Although HSG has been historically regarded as the imaging study of choice in assessing tubal patency, it is only 65% sensitive and 85% specific for diagnosing tubal patency when compared Female Infertility with laparoscopy with chromopertubation [58], which is widely accepted as the reference standard for evaluating tubal patency. MRI Pelvis MRI is useful in the detection of hydrosalpinges, most commonly due to prior PID, and is superior to TVUS in the assessment of PID, although this refers to acute PID, which is outside of the scope of this topic (95% sensitive and 89% specific compared to 81% sensitive and 78% specific) [59]. Hydrosalpinges are detected in subclinical or chronic PID secondary to scarring of the fallopian tubes or tubal obstruction by peritoneal bands from previous inflammation [60]. In a blinded study of 41 patients with hydrosalpinx at surgery, hydrosalpinx was accurately diagnosed in 31 patients (75.6%) on MRI [61]. Although IV contrast is useful in assessing additional complications of PID, it is not necessary for the evaluation of hydrosalpinges [34,60]. US Pelvis Transvaginal Hydrosalpinx may occur in the setting of distal tubal occlusion, most commonly due to prior PID [62]. The finding of hydrosalpinx has implications for patients who may undergo in vitro fertilization [63]. TVUS has been shown to be 86% sensitive in detecting hydrosalpinx [64]. Apart from detection of hydrosalpinges, TVUS has not been shown to be effective in documenting tubal patency. US Sonohysterography To our knowledge, there is no relevant literature to support performing isolated US sonohysterography in patients with suspicion of tubal occlusion; however, the presence of increased fluid in the posterior cul-de-sac following sonohysterography may indicate tubal patency.
Female Infertility. Although HSG has been historically regarded as the imaging study of choice in assessing tubal patency, it is only 65% sensitive and 85% specific for diagnosing tubal patency when compared Female Infertility with laparoscopy with chromopertubation [58], which is widely accepted as the reference standard for evaluating tubal patency. MRI Pelvis MRI is useful in the detection of hydrosalpinges, most commonly due to prior PID, and is superior to TVUS in the assessment of PID, although this refers to acute PID, which is outside of the scope of this topic (95% sensitive and 89% specific compared to 81% sensitive and 78% specific) [59]. Hydrosalpinges are detected in subclinical or chronic PID secondary to scarring of the fallopian tubes or tubal obstruction by peritoneal bands from previous inflammation [60]. In a blinded study of 41 patients with hydrosalpinx at surgery, hydrosalpinx was accurately diagnosed in 31 patients (75.6%) on MRI [61]. Although IV contrast is useful in assessing additional complications of PID, it is not necessary for the evaluation of hydrosalpinges [34,60]. US Pelvis Transvaginal Hydrosalpinx may occur in the setting of distal tubal occlusion, most commonly due to prior PID [62]. The finding of hydrosalpinx has implications for patients who may undergo in vitro fertilization [63]. TVUS has been shown to be 86% sensitive in detecting hydrosalpinx [64]. Apart from detection of hydrosalpinges, TVUS has not been shown to be effective in documenting tubal patency. US Sonohysterography To our knowledge, there is no relevant literature to support performing isolated US sonohysterography in patients with suspicion of tubal occlusion; however, the presence of increased fluid in the posterior cul-de-sac following sonohysterography may indicate tubal patency.