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

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

Publication History

Received: 30 March 2024

Accepted after revision: 09 May 2024

Article published online:
09 July 2024

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