الفهرس 
Role of Transvaginal Ultrasonography (TVS) with Office Hysteroscopy (HSC) versus Hysterosalpingography (HSG) in assessment of tubal patency
AbstractOnly 14 pages are availabe for public view
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Abstract
INFERTILITY IS DEFINED AS A WOMAN OF REPRODUCTIVE AGE WHO HAS NOT
CONCEIVED AFTER 1 YEAR OF UNPROTECTED REGULAR VAGINAL SEXUAL INTERCOURSE.
(RCOG GREEN TOP GUIDELINES MARCH 2011)
ABOUT 17% OF COUPLES IN WELL DEVELOPED COUNTRIES SEEK HELP FOR
INFERTILITY, WHICH MAY BE CAUSED BY OVULATORY FAILURE, TUBAL DAMAGE OR
ENDOMETRIOSIS, OR A LOW SPERM COUNT. IN RESOURCE-RICH COUNTRIES, 80-90%
OF COUPLES ATTEMPTING TO CONCEIVE ARE SUCCESSFUL AFTER 1 YEAR AND 95% AFTER
2 YEARS.
TUBAL FACTOR INFERTILITY ACCOUNTS FOR ABOUT 15-25% OF ALL CASES OF
INFERTILITY.
THE FALLOPIAN TUBES PICK UP THE EGG from THE OVARY AFTER OVULATION
AND THE SPERM TRAVELS TO MEET THE EGG AND FERTILIZES IT IN THE TUBE. THE
FERTILIZED EGG (EMBRYO) TRAVELS THROUGH THE TUBE TO THE WOMB where IT
SHOULD IMPLANT AND GROW INTO A PREGNANCY.
IF THE TUBES ARE SCARRED OR BLOCKED, FERTILITY WILL BE AFFECTED AND CAN
ALSO INCREASE THE RISK OF ECTOPIC PREGNANCY (WHEN THE PREGNANCY GETS STUCK
IN THE TUBE RATHER THAN MAKING IT TO THE WOMB).
TUBAL DAMAGE IS OFTEN CAUSED BY PELVIC INFLAMMATORY DISEASE (PID)
WHICH IS A COMMON INFLAMMATORY CONDITION CAUSED BY BACTERIA SUCH AS
CHLAMYDIA AND IT IS A COMMON COMPLICATION OF SEXUALLY TRANSMITTED
INFECTIONS. (RCOG GREEN TOP GUIDELINES MARCH 2011)
HYSTEROSALPINGOGRAPHY (HSG) IS A RADIOGRAPHIC DIAGNOSTIC STUDY OF
THE UTERUS AND FALLOPIAN TUBES MOST COMMONLY USED IN THE EVALUATION OF
INFERTILITY.
UTERINE ABNORMALITIES ARE THOUGHT TO BE A CONTRIBUTING FACTOR IN
APPROXIMATELY 10% OF INFERTILE WOMEN AND 50% OF WOMEN WITH RECURRENT
EARLY PREGNANCY LOSS, WHILE THE PREVALENCE OF TUBAL ABNORMALITIES IN
INFERTILITY IS APPROXIMATELY 20%-30%. THUS, ASSESSMENT OF THE UTERINE
CAVITY AND FALLOPIAN TUBES IS A STANDARD PRACTICE IN THE BASELINE INFERTILITY
WORKUP.
HSG HAS LONG BEEN RECOGNIZED FOR ITS USE IN DETECTING TUBAL PATENCY,
POLYPS, SUBMUCOSAL LEIOMYOMAS, SYNECHIAE, MÜLLERIAN ANOMALIES,
HYDROSALPINGES, SALPINGITIS ISTHMICA NODOSUM (SIN), AND PERITUBAL
ADHESIONS.
OUTPATIENT HYSTEROSCOPY IS AN ESTABLISHED DIAGNOSTIC TEST THAT IS IN
WIDESPREAD USE ACROSS THE WORLD. THE PROCEDURE INVOLVES THE USE OF
MINIATURIZED ENDOSCOPIC EQUIPMENT TO DIRECTLY VISUALIZE AND EXAMINE THE
UTERINE CAVITY, WITHOUT THE NEED FOR FORMAL THEATRE FACILITIES OR GENERAL OR
REGIONAL ANESTHESIA. OUTPATIENT HYSTEROSCOPY IS INDICATED PRIMARILY IN THE
ASSESSMENT OF WOMEN WITH ABNORMAL UTERINE BLEEDING, BUT IS ALSO EMPLOYED
IN THE DIAGNOSTIC WORK-UP OF REPRODUCTIVE PROBLEMS. (RCOG GREEN TOP GUIDELINE MARCH 2011)
TOGETHER WITH ULTRASOUND, IT REPRESENTS A FIRST-LINE DIAGNOSTIC
TOOL FOR THE EVALUATION OF THE UTERINE REPRODUCTIVE CAPACITY.