Influence of Discordant Tubal Blockage on Clinical Pregnancy Rates: A Retrospective Cohort Study

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Methods: This retrospective cohort study included 78 infertile women, who underwent tubal patency assessment between January 2016 and June 2024 at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna. Tubal patency was assessed twice. Initial assessment of tubal patency had been performed by hysterosalpingo-contrast sonography (HyCoSy) or hysterosalpingography (HSG) and had suggested bilateral occlusion in the DTB group ( n= 38) and bilateral patency in controls ( n= 38). Bilateral patency was found in all patients during subsequent laparoscopic chromopertubation. The primary outcome parameter was the clinical pregnancy rate within six months. Results: The basic patient characteristics showed no significant differences between the DTB and the control groups. Clinical pregnancy was found in 47.4% (18/38) of control patients (patent tubes) and in 21.1% (8/38) of DTB patients ( p= 0.029) over six months of follow-up. In a multivariate model, younger age (odds ratio (OR), 0.856, p= 0.013) and bilateral patency (OR 4.210, p= 0.010) in both examinations (control group) were associated with higher clinical pregnancy rates. Conclusion: DTB reflects lower fecundity even when subsequent patency is demonstrated. Tubal patency following prior occlusion should not be grounds for complete reassurance, and given lower odds of pregnancy, such patients may be warranted a faster transition to ART given the decreased efficacy of other methods. Fallopian tubes chromopertubation laparoscopy female infertility pregnancy rate discordant tubal blockage Key message Clinical pregnancy was found in 18 (47.4%, n=38) women with patent fallopian tubes and in 8 (21.1%, n=38) women with discordant tubal blockage after 6 months of follow-up. Introduction In 2023 the WHO acknowledged that one in six reproductive adults will experience infertility [ 1 ]. This high prevalence reflects its relevance and speaks to the need for effective procreative care. Tubal factor infertility (TFI) plays a role in 25% of infertile women according to recent data [ 2 ], which is in line with the prevalence of 25–30% reported by a study from 1989 [ 3 ]. Common methods of assessing tubal patency include hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), laparoscopic chromopertubation, and, increasingly, hysteroscopic assessment. HSG and HyCoSy are less invasive techniques since no surgery is required. Laparoscopy with chromopertubation is considered the gold standard, but given the typical effectiveness of screening methods, it is primarily performed for superimposed additional indications. The impact of contradictory results between screening and diagnostic tests on fecundity was previously assessed by Gleicher et al., in 1993, leaving data on this issue sparse. Though typically described as tubal spasm, technically this is primarily myometrial contraction around the tube, even though the tube does have muscle [ 6 ]. Such spasms have been documented during both HSG [ 7 ] and laparoscopic chromopertubation [ 8 ]. Notably, pain with dilation and technique can amplify myometrial spasm, which explains why patients with pelvic pathology (adhesions, endometriosis) are more susceptible to tenderness which can drive spasm even with gentle technique. Moreover, chlamydia cervicitis structuring the cervix, coupled with tubal stricture associated with previous infection, can make for more painful introduction of media, given that entry requires high pressure due to difficult egression (through occlusion of outflow). This means that while treatment can have false positives, previous infection can increase the risk for a spasm, suggesting full occlusion which may not be present, but also being a proxy for intraluminal damage. To enlarge our study population, we decided to compare patients with patent tubes according to HSG/HyCoSy and chromopertubation with patients showing signs for DTB after HSG/HyCoSy and chromopertubation. Doctors at the Medical University of Vienna reported cases with subjectively elevated flushing pressures during chromopertubation. This phenomenon was also described by a study in 2004 [ 9 ], which strengthens the significance of elevated flushing pressure, probably being associated with poor pregnancy rates. Recent reliable data remains limited, even though discordance between screening and diagnostic