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==Alternatives==
==Alternatives==
There are also other procedures to determine whether or not someone's fallopian tubes are blocked. [[Hysterosalpingography]] (HSG) is a different diagnostic procedure done initially with an X-ray examination performed by a radiologist. While the main purpose of HSG is to evaluate the fallopian tubes, HSG does not provide an explanation for why the tubes are blocked. The examination should be scheduled between 7-12 days of a women's menstrual cycle.<ref>{{Cite journal|last=Simpson|first=William L.|last2=Beitia|first2=Laura G.|last3=Mester|first3=Jolinda|date=2006|title=Hysterosalpingography: A Reemerging Study|url=https://pubs.rsna.org/doi/10.1148/rg.262055109|journal=RadioGraphics|volume=26|issue=2|pages=419–431|doi=10.1148/rg.262055109|issn=0271-5333}}</ref> Radiographic dye is used to assess the uterine cavity and fallopian tubes. It can be used to study suspected infertility as well as tubal disease. <ref name=":5">{{Citation|last=Kallen|first=Amanda N.|title=Diagnosis and Management of Tubal Factor Infertility|date=2011-03-08|url=http://dx.doi.org/10.1002/9781444393958.ch3|work=Infertility|pages=18–25|place=Oxford, UK|publisher=Wiley-Blackwell|isbn=978-1-4443-9395-8|access-date=2021-07-30|last2=Kodaman|first2=Pinar H.}}</ref> During a HSG procedure, the uterus is injected with contrast dye, which can be observed via fluoroscopy.<ref>{{Cite journal|date=2009-09-01|title=Hysterosalpingography: Technique and Applications|url=https://www.sciencedirect.com/science/article/abs/pii/S0363018808000200|journal=Current Problems in Diagnostic Radiology|language=en|volume=38|issue=5|pages=199–205|doi=10.1067/j.cpradiol.2008.02.003|issn=0363-0188}}</ref> The test results are normal if the X-ray shows a normal uterine shape, and the dye spills out from the ends of the fallopian tubes. There may be a problem if the dye shows an abnormally shaped uterus and the dye does not freely flow from the fallopian tubes.<ref>{{Cite journal|last=Simpson|first=William L.|last2=Beitia|first2=Laura G.|last3=Mester|first3=Jolinda|date=2006|title=Hysterosalpingography: A Reemerging Study|url=https://pubs.rsna.org/doi/10.1148/rg.262055109|journal=RadioGraphics|volume=26|issue=2|pages=419–431|doi=10.1148/rg.262055109|issn=0271-5333}}</ref> While this method can be completed relatively quickly since anesthesia is not needed, there is a risk of tubal spasm, which typically occurs during injection of the contrast dye due to increased pressure. <ref name=":5" /> With tubal spasm, the fallopian tubes can close, and this may give a false diagnosis of tubal occlusion. <ref name=":5" />
There are also other procedures to determine whether or not someone's fallopian tubes are blocked. While laparoscopy with chromopertubation is considered to be the first-line practice for the diagnosis of tubal occlusion, it is generally a more expensive and invasive procedure, and it is recommended for women with suspected comorbidities (tubal occlusion and another pelvic pathology).<ref>{{Cite journal|last=Maheux-Lacroix|first=Sarah|last2=Boutin|first2=Amélie|last3=Moore|first3=Lynne|last4=Bergeron|first4=Marie-Ève|last5=Bujold|first5=Emmanuel|last6=Laberge|first6=Philippe Y.|last7=Lemyre|first7=Madeleine|last8=Dodin|first8=Sylvie|date=2013-07-04|title=Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review protocol|url=https://pubmed.ncbi.nlm.nih.gov/23826862|journal=Systematic Reviews|volume=2|pages=50|doi=10.1186/2046-4053-2-50|issn=2046-4053|pmc=3703290|pmid=23826862}}</ref>[[Hysterosalpingography]] (HSG) is a different diagnostic procedure done initially with an X-ray examination performed by a radiologist. While the main purpose of HSG is to evaluate the fallopian tubes, HSG does not provide an explanation for why the tubes are blocked. The examination should be scheduled between 7-12 days of a women's menstrual cycle.<ref>{{Cite journal|last=Simpson|first=William L.|last2=Beitia|first2=Laura G.|last3=Mester|first3=Jolinda|date=2006|title=Hysterosalpingography: A Reemerging Study|url=https://pubs.rsna.org/doi/10.1148/rg.262055109|journal=RadioGraphics|volume=26|issue=2|pages=419–431|doi=10.1148/rg.262055109|issn=0271-5333}}</ref> Radiographic dye is used to assess the uterine cavity and fallopian tubes. It can be used to study suspected infertility as well as tubal disease. <ref name=":5">{{Citation|last=Kallen|first=Amanda N.|title=Diagnosis and Management of Tubal Factor Infertility|date=2011-03-08|url=http://dx.doi.org/10.1002/9781444393958.ch3|work=Infertility|pages=18–25|place=Oxford, UK|publisher=Wiley-Blackwell|isbn=978-1-4443-9395-8|access-date=2021-07-30|last2=Kodaman|first2=Pinar H.}}</ref> During a HSG procedure, the uterus is injected with contrast dye, which can be observed via fluoroscopy.<ref>{{Cite journal|date=2009-09-01|title=Hysterosalpingography: Technique and Applications|url=https://www.sciencedirect.com/science/article/abs/pii/S0363018808000200|journal=Current Problems in Diagnostic Radiology|language=en|volume=38|issue=5|pages=199–205|doi=10.1067/j.cpradiol.2008.02.003|issn=0363-0188}}</ref> The test results are normal if the X-ray shows a normal uterine shape, and the dye spills out from the ends of the fallopian tubes. There may be a problem if the dye shows an abnormally shaped uterus and the dye does not freely flow from the fallopian tubes.<ref>{{Cite journal|last=Simpson|first=William L.|last2=Beitia|first2=Laura G.|last3=Mester|first3=Jolinda|date=2006|title=Hysterosalpingography: A Reemerging Study|url=https://pubs.rsna.org/doi/10.1148/rg.262055109|journal=RadioGraphics|volume=26|issue=2|pages=419–431|doi=10.1148/rg.262055109|issn=0271-5333}}</ref> While this method can be completed relatively quickly since anesthesia is not needed, there is a risk of tubal spasm, which typically occurs during injection of the contrast dye due to increased pressure. <ref name=":5" /> With tubal spasm, the fallopian tubes can close, and this may give a false diagnosis of tubal occlusion. <ref name=":5" />


