Hysteroscopic Evaluation of Tubal Patency Using Bubble Sign in Comparison to Diagnostic Laparoscopy

Background: Tubal patency assessment is vital in infertility evaluation. The bubble sign observed during hysteroscopy has emerged as a potential indicator of tubal patency, offering a less invasive alternative to diagnostic laparoscopy. Aim of the work: This study aimed to compare the efficacy of hysteroscopy utilizing the bubble sign with diagnostic laparoscopy in evaluating tubal patency. Patients and Methods: A prospective study was conducted on 100 patients undergoing infertility evaluation. Hysteroscopy with the observation of the bubble sign and diagnostic laparoscopy were performed to assess tubal patency. Sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] of the bubble sign in comparison to laparoscopy were calculated. Results: Positive predictive value of hysteroscopy was estimated to be 94.2% [87.6%-99.9%] and negative predictive value was estimated to be 87.5% [81.4%-92.8%]. When the laparoscopic method was used as a standard, the accuracy of the hysteroscopic method was 91.5% [85.1%-97%] overall. Conclusion: Hysteroscopic evaluation using the bubble sign proved to be a reliable method for assessing tubal patency, comparable to diagnostic laparoscopy. The non-invasive nature of hysteroscopy and its accuracy in determining tubal patency make it a promising tool in infertility investigations, potentially reducing the need for more invasive procedures.