testing remains an important issue. Our retrospective study further explores how discordant findings impact fecundity. Methods Patient population This retrospective study included 78 infertile women, ages 18 to 40, who underwent tubal patency testing via HSG or HyCoSy, followed by laparoscopic chromopertubation at the Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria, between January 2016 and June 2024. In women of Group A, HSG or HyCoSy demonstrated bilateral tubal patency, which was confirmed by laparoscopic chromopertubation subsequently. In women of Group B, contradictory results were identified: bilateral tubal occlusion had been diagnosed using HSG or HyCoSy, whereas subsequent laparoscopic chromopertubation showed bilateral tubal patency. The following exclusion criteria were applied: uni- or bilateral hydrosalpinx; uterine fibroids; polycystic ovary syndrome (PCOS); oligo- or amenorrhea, shortened menstrual cycles < 24 days; ASRM stage 3 and 4 endometriosis; previous unilateral or bilateral salpingectomy; planned intrauterine insemination or IVF or ovarian stimulation/ovulation induction; women with partners with abnormal semen analysis results. Notably, all women were advised to start trying to conceive subsequent to the operation. The study was approved by the Ethics Committee of the Medical University of Vienna on July 7th, 2023. (IRB number: 1395/2023). Sample size analysis Assuming an absolute difference of 30 percent between the two groups for clinical pregnancy rates within 6 months after the operation (40% in Group A, 10% in Group B), a sample size of 38 patients per group is necessary to achieve statistical significance at p = 0.05, with a power of 80% after correction of Fleiss. Parameters analyzed Data acquisition was conducted using AKIM Software (version 7, SAP Software Solutions Austria, Vienna, Austria; SAP-based patient management system at the Medical University of Vienna). The main outcome parameter was clinical pregnancy after six months of regular, unprotected sexual intercourse. In addition, we also included the following data: results of tubal patency testing; age at surgery; body mass index (BMI); infertility type (primary versus secondary); the indication for laparoscopy (preliminary concern for tubal occlusion, suspicion of endometriosis, presence of ovarian cysts, unexplained infertility); and whether endometriosis was diagnosed using laparoscopy. [ 2 ] Assessment of tubal patency The following techniques were used to assess tubal patency for the patients included in this study: HSG and HyCoSy were performed by experienced clinicians according to international standards [ 10 , 11 ]. Laparoscopic chromopertubation was carried out as reported previously [ 2 , 12 , 13 ]: The surgical assessment of tubal patency was performed under general anesthesia, and either executed or supervised by experienced specialists in infertility surgery. For this procedure, a Spackman uterine manipulator with clamp fixation and a rubber cone (18 mm diameter) (reference number 1264; WISAPR Medical Technology GmbH, Brunnthal/Hofolding, Brunnthal, Germany) was inserted through the cervix, positioning the tip one centimeter from the uterine fundus. Chromopertubation was conducted using a syringe containing 50 mL of a diluted indigo carmine blue dye solution (Amino AG, Gebenstorf, Switzerland) to assess tubal patency. All women included with endometriosis revealed superficial peritoneal lesions only, and endometriosis was removed completely in all cases. Statistical analysis Statistical analyses were performed with the SPSS software package, version 28.0.1.0 (SPSS, Chicago). Numerical variables are reported as median and interquartile ranges (IQR), and categorical variables as numbers (frequency). Groups were compared using analyses of variances (ANOVA) for numerical parameters, and Fisher’s exact tests for categorical parameters. To test factors associated with the chance for a clinical pregnancy, univariable ,followed by multivariable, binary logistic regression models were used. Only parameters which were statistically significant in the univariable approach were entered into the multivariable model. This analysis used odds ratios (OR) with 95% confidence intervals (95% CI). Differences were considered significant if p < 0.05. Results An overview of basic patient characteristics, which also include the indications for laparoscopy and the final diagnosis of endometriosis, is provided for both