Sonohysterosalpinography is another procedure done using varying contrast medium to assess patency. One method is to introduce air into the uterine cavity and observe air bubbles in the fallopian tubes. <ref name=":1" /> The second method is to use distilled water or normal saline to observe the movement of fluid through the tubes. <ref name=":6">{{Cite journal|last=Panchal|first=Sonal|last2=Nagori|first2=Chaitanya|date=2014|title=Imaging techniques for assessment of tubal status|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018793/|journal=Journal of Human Reproductive Sciences|volume=7|issue=1|pages=2–12|doi=10.4103/0974-1208.130797|issn=0974-1208|pmc=4018793|pmid=24829524}}</ref> The last method involves combining air with saline to make it easier to see on ultrasound. <ref name=":6" />
Sonohysterosalpinography is another procedure done using varying contrast medium to assess patency. One method is to introduce air into the uterine cavity and observe air bubbles in the fallopian tubes. <ref name=":1" /> The second method is to use distilled water or normal saline to observe the movement of fluid through the tubes. <ref name=":6">{{Cite journal|last=Panchal|first=Sonal|last2=Nagori|first2=Chaitanya|date=2014|title=Imaging techniques for assessment of tubal status|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018793/|journal=Journal of Human Reproductive Sciences|volume=7|issue=1|pages=2–12|doi=10.4103/0974-1208.130797|issn=0974-1208|pmc=4018793|pmid=24829524}}</ref> The last method involves combining air with saline to make it easier to see on ultrasound. <ref name=":6" />

Revision as of 23:10, 1 August 2021

Chromopertubation is a method for the study of fallopian tube patency, a state of being open or unobstructed, for suspected infertility in women caused by fallopian tube obstruction. It is currently one of the standard procedures in this field.[1] In most cases, chromopertubation is performed to assess and determine the cause of someone's difficulties in getting pregnant. [2]

