posição anormal do oviduto, adesão pélvica e má operação de imagem. CONCLUSÃO TVS RT-3D-HyCoSy pode bem avaliar a patência tubária, e compreender e melhorar a causa do erro de diagnóstico. Além disso, a eficiência diagnóstica do TVS RT-3D-HyCoSy ainda pode ser melhorada.

Rendimiento diagnóstico de la histerosalpingografía por resonancia magnética: resultados iniciales / Diagnostic performance of magnetic resonance hysterosalpingography: initial results Abstract

Objetivo: Determinar el rendimiento diagnóstico de la histerosalpingografía por resonancia magnética (HSG-RM), utilizando la laparoscopia como método de referencia. Materiales y métodos: Se incluyeron 22 pacientes. A todas se les realizó una HSG-RM con un resonador 1.5 Tesla y luego una laparoscopia con cromotubación. Dos radiólogos examinaron las RM, determinando la permeabilidad tubaria por consenso. Se realizaron análisis descriptivos y de rendimiento diagnóstico. Resultados: La HSG-RM tuvo una tasa de éxito del 91%. La duración del estudio fue 49ą15 minutos, el volumen inyectado 26 ą 16 cm³ y la escala de dolor 30ą 19 de 100. La sensibilidad y especificidad de la HSG-RM fueron del 100% para la prueba de Cotte global y a la izquierda, y del 25% y 93,3% para la prueba de Cotte a la derecha, respectivamente. Hubo 2 complicaciones menores y ninguna importante. Discusión: Nuestros resultados iniciales demostraron una alta sensibilidad y especificidad. Si bien otros estudios analizaron la capacidad de la HSG-RM para evaluar la permeabilidad tubaria con buenos resultados, el uso de un patrón de referencia defectuoso dejaba margen para una duda razonable, impidiendo una recomendación basada en pruebas sólidas. Sin embargo, al cotejar nuestros resultados con los publicados, observamos un alto grado de concordancia en tanto el derrame positivo se diagnostica correctamente con una especificidad de 100% o con un porcentaje cercano a esta cifra. Conclusión: La HSG-MR es una alternativa factible y segura de la HSG convencional o virtual, la histerosonografía y la cromotubación.

Objective: To determine the diagnostic performance of magnetic resonance hysterosalpingography (MRHSG) using laparoscopic chromotubation as a method of reference. Materials and methods: Twenty-two patients were included. The MRHSG was performed in a 1.5 Tesla MR scanner. Afterwards, patients underwent laparoscopic chromotubation. MR images were examined by two trained radiologists, and tubal patency was determined by consensus. A descriptive analysis was carried out, as well as an analysis of the diagnostic performance. Results: MRHSG had a 91% success rate. Exam duration of the examination was 49ą15min, with an injected volume 26ą 16cc, and pain scale 30ą 19 out of 100. Sensitivity and specificity of MRHSG was 100% for global and left Cotte, and 25% and 93.3% for right Cotte, respectively. Only 2 minor and no major complications were observed. Discussion: The initial results of MRHSG have shown high sensitivity and specificity. Even though other studies have analysed the potential of MRHSG with good results, the use of a flawed reference standard left a margin for a reasonable doubt as regards its true potential, thus preventing a solid evidence based recommendation. Nevertheless, if our results are compared to those published, a high level of agreement is observed in that positive spillage is correctly diagnosed with specificities near or at 100%. Conclusion: MRHSG is a feasible and safe alternative to conventional or virtual HSG, ultrasound-hysterography and chromotubation.

Cromotubación histeroscópica: técnica alternativa para la evaluación de la permeabilidad tubárica y la cavidad uterina en un solo paso / Hysteroscopic chromotubation: an alternative technique for the evaluation of tubal patency and uterine cavity in a single step

La evaluación de la permeabilidad tubárica es un paso esencial en el estudio de la infertilidad femenina. Existen varios métodos que permiten realizar esta evaluación. La histerosalpingografía (HSG) se ha considerado el método estándar, sin embargo es conocida su limitación en la evaluación de la obstrucción proximal con alta tasa de falsos positivos. Presentamos una técnica alternativa para la evaluación por medio de cromotubación histeroscópica, que tiene entre otras, la ventaja de permitir la evaluacion del factor uterino y tubárico en un solo paso y además, supera la dificultad de los falsos positivos de la HSG, en cuanto a la obstrucción proximal.