study groups in Table 1 . No significant differences were found. Notably, endometriosis was detected laparoscopically in 44.7% of Group A patients and 42.1% of Group B patients. Table 1 Basic characteristics of group A and group B patients . Group A (n = 38) Group B (n = 38) p Age (years) 1 31.0 (28.5;33.3) 31.4 (22.8;33.2) 0.662 BMI (kg/m 2 ) 1 22.7 (19.9;26.8) 22.5 (20.0;26.4) 0.776 Primary infertility 2 28 (73.7) 31 (81.6) 0.583 Indications for laparoscopy 3 Preliminary concern for tubal occlusion 2 0 38 (100) < 0.001 Suspicion of endometriosis 2 20 (52.6) 20 (52.6) 1.000 Ovarian cyst 2 8 (21.1) 15 (39.5) 0.133 Unexplained infertility 10 (26.3) 0 0.025 Final diagnosis of endometriosis 2 17 (44.7) 16 (42.1) 1.000 Data are provided as 1 median (IQR) for numeric parameters or 2 n (%) for categorical parameters, 3 Multiple mentions possible After six months of regular menstrual cycles, clinical pregnancy was found more often in women of Group A (bilateral tubal patency in both HSG/HyCoSy and chromopertubation: 18/38, 47.4%) than in Group B patients (bilateral tubal occlusion in HSG/HyCoSy followed by bilateral tubal patency in chromopertubation: 8/38, 21.1%; p = 0.029). Predictive factors for clinical pregnancy were tested in a univariate, followed by a multivariate, binary logistic regression model (Table 2 ). In both models, a lower age (OR 0.877, p = 0.024 and OR 0.856, p = 0.013, respectively) and Group A (OR 3.375, p = 0.018 and OR 4.210, p = 0.010, respectively) were significantly associated with a higher chance for clinical pregnancy. Table 2 Predictive factors for clinical pregnancy: results of a univariable flowed by a multivariable regression model . Clinical pregnancy ( n = 26) No clinical pregnancy ( n = 50) Univariable model Multivariable model OR (95% CI) p OR (95% CI) p Age (years) 1 29.2 (26.8;31.6) 32.0 (28.6;34.0) 0.877 (0.783;0.983) 0.024 0.856 (0.758;0.967) 0.013 BMI (kg/m 2 ) 1 22.7 (19.3;27.4) 22.5 (20.5;26.2) 1.016 (0.915;1.128) 0.770 - - Primary infertility 2 21 (80.8) 38 (76.0) 1.326 (0.411;4.280) 0.637 - - Endometriosis 2 9 (34.6) 24 (48.0) 0.574 (0.215;1.528) 0.266 - - Group A 2 18 (69.2) 20 (40.0) 3.375 (1.233;9.237) 0.018 4.210 (1.412;12.556) 0.010 Data are provided as 1 median (IQR) for numeric parameters or 2 n (%) for categorical parameters Discussion These research findings fundamentally call in to question the widespread practice of telling patients that they are fine and it was simply tubal spasm if they have tubal occlusion at screening, followed by patency at laparoscopy. This study found significant differences between the two cohorts in the likelihood of achieving natural pregnancy after a 6-month follow-up period. Patients with consistently patent fallopian tubes in both preoperative HyCoSy/HSG and laparoscopic chromopertubation yielded higher pregnancy rates compared to patients with DTB. While this finding may seem intuitive, it has not been thoroughly examined in previous research. DTB may represent a substantially compromised form of tubal patency, negatively affecting fertility. The impact of DTB on pregnancy rates was particularly striking, as women with patent tubes had a pregnancy rate of 47.4% (18/38), more than twice as high as the 21.1% (8/38) observed in the DTB group. Though the magnitude of difference with short-term follow-up is striking, in some ways the findings should not be. The concept of tubal disease as “patent” or “non-patent” is reductive and oversimplifying. Rather than as a pipe, as so many describe the Fallopian tubes, a conveyor belt is a more apt analogy given ciliary function. We have previously shown that inflammatory states such as endometritis increase intraluminal damage, as well as that up to 95% of occlusion is proximal or full length and not just purely distal [ 12 ]. Cannulation and more aggressive measures cannot restore ciliary function when repairing intrinsic and not just extrinsic damage (peritubal adhesions and phimosis). Moreover, if under anesthesia at laparoscopy one can use greater supraphysiologic pressures for chromopertubation than a conscious patient would tolerate with a screening test, technical patency does not necessarily reflect a normal tube or normal fecundity. Accordingly, we need to shift the paradigm for when occlusion is suggested at HSG or HyCoSy from one of open or closed, instead to one of a proxy for the degree of risk of tubal inefficiency lowering fecundity with spontaneous or non-ART-assisted