Procedure

Chromopertubation is a medical procedure in which blue dye is injected into the fallopian tubes to detect if there are any blockages. It is performed as a laparoscopy, a minimally invasive procedure with small incisions. A laparoscope, a long, fine instrument is inserted into the abdomen close to the umbilicus in order to see one's internal organs, in particular the fallopian tubes. There is also a device called a uterine manipulator that is placed through the vagina and cervix into the uterus.[3] As part of a laparoscopy, a blue dye solution (methylene blue or indigo carmine) is introduced into the uterine cavity. The dye solution will help determine if the fallopian tubes are open or blocked. If the fallopian tubes are open, the dye solution will enter and drain out into the pelvic cavity through the ends of the tubes. A tubular blockage is suspected if the fluid does not enter into the fallopian tubes or enters, but does not drain out of the fallopian tubes. [4] Blocked fallopian tubes can be a factor of infertility in which the fallopian tubes will not allow the egg and sperm to meet.

Advantages

Chromopertubation with laparoscopy is considered the "gold standard" to evaluate tubal patency.[5] It is the most accurate way to look at the abdominal cavity and other pelvic structures. Other problems that can be viewed during the procedure are malformations of the uterus, adhesions, blocked fallopian tubes or endometriosis. Slight adhesions inside a fallopian tube can be observed by the flow of dye solution and removed during the procedure.[5] Other findings, such as endometriotic lesions, may also be treated as part of laparoscopy.[5] Studies have shown that tubal flushing with a contrast medium could be used as a treatment for infertility as it was noted that many women were able to conceive within the first 3-6 months after the procedure was done. [6] Based on available evidence, tubal flushing with an oil-based contrast medium may increase the chance of clinical pregnancy, while the benefit of a water-soluble contrast medium in tubal flushing is unclear.[6] If laparoscopy with chromopertubation shows a mild blockage within one or both of the fallopian tubes, surgical reconstruction of the tubes can be performed.[7]

Disadvantages

Chromopertubation is done during laparoscopy, which requires general anesthesia. General anesthesia is usually safe, but problems, such as pain, nausea and vomiting, sore throat, and muscle aches may arise. Around the small incisions on the abdomen, there will be some pain and may also be some bruising around the lower abdomen.[8] There is a risk of procedural complications, such as bleeding or abdominal injury, which may result in longer recovery times.[5] Also, some bleeding in the vagina can be from the placement of the instrument during the dye test. Minor bleeds should stop within a couple of days.[9] Furthermore, the insertion of the instruments into the abdomen can potentially injure major abdominal organs, such as the small and large intestines, bladder, and blood vessels. Previous surgeries or procedures, such as Caesarean surgery, ovarian cyst removal, bladder surgery, or appendix removal can increase the chances of abdominal organs damage during chromopertubation. Difficulties with the insertion of the laparoscope can rarely happen. These difficulties usually occur in those who are overweight or who have had previous abdomen scarring from another procedure. If the instrument cannot be inserted into the abdominal cavity, chromopertubation will not be recommended. Instead, alternative methods of checking the fallopian tubes will be taken into consideration.

Allergic-like reactions and methemoglobenemia have been documented after the use of methylene blue dye in laproscopic chromopertubation. [10] These reported symptoms vary from blue discoloration of body fluids to anaphylactic shock.[11] Methemoglobinemia is a condition in which the iron of heme is oxidized to the ferric (Fe3+) form, potentially resulting in various levels of cyanosis.[12] High levels of methylene blue dye can also result in hemolysis. In particular, methylene blue dye should be avoided in people using serotonergic drugs, such as selective serotonin reuptake inhibitors (SSRIs) and antidepressants, since this interaction may cause fatal serotonergic syndrome.[13] Serotonergic syndrome presents as changes in mental status, in addition to overactivation of the neuromuscular and autonomic systems.[14] Common symptoms of fatal serotonergic syndrome include high grade fevers, seizures, and tremors.[15] Other reported features of fatal serotonergic syndrome include hyperthermia, respiratory failure, rhabdomyolysis, metabolic acidosis, myoglobinuria, renal failure, coma, and death.[14] Because laparoscopy with chromopertubation is a more time intensive diagnostic procedure, if no significant findings are found, then there may be a delay in starting other infertility therapies.[5]