The evaluation of tubal patency is an essential step in the study of female infertility. There are several methods to perform this evaluation. Hysterosalpingography (HSG) has been considered the standard method, however it is known to limitations in the assessment of proximal obstruction with high false positive rate. We present an alternative technique for evaluation by hysteroscopic chromo tubation, which has among others, the advantage of allowing the evaluation of uterine and tubal factor in one step and also overcomes the difficulty of false-positive HSG, as to the proximal obstruction.

Evaluation of Tubal Patency with Transvaginal Three-dimensional Hysterosalpingo-contrast Sonography / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in assessing tubal patency with chromolaporoscopy.</p><p><b>METHODS</b>A total of 157 infertile women underwent 3D-HyCoSy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test.</p><p><b>RESULTS</b>Among the 306 oviducts examined by 3D-HyCoSy, 99 (32.4%) were patent, 126 (41.2%) partially obstructed, and 81 (26.5%) completely obstructed. Diagnostic results with 3D-HyCoSy were not statistically different from those obtained in the 39 women (78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance (k=0.747, P=0.000). The 3D-HyCoSy procedure had a sensitivity of 84.8% (28/33), a specificity of 96.2% (25/26), and positive and negative predictive values of 93.3% (28/30) and 86.2% (25/29) respectively.</p><p><b>CONCLUSION</b>Transvaginal 3D-HyCoSy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.</p>

Qual o papel do Toll-Like Receptor (TLR) na indução de lesão de tuba uterina nas infecções por Chlamydia Trachomatis? / What is the role of Toll-Like Receptor (TLR) in the induction of tubal damages caused by Chlamydia Trachomatis infection?

A suscetibilidade à infecção por C. trachomatis, curso, complicações e resolução da doença depende do tipo da bactéria, de fatores ambientais eda genética do paciente. Entre as mulheres uma forma frequente da infecção é a endocervicite, que pode se complicar com salpingite com consequente lesãotubária. Acredita-se que as complicações a longo prazo desta infecção ocorrem via heat shock protein HSP 60 e toll-like receptors (TLR)...

The susceptibility, course, complications and outcome of Chlamydia trachomatis infection depends on the type of bacteria, environmentalfactors and host genetic factors. Among women, the most common infection is cervicitis that can be complicated by salpingitis leading to tubal damage.It is believed that long-term complications occur via HSP 60 and toll-like receptors...

Selective salpingography and tubal catheterization in infertile women

Use of selective salpingography [SS] and fallopian tube catheterization [TC] has revolutionized the diagnosis and treatment of proximal tubal infertility. To evaluate results of women treated for proximal tubal obstruction by selective salpingography and tubal catherization. Selective salpingography was performed in women with proximal bilateral tubal obstructions. Follow-up ranged from 4 to 12 months. Twelve patients had been shown to have bilateral proximal obstruction of the fallopian tube. After SS/TC, patency was achieved in 8 cases. Spontaneous conceptions occurred in 4 women. SS and TC should be used more widely because it is simple and effective in case of proximal tubal blockage

Laparoscopic evaluation in infertility

To describe the different causes of infertility based on findings of diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A cross-sectional study. Obstetrics and Gynaecology Unit of Hayatabad Medical Complex, Peshawar, from January to December 2005. All patients undergoing diagnostic laparoscopy for primary or secondary infertility were included. Male factor infertility cases was excluded. Frequency of the causes and finding was determined. One hundred and thirty six [70.46%] patients with primary and 57 [29.54%] with secondary infertility underwent diagnostic laparoscopy. Seventy [51.47%] with primary and 26 [45.51%] with secondary infertility had no visible abnormality. Bilateral tubal blockage was found in 32 [23.53%] primary and 16 [28.07%] cases of secondary infertility. Dense pelvic adhesions forming adnexal mass were found in 9 [6.61%] and 6 [10.5%] of primary and secondary respectively. Two cases each of bicornuate uterus and double uterus in primary infertility patients. Ovarian pathology was found in 18 [13.23%] primary and 4 [7.01%] cases of secondary infertility. PCO [polycystic ovaries] were detected in 12 [8.82%] and 2 [3.5%] cases of primary and secondary infertility respectively. Endometriotic cysts and deposits were found in 15 [10.29%] cases of primary and 3 [5.26%] cases of secondary infertility. Tubal disease is a common factor responsible for infertility and diagnositc laparoscopy is a valuable technique for complete assessment of female infertility and making treatment decisions according to the cause