conception. Another factor significantly associated with lower pregnancy rates was younger age. Younger women had a higher chance of becoming pregnant within six months of follow-up. The median age of women who conceived was 29.2 years, compared to 32.0 years in those who did not. In a univariable model, the p-value was 0.024, while in a multivariable model, it was 0.013, indicating even greater relevance. The essence of this finding is not new, but it is reassuring that the study reaffirmed core biologic principles, where earlier in the reproductive years there is higher fecundity, consistent with a lower probability of age-associated aneuploidy [ 14 , 15 ]. A key objective of our study was to compare our findings with those of Gleicher et al. (1993), whose study served as the motivation for our retrospective analysis. Gleicher reported an absolute 10 percentage point difference in pregnancy rates (39% vs. 29%) between their study groups [ 16 ]. However, beyond their having a longer duration of follow-up, a methodological distinction must be made between the two studies. In our research, the control group consisted of women with consistently patent tubes, whereas Gleicher’s control group included patients who had undergone tubal cannulation after occlusion. This calls attention to two core issues relating to tubal “occlusion” on screening and cannulation. The first is that cannulation does not “repair the hair”, where ciliary damage will persist even with successful cannulation. This likely explains why there was only a subtle increase in fecundity when cannulation was successfully achieved. Second, the yield of cannulation is often less dependent on inherent technique, but rather on the probability of inaccuracy with the initial screening test. Other research showing high success with cannulation was more likely attributable to higher rates of spasm, through REI fellows performing HSG with suboptimal technique, where subsequent fertility was through normal tubes and not improved through cannulation per se (Parry, personal communication). There are several core reasons why misleading occlusion at HSG may be associated with lower fecundity despite technical patency. As noted before, patency does not automatically translate to ciliary function. Moreover, pelvic sensitivity to pain may reflect a predisposition to inflammatory states, such as endometriosis, pelvic inflammatory disease-associated adhesions, endometritis, adhesions after ruptured appendicitis, and more. Accordingly, pain-induced uterine spasm occluding the tubes may be a proxy for pathology, independently creating risk for subfertility. Moreover, though contrast dye and air bubbles can fit through a narrow tubal lumen, if there is stricture from previous damage, this could require more force to demonstrate patency, resulting in pain that, in turn, results in spasm again creating a false positive suggestive of total occlusion instead of partial. All of these considerations call in to question ultimately the yield of diagnostic laparoscopy when there is occlusion suggested by screening tests. Diagnostic laparoscopy may demonstrate technical patency, which matters, but if fecundity is greatly reduced even with patency, given the costs and surgical delays inherent to laparoscopy, some patients may get better value in using copay/deductibles towards oral medication and insemination instead of laparoscopy. In other words, for some, exploring assisted conception may offer a better balance than surgical confirmation to guide next steps. The small sample size might be seen as a study limitation. Initially, we had based our sample size calculation on the assumption of a 30 percentage point difference in pregnancy rates between the groups (40% versus 10%). While the actual difference turned out to be slightly smaller, at 26 percentage points, it still represents a substantial and clinically meaningful gap. Even in the small multivariable analysis (Table 2 ), where the data were corrected for age, DTB remained a significant predictive parameter for pregnancy, with an OR of 4.210 (IQR: 1.412–12.556; p = 0.010). Notably, many women in both groups revealed other female factors for sub-/infertility, first and foremost endometriosis and ovarian cysts (Table 1 ), which explains the moderate pregnancy rate of 47% after six months. For comparison, a North American study from 2017 reported that women aged 31–33 years generally have a 61% chance of becoming pregnant within