Alternatives

There are also other procedures to determine whether or not someone's fallopian tubes are blocked. While laparoscopy with chromopertubation is considered to be the first-line practice for the diagnosis of tubal occlusion, it is generally a more expensive and invasive procedure, and it is recommended for women with suspected comorbidities (tubal occlusion and another pelvic pathology).[16]Hysterosalpingography (HSG) is a different diagnostic procedure done initially with an X-ray examination performed by a radiologist. While the main purpose of HSG is to evaluate the fallopian tubes, HSG does not provide an explanation for why the tubes are blocked. The examination should be scheduled between 7-12 days of a women's menstrual cycle.[17] Radiographic dye is used to assess the uterine cavity and fallopian tubes. It can be used to study suspected infertility as well as tubal disease. [18] During a HSG procedure, the uterus is injected with contrast dye, which can be observed via fluoroscopy.[19] The test results are normal if the X-ray shows a normal uterine shape, and the dye spills out from the ends of the fallopian tubes. There may be a problem if the dye shows an abnormally shaped uterus and the dye does not freely flow from the fallopian tubes.[20] While this method can be completed relatively quickly since anesthesia is not needed, there is a risk of tubal spasm, which typically occurs during injection of the contrast dye due to increased pressure. [18] With tubal spasm, the fallopian tubes can close, and this may give a false diagnosis of tubal occlusion. [18]

Sonohysterosalpinography is another procedure done using varying contrast medium to assess patency. One method is to introduce air into the uterine cavity and observe air bubbles in the fallopian tubes. [12] The second method is to use distilled water or normal saline to observe the movement of fluid through the tubes. [21] The last method involves combining air with saline to make it easier to see on ultrasound. [21]

Nowadays, hystero contrast sonography (HyCoSy) is an alternative to chromopertubation. This is done using transvaginal ultrasound, and therefore is less invasive than chromopertubation. Using a contrast agent, the ultrasound image can be used to detect whether and how the contrast medium flows through the fallopian tubes. The contrast medium used is often a manufactured product with microbubbles or a gel-based product that creates foam when passing through the tubes. [21]

Gallery

  • Dye visible in the fallopian tube
    Dye visible in the fallopian tube
  • Blue dye filling in the pouch of Douglas
    Blue dye filling in the pouch of Douglas
  • Blue dye exiting from fallopian tube
    Blue dye exiting from fallopian tube
  • Laparoscopy of the uterus and fallopian tubes
    Laparoscopy of the uterus and fallopian tubes

