161 Cochrane study protocol: Accuracy of tubal patency tests 7 participants (i.e. participants undergoing a visual tubal patency test without knowing about their risk of having tubal pathology). High risk incorporates all women with a positive history of pelvic inflammatory disease/chlamydia or who are CAT positive, those with extensive abdominal or tubal surgery in the past, and those with abnormalities like endometrioses/possible hydrosalpinx discovered during physical examination. Participants with low risk on tubal pathology are those with no previously‐mentioned conditions for high risk. We will include participants who have had previous tubal testing only when the outcome of this test was not used to select the participants, as we will not include studies with a two‐gate design. We will exclude participants undergoing tubal testing after refertilization (surgery to undo a tubal sterilization). Index tests We will include the following types of index texts. • HSG, with either oil‐based or water‐based contrast. • MR‐HSG, including all techniques/MR‐protocols or contrast media used. • THL, transvaginal endoscopy or fertiloscopy, conducted with reusable instruments or disposable trocars. • Sono‐HSG (including HyFoSy and HyCoSy), used with commercially available foam, saline, saline and air or galactose, or combinations of these. We will exclude studies conducted with contrast that is no longer available (Echovist; galactose microparticles; Bayer Schering Pharma AG, Berlin, Germany). Furthermore, we will include studies that use two‐ or three‐dimensional modality, with or without colour doppler. Target conditions We will consider tubal occlusion as a dichotomous diagnosis for all tests, i.e. occluded or patent (not occluded). As the unit of analysis will be at the individual level, due to its clinical importance, we will treat bilateral tubal occlusion and at least one‐sided tubal occlusion as two separate conditions, instead of a threshold. Similarly, we will also consider hydrosalpinx as a dichotomous diagnosis. Reference standards Laparoscopy with methylene blue dye tubal patency testing is the reference standard. All participants in the included studies should undergo this reference standard to avoid verification bias.
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