comparative study of single dose, double-dose methotrexate and surgical management of ectopic pregnancy regarding safety, efficacy and tubal patency

To evaluate the safety, efficacy of two Meth-otrexate [MTX] regimens for treatment of ectopic pregnancy [EP] and determine the future fertility after medical and surgical management of ectopic pregnancy. 75 cases with EP, 52 were stable and eligible for medical treatment. 24 cases received MTX 50mg/m2, additional dose was given one week later if B-HCG did not decline by 15% between day 4 and 7, while 28 cases received MTX 50mg/m[2] on days 0 and 4, additional doses were given on day 7 and/or on day 11 if HCG levels did not decrease by 15% during the follow-up period. 23 cases underwent surgery. Hysterosalpingogram [HSG] was performed to assess future fertility of patients after receiving treatment for EP. Overall success rate for single-dose and double-dose protocol was 79% and 85.7% respectively. The difference in success rate between the two regimens was most evident at B-HCG concentrations between 2000-5000mIU/mL; 75% for the single dose regimen and 85.7% for the two-dose regimen which favor using the two-dose regimen in this category of patients. Treatment was well tolerated in both groups, most side effects were mild and transient. Regarding future fertility; tubal patency was 94.2% after medical treatment and 82.6% after salpingectomy. The 2-dose protocol is a hybrid between the two previously established protocols; the single dose and the multi-dose MTX. It may optimize the balance between convenience and efficacy. Single-dose regimen is most suitable for low B-HCG <2000mIU/mL mIU/mL, the 2-dose regimen is more suitable for higher B-HCG 2000-5000, while B-HCG >5000mIU/mL has a high failure rate with medical treatment. In a limted number of patients, no safety concerns were noted with either the single-dose or the 2-dose protocols. Medical treatment should be offered to stable patients whenever feasible because it preserves their future fertility meanwhile cost effective

Evaluation of tubal patency by hysterosalpingograhy in infertile patients

To evaluate tubal patency by hysterosalpingography in infertile patients. This prospective study was carried out on 200 female subjects, with primary and secondary infertility aged 20-41 years, attending the Department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore, from 1997 to 1999. After detailed history, thorough clinical examination and investigations, all the patients underwent hysterosalpingography during the proliferative phase of cycle and the findings recorded. The age of 100 patients included in the study varied from 20-40 year in primary infertility and 20-45 in secondary infertility. An evaluation of the status of the tubes assessed by each of the two techniques. HSG showed bilateral peritubal adhesion in one patient and unilateral peritubal adhesions in 2 patients. It is evident that HSG is more informative in uterine malformation while laparoscopy gave extra information like polycystic ovaries, subserous fibroid and endometriosis, which are totally missed by HSG. Hysterosalpingography is a valuable tool in assessing tubal patency. In addition it gives information regarding contour of urine cavity, any uterine malformations, level of obstruction in fallopian tubes and presence of any hydrosalpinx

Tubal patency following surgical and clinical treatment of ectopic pregnancy

CONTEXT AND OBJECTIVE: As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m²), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84 percent after methotrexate treatment and 78 percent after expectant management. In addition, contralateral tubal patency was 97 percent after methotrexate treatment, 92 percent after expectant management and 83 percent after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.