References

  1. ^ Essential reproductive medicine. Carr, Bruce R., Blackwell, Richard E., Azziz, Ricardo. New York: McGraw-Hill, Medical Pub. Div. 2005. ISBN 0071409939. OCLC 53955548.{{cite book}}: CS1 maint: others (link)
  2. ^ Petri, Elke; Berlit, Sebastian; Sütterlin, Marc; Hornemann, Amadeus (2013). "Chromopertubation – Presentation of a Modification of the Standard Technique". Anticancer Research. 33 (4): 1591–1594. ISSN 0250-7005. PMID 23564802.
  3. ^ "Laparoscopy and Chromotubation (Dye Test) – East Sussex Healthcare NHS Trust". Retrieved 2021-07-29.
  4. ^ "Laparoscopy and Chromotubation (Dye Test) – East Sussex Healthcare NHS Trust". Retrieved 2021-07-29.{{cite web}}: CS1 maint: url-status (link)
  5. ^ a b c d e Saunders, Rhiana D.; Shwayder, James M.; Nakajima, Steven T. (2011). "Current methods of tubal patency assessment". Fertility and Sterility. 95 (7): 2171–2179. doi:10.1016/j.fertnstert.2011.02.054. ISSN 0015-0282.
  6. ^ a b Wang, Rui; Watson, Andrew; Johnson, Neil; Cheung, Karen; Fitzgerald, Cheryl; Mol, Ben Willem J; Mohiyiddeen, Lamiya (2020). "Tubal flushing for subfertility". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003718.pub5. ISSN 1465-1858.
  7. ^ Thurston, Layla; Abbara, Ali; Dhillo, Waljit S. (2019). "Investigation and management of subfertility". Journal of Clinical Pathology. 72 (9): 579–587. doi:10.1136/jclinpath-2018-205579. ISSN 0021-9746. PMID 31296604.
  8. ^ "Laparoscopy and Chromotubation (Dye Test) – East Sussex Healthcare NHS Trust". Retrieved 2021-07-30.{{cite web}}: CS1 maint: url-status (link)
  9. ^ "Laparoscopy and Chromotubation (Dye Test) – East Sussex Healthcare NHS Trust". Retrieved 2021-07-30.
  10. ^ Akazawa, Munetoshi; Wu, Yi-Hua; Liu, Wei-Min (2019). "Allergy-like reactions to methylene blue following laparoscopic chromopertubation: A systematic review of the literature". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 238: 58–62. doi:10.1016/j.ejogrb.2019.03.019. ISSN 1872-7654. PMID 31112852.
  11. ^ Uçar, Duygy; Artunç Ülkümen, Burcu (2021). "A Rare Complication: Blue Urine Developed After Laparoscopic Chromopertubation". Forbes Journal of Medicine. doi:10.5222/forbes.2021.19483.
  12. ^ a b Rehman, Habib Ur (2001). "Methemoglobinemia". Western Journal of Medicine. 175 (3): 193–196. ISSN 0093-0415. PMC 1071541. PMID 11527852.
  13. ^ Food and Drug Administration (2019). "FDA Drug Safety Communication: Serious CNS reactions possible when methylene blue is given to patients taking certain psychiatric medications". FDA.
  14. ^ a b Volpi-Abadie, Jacqueline; Kaye, Adam M.; Kaye, Alan David (2013). "Serotonin syndrome". The Ochsner Journal. 13 (4): 533–540. ISSN 1524-5012. PMC 3865832. PMID 24358002.
  15. ^ Prakash, Sanjay; Rathore, Chaturbhuj; Rana, Kaushik; Prakash, Anurag (2021). "Fatal serotonin syndrome: a systematic review of 56 cases in the literature". Clinical Toxicology (Philadelphia, Pa.). 59 (2): 89–100. doi:10.1080/15563650.2020.1839662. ISSN 1556-9519. PMID 33196298.
  16. ^ Maheux-Lacroix, Sarah; Boutin, Amélie; Moore, Lynne; Bergeron, Marie-Ève; Bujold, Emmanuel; Laberge, Philippe Y.; Lemyre, Madeleine; Dodin, Sylvie (2013-07-04). "Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review protocol". Systematic Reviews. 2: 50. doi:10.1186/2046-4053-2-50. ISSN 2046-4053. PMC 3703290. PMID 23826862.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  17. ^ Simpson, William L.; Beitia, Laura G.; Mester, Jolinda (2006). "Hysterosalpingography: A Reemerging Study". RadioGraphics. 26 (2): 419–431. doi:10.1148/rg.262055109. ISSN 0271-5333.
  18. ^ a b c Kallen, Amanda N.; Kodaman, Pinar H. (2011-03-08), "Diagnosis and Management of Tubal Factor Infertility", Infertility, Oxford, UK: Wiley-Blackwell, pp. 18–25, ISBN 978-1-4443-9395-8, retrieved 2021-07-30
  19. ^ "Hysterosalpingography: Technique and Applications". Current Problems in Diagnostic Radiology. 38 (5): 199–205. 2009-09-01. doi:10.1067/j.cpradiol.2008.02.003. ISSN 0363-0188.
  20. ^ Simpson, William L.; Beitia, Laura G.; Mester, Jolinda (2006). "Hysterosalpingography: A Reemerging Study". RadioGraphics. 26 (2): 419–431. doi:10.1148/rg.262055109. ISSN 0271-5333.
  21. ^ a b c Panchal, Sonal; Nagori, Chaitanya (2014). "Imaging techniques for assessment of tubal status". Journal of Human Reproductive Sciences. 7 (1): 2–12. doi:10.4103/0974-1208.130797. ISSN 0974-1208. PMC 4018793. PMID 24829524.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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