الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infertility is a universal phenomenon which has psychological impact on the couples. It is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
There are different causes of infertility that should be outlined;
• Male factor which may be in the form of oligospermia, azospermia, asthenospermia or teratospermia.
• Female factor infertility which is mainly due to ovulatory dysfunction or tubal factor, less commonly uterine and cervical factors and peritoneal factor (adhesions or endometriosis).
• It may be unexplained infertility.
Evaluation of infertile couples should include;
• Male factor: Semen analysis; Computer assisted semen analysis (CASA).
• Female factor: assessment of ovarian reserve (AFC, AMH), tubal patency (HSG, ultrasound or DL) and uterine factor (HSG or hysteroscopy).
Tubal factor is responsible for about 20- 30% of cases of female infertility. Pelvic inflammatory disease (PID) is a leading cause of tubal factor infertility as a result of STDs (Chlamydia infection). The fallopian tubes may also be occluded by septic abortion and intra-abdominal infections including appendicitis and peritonitis. The evaluation of tubal patency represents a key step in assessment of infertile women. That could be assessed by using either non-surgical techniques such as hystero-salpingography (HSG) and ultrasound based techniques or surgical technique such as diagnostic laparoscopy (Chromopertubation).
Hysterosalpingography (HSG) is considered the initial modality for evaluation of tubal patency. However, it has disadvantages like radiation exposure, pain, pelvic infections in pathological tube and allergic reactions to contrast medium. It may give false negative results due to tubal spasm and cannot diagnose presence of pelvic adhesions so those cases should be further investigated by laparoscopy which is considered the gold standard in assessment of tuboperitoneal factor.
Hysteroscopy is considered the gold standard modality for evaluation of uterine cavity and endometrial pathology but it cannot assess fallopian tubes.
We aimed at our study to use a new, simple, reliable, non invasive technique , to be well tolerated by the patients and avoid disadvantages of HSG to assess patency of fallopian tubes by introduction of fluid distension medium into the fallopian tubes through the uterine cavity with detection of fluid in DP by TVS.
Our study included forty (40) infertile females who attended the infertility clinic in the period from November 2016 to April 2017 and were recommended for diagnostic laparoscopy.
HSG was used as initial modality to assess tubal patency. Office hysteroscopy was done for all cases 1-2 days after cessation of menses. Initial TVS was done to exclude presence of fluid in DP. Hysteroscopy was done using vaginoscopic approach, normal saline was used as distension medium and endometrial cavity was assessed. TVS was done again directly after hysteroscopy to assess presence of fluid in DP with any fluid was considered positive for at least one patent tube which is sufficient for either spontaneous pregnancy or intrauterine insemination. DL was done for all cases