SELECTED ORAL COMMUNICATION SESSION SESSION 06: ENDOMETRIOSIS AND SURGERY Monday 4 July 2011 10:00 - 11:30

Introduction: Tubal dysfunction is a leading factor in female infertility. Laparoscopy dye is the gold standard to detect tubal patency (laparoscopic chromohydrotubation, LSC-CHT), but hysterosalpingography (HSG) and hystero-contrast-sonography (HyCoSy) are also widely applied. Using office hysteroscopy guided selective chromopertubation (OHSC-SPT) we aimed to develop a less invasive effective and reproducible method, which can be performed in an outpatient setting without anesthesia.Material and Methods: 23 infertile patients (mean age: 32,77 ? 3,42) were examined before planned laparoscopy. A 2.7 mm optic was used, with a 5.5 mm sheath (EMD Endoscopy Technologies). A 1.7 mm diameter flexible plastic catheter (Cavafix, B-Braun) was introduced through an inbuilt channel of the sheath. Normal saline was used for the distension. The hysteroscope was introduced without grasping or dilatation of the cervix. A diagnostic hysteroscopy is performed first, then the catheter is inserted through the working channel and the tip of it is placed into the tubal orifice, through which methylene blue dye is injected slowly. In the absence of tubal occlusion the blue dye does not appear in the uterine cavity and normal color of the endometrium is seen. With damaged tubal patency the distension media of the uterine cavity turns blue, according to the backflow of the methylene blue. Laparoscopic standard tubal CHT was then performed by an operator uninformed about the OHSC-SPT results and the result were then compared.Results: Both tubes of the 23 patient were examined (N = 46). In 43 cases (93.5%) either there was an agreement with the laparoscopic findings or (5 cases, 11.6%) in spite of presence of the dye in the abdominal cavity, patency couldn't be proved properly at the time of laparoscopy. Three tubes (3 out of 41, 7,3%) were found patent with laparoscopy and were found occluded according to the OHSC-SPT. All of these false positive cases occurred at the beginning of the learning curve.Conclusion: The novel method of OHSC-SPT is an effective, highly minimal invasive method to investigate the tubal patency, which can be performed in an office setting without anesthesia. The OHSC-SPT negative/LSC-CHT positive cases suggest especially high sensitivity for tubal patency, but this finding requires further confirmatio