Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization

The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.