CONTEXTO E OBJETIVO: Como existem poucas informações a respeito do futuro reprodutivo das pacientes tratadas de gravidez ectópica através do tratamento clínico (metotrexato e conduta expectante) e da cirurgia (salpingectomia), avaliamos as histerossalpingografias após o tratamento da gravidez ectópica. O objetivo foi avaliar a permeabilidade da tuba contralateral pela histerossalpingografia após o tratamento cirúrgico e clínico da gravidez tubária. TIPO DE ESTUDO E LOCAL: Estudo prospectivo realizado no Departamento de Obstetrícia da Universidade Federal de São Paulo (centro terciário). MÉTODOS: Foram realizadas 115 histerossalpingografias após o tratamento clínico e cirúrgico da gravidez tubária no período de 1994 a 2002, sendo que 30 após o tratamento com dose única de metotrexato (50 mg/m²) intramuscular, 50 após a conduta expectante e 35 após a salpingectomia. RESULTADOS: A permeabilidade tubária ipsilateral foi de 84 por cento após o tratamento com metotrexato e de 78 por cento após a conduta expectante. A permeabilidade da tuba contralateral foi de 97 por cento após o tratamento com metotrexato, 92 por cento após a conduta expectante e 83 por cento após a salpingectomia. Não houve diferença estatisticamente significante entre os grupos de tratamento cirúrgico e clínico. CONCLUSÃO: Os dados deste estudo sugerem que a permeabilidade tubária contralateral é similar após a salpingectomia, o tratamento com metotrexato e a conduta expectante.

Laparoscopic guided transcervical hysteroscopic tubal cannulation in the treatment of proximal tubal block

Proximal tubal obstruction [PTO] represent up to 25% of tubal disease in infertile women. Hysteroscopic tubal cannulation, tubal reanastamosis and IVF are the available modalities for the treatment of PTO The aim of this study is to evaluate the value of treatment of PTO using hysteroscopic tubal cannulation under laparoscopic guidance. Randomized study, Bab El Sharia University Hospital. Thirty infertile patients [either primary or secondary infertility] due to PTO as evidenced by hysterosalpingography were recruited from infertility clinic. Duration of infertility, history of pelvic inflammatory disease and any methods of contraception were asked for. Immediately after menstruation combined laparoscopy and hysteroscopic tubal cannulation were done for each patient. Hysteroscopic tubal cannulation successfully re-established tubal patency in forty [83.33%] out of forty eight tubes originally diagnosed with PTO. No significant relation between success of recanalization and either of duration of infertility, history of PID, method of contraception or type of infertility. There was significant relation between incidence of tubal perforation and duration of infertility as well as history of IUD

Hysteroscopic tubal cannulation

To evaluate the safety and efficacy of hysteroscopic tubal cannulation for treatment of proximal tubal obstruction [PTO]. Department of Obstetric and Gynecology, El Matareya Teaching Hospital. During the period from April 2001 through December 2003 A prospective clinical study a total of 50 women with PTO were subjected to hysteroscopic tubal cannulation under concomittent laparoscopic control The age of patients ranged from 23 to 38 with a mean of 29.79 [ +/- 2.35] years. The mean weight of patients was 81.5 years [ +/- 13.15]. Primary infertility was present in 14 [28 percent] and secondary infertility in 36 [72 percent] of cases. The duration of infertility ranged from 1 year to 13 years. The operative procedure was successful in 41 [82 percent] and unsuccessful in 9 [18 percent] including 6 [12 percent] incomplete procedure and 3 [6 percent] cases of perforation. After 6 months, follow up of 36 women showed 12 pregnancies [33.3 percent]. Among the remaining 24 cases [66.7 percent] HSG confirmed tubal patency in 18 cases [75.0 percent] and reclosure in 6 women [25 percent]. The reproductive outcome in 36 women after one year of follow up showed 21[58.3 percent] pregnancies including 16 [44.4 percent] intrauterine and 5 [13.9 percent] ectopic pregnancies. Failure of pregnancy was present in 41.7 percent of cases. hysteroscopic tubal cannulation is safe procedure that should be resorted to for management of PTO with an expected pregnancy rate of about 50 percent

Sonohysterosalpingography versus laparoscopy in infertility

To evaluate the safety and efficacy of Sonohysterosalpingography as a tubal patency test. One hundred infertile women underwent Sonohysterosalpingography followed by laparoscopy and dye pertubation, findings were compared. Patency was proved in higher proportion of patients with laparoscopy and dye pertubation than with Sonohysterosalpingography [84 percent versus 80 percent], but not statistically significant, women with normal Sonohysterosalpingography had a normal pelvic anatomy apart from mild endometriosis or mild pelvic adhesions not comprising tubal patency, these cases may not need laparoscopy, pelvic pathology detected included uterine myoma in 8 cases, polycystic ovaries in 8 cases, mild pelvic adhesions in 12 cases and mild endometriosis in 8 cases. Sonohysterosalpingography is a good screening test for tubal patency without exposure to radiation in x -ray H.S.G.; and it is less invasive and cost effective than laparoscopy dye pertubation

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.

