••• Chapter 54^ Infertility^545
❍ Is chromotubation done with indigo carmine or methylene blue?
Indigo carmine is the recommended prophylactic treatment as methylene blue can cause methemoglobinemia in
patients with G6PD deficiency. Also, the patient should be treated with doxycycline 100 mg orally twice daily for
5 days.
❍ When is a chlamydial antibody test used?
In patients with a normal HSG, a positive chlamydial antibody test may be useful in unexplained infertility to
detect tubal dysfunction.
❍ How is distal tubal occlusive disease diagnosed?
Laparoscopy is the gold standard for diagnosis.
❍ What is the percentage of patients that regret having a tubal ligation?
7% and 1% request reversal.
❍ What is the percentage of patients who request reversal but have irreparable tubes?
<5%.
❍ Which type of tubal ligation has the greatest and the least success with reversal?
Reversal has greatest success with pins or clips in patients with no other infertility factors.
Low success with cauterized tubes.
❍ What is the risk of ectopic pregnancy after tubal reversal?
1% to 7%. Ectopic rates are higher with isthmic-ampullary anastomoses compared with isthmic-isthmic
anastomoses.
❍ What is the process of separating adherent fimbriae?
Fimbriolysis.
❍ What is the process of correcting the phimotic or partially obstructed fimbriated end of tube?
Fimbrioplasty.
❍ What is neosalpingostomy?
Surgically reopening an obstructed tube with the understanding that patency may be restored but function may
not and if pregnancy does not occur in 1 year, patient will need IVF.
❍ Does performing a salpingectomy in the presence of large hydrosalpinges increase the success rate of IVF?
Yes, there is a twofold increase in success with IVF.
❍ How is proximal tubal occlusive disease diagnosed?
HSG, one-third of all obstructions found on HSG located at the proximal tube but 20% to 40% of the time it is a
false-negative result, and repeat HSG often reveals patency.