155 Cochrane study protocol: Accuracy of tubal patency tests 7 BACKGROUND Infertility, defined as the failure to conceive within 12 months of regular unprotected sexual intercourse, occurs in at least 12% of the couples who wish to conceive (1, 2). Around 18% to 33% of couples with infertility present with tuboperitoneal pathologies such as blocked or damaged Fallopian tubes (3-5). As the Fallopian tubes are essential for transportation of the spermatozoa, the ovum and the embryo (6), bilateral occluded tubes exclude the chance of natural pregnancy. Therefore, bilateral tubal occlusion formed the basis of the development of in vitro fertilization (IVF) and was the earliest indication for IVF (7). Most diagnostic protocols for fertility assessment include a test to rule out tubal occlusion (8, 9). During such tubal patency tests, a contrast agent is flushed into the uterus and through the Fallopian tubes, visualizing tubal patency. Diagnostic laparoscopy with methylene blue dye tubal patency testing, also known as chromopertubation, is generally accepted as the reference standard (9). However, due to its invasiveness and costs, alternative less invasive tests have been carried out as replacements. These visual tubal patency tests have evolved alongside the development of radiography, ultrasonography and laparoscopy, including hysterosalpingography (HSG), sono‐hysterosalpingography (sono‐HSG), magnetic resonance hysterosalpingography (MR‐HSG), and outpatient transvaginal hydrolaparoscopy (THL). The choice of these visual tubal patency tests varies in different settings. Visual tubal patency tests can be used to diagnose tubal, uterine and other pelvic conditions. The most important tubal conditions are bilateral tubal occlusion, unilateral tubal occlusion and hydrosalpinx. The diagnoses of these conditions will directly guide clinical management, so they will be the focus of this Cochrane Review. Target condition being diagnosed Target conditions of interest are tubal occlusion and hydrosalpinx. 1. Tubal occlusion: women with untreated bilateral occlusion have no chance of a natural pregnancy, as there is no way for the ovum and spermatozoa to meet, and these women can benefit from early IVF (7). Therefore, women diagnosed with bilateral tubal occlusion are mostly offered IVF directly, although IVF is not available to all couples worldwide due to differences in health care systems and reimbursements. IVF can be preceded by laparoscopic surgery to optimize pelvic anatomy. Management in women with unilateral tubal blockage is more diverse, as in these women the patent Fallopian tube still facilitates transport of the ovum,
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