[ assessment of sonohysterography as a diagnostic tool for uterine cavity defects and tubal patency]

In a prospective blind study, we evaluated Sonohysterography [SHG] as a diagnostic tool for uterine cavity and tubal patency and compare SHG with laparoscopy in tubal patency and hysterosalpyngography for Uterine anomaly as gold standard methods. 76 infertile patients undergone SHG and HSG and laparoscopy and comparison between the different diagnostic techniques for the evaluation of the uterine cavity and tubes was carried out. In comparison between SHG and HSG in the evaluation of uterine cavity, the sensivity of SHG for uterine anomalies was 50% and its specificity was 86.95%. In comparison between SHG and laparoscopy in evaluating tubal patency, specificity of SHG was 81.29% and its sensivity was 28.57%. Sonohysterography can be considered as a reliable and accurate method in the first line of evaluation of uterine cavity and tubal patency in infertile patients before HSG, Hysteroscopy, laparoscopy and the all of patients with history of failed IVF

Laparoscopic balloon neosalpingostomy and fimbrioplasty in cases of distal tubal occlusion

The objective of this study was to evaluate the technique of balloon catheterization of the fallopian tube after either laparoscopic neosalpingostomy or fimbrioplasty in cases of distal tubal occlusion and compare the results with those of laparoscopic neosalpingostomy or fimbrioplasty alone. In this work, 100 women with distal tubal occlusion were scheduled for either laparoscopic neosalpingostomy [52 cases] or fimbrioplasty [48 cases]. Balloon catheterization of the Fallopian tube using transluminal angioplasty catheter was done for 23 patients after laparoscopic neosalpingostomy and 27 patients after laparoscopic fimbrioplasty. Three out of 29 patients who underwent laparoscopic neosalpingostomy alone achieved intrauterine pregnancy and one patient proved to have tubal pregnancy. Among 23 patients who underwent laparoscopic neosalpingostomy with balloon catheterization of the Fallopian tube, six patients achieved intrauterine pregnancy. The difference was statistically significant and a positive tubal potency after laparoscopic neosalpingostomy with catheterization of the Fallopian tube was significantly more than that after laparoscopic neosalpingostomy, alone [86.9% versus 72.4%, respectively]. In conclusion, the technique of laparoscopic neosalpingostomy with balloon catheterization of the fallopian tube may lead to better results than that after laparoscopic neosalpingostomy alone as regards the pregnancy rate and postoperative tubal patency

Detection of chlamydia trachomatis DNA by polymerase chain reaction in urine of women with tubal infertility as diagnosed by hysterosalpingography and laparoscopy

This study included 30 women with tubal infertility and 14 women with other causes of infertility documented by laparoscopy. The presence of C. trachomatis DNA in first void urine was determined using PCR assay and the presence of C. trachomatis-specific IgG in serum samples was also investigated using microimmunofluorescence [MIF] technique. C. trachomatis-specific IgG was present in 14 of 30 women with tubal infertility compared with seven of 14 with other causes of infertility. In conclusion, there was a strong association between the presence of C. trachomatis DNA and the development of chlamydial- associated infertility

Hysteroscopic tubal cannulation for management of proximal tubal obstruction

Tubal obstruction is a frequent cause of infertility, proximal tubal block represents 25-30% of the cases of tubal obstruction and is always challenging in its diagnosis and treatment. This study which took part in Ain Shams University Maternity Hospital and recruited 24 patients evaluates hysteroscopy tubal cannulation for the management of proximal tubal block. Results are evaluated in terms of tubal patency and pregnancy rate following the procedure