six months and 77% within 12 months [ 17 ]. According to European data from 2003, the pregnancy rate among truly fertile couples, using natural-family-planning applications, was 88% after six months of follow-up and 98% after 12 months [ 18 ]. It can be seen as a potential limitation, as we did not compare otherwise completely healthy DTB patients with the general fertile population. Empirically, many women who have bilateral tubal blockage in HyCoSy/HSG chose to undergo IVF directly and, thus, cases of DTB are quite rare, probably due to underdiagnosis. However, given the fact that the rates of endometriosis and ovarian cysts did not differ between the two groups (Table 1 ) this should only be a minor limitation. On a related note, many with DTB in our patient base had unilateral occlusion, which still matters, and while incorporating them in to this study would have increased sample size, it would have made for less clean results. It is also noteworthy that our DTB patients presented with tubal occlusion during the initial assessment (HyCoSy/HSG), whereas tubal patency was found during the second examination (chromopertubation). Had this sequence been reversed, the findings would have been less compelling, in our view. This is because clinicians would intuitively interpret newly patent tubes following prior occlusion as a positive outcome, suggesting restored or intact tubal function. A transition from patency to occlusion, on the other hand, is more likely to raise doubts and prompt further diagnostic consideration. This is why our findings are particularly relevant: they help identify a subset of patients with tubal infertility that could otherwise be overlooked due to a seemingly favorable finding of tubal patency at the time of chromopertubation. Conclusion In conclusion, our findings provide distinct insights into the detrimental impact of DTB on female fertility and emphasize the need for further research into the underlying mechanisms of tubal dysfunction. With a 26-percentage-point difference in pregnancy rates between DTB patients and the control group, we identified clinically relevant associations. The detection of tubal patency following a previous diagnosis of occlusion should be interpreted with caution. Although natural conception can occur in women with DTB, especially in younger women, patients should be informed that they could still be in need for IVF in the future. A pregnancy rate of 21.1% over six months indicates pronounced below-average fertility [ 17 ]. Further studies are needed to uncover the causes and maybe develop potential treatments for DTB. Declarations Funding Statement : The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Author’s Contributions: Protocol/project development: J. Ott, M. Hager, S. Thieme, J. Parry, F. Bormann Data collection or management: J. Ott, S. Thieme Data analysis: J. Ott, M. Hager Data interpretation: F. Bormann, J. Parry, J. Ott, Funding acquisition: none Methodology: J. Ott, M. Hager, F. Bormann Project administration: J. Ott Validation: J. Ott, J. Parry Visualization: J. Ott Writing - original draft: F. Bormann, J. Ott Writing - review and editing: F. Bormann, M. Hager, S. Thieme, J. Parry, J. Ott Acknowledgements: Not applicable. 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Fertil Steril, 2023. 119 (5): p. 883-885. Mayer C, D.P., Hysterosalpingogram. StatPearls, 2023. Hager, M., et al., Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion. Arch Gynecol Obstet, 2021. 304 (4): p. 1073-1080. Papaioannou, S., A hypothesis for the pathogenesis and natural history of proximal tubal blockage. Hum Reprod, 2004. 19 (3): p. 481-5. Baramki, T.A., Hysterosalpingography. Fertil Steril, 2005. 83 (6): p. 1595-606. Lo Monte, G., et al., Hysterosalpingo contrast sonography (HyCoSy): let's make the point! Arch Gynecol Obstet, 2015. 291 (1): p. 19-30. Holzer, I., et al., Is Chronic Endometritis Associated with Tubal Infertility? A Prospective Cohort Study. J Minim Invasive Gynecol, 2021. 28 (11): p. 1876-1881. Ghobrial, S., et al., The Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study. J Clin Med, 2022. 11 (19). Piette, C., et al., In-vitro fertilization: influence of women's age on pregnancy rates. Hum Reprod, 1990. 5 (1): p. 56-9. Vitagliano, A., A. Paffoni, and P. Viganò, Does maternal age affect assisted reproduction technology success rates after euploid embryo transfer? A systematic review and meta-analysis. Fertility and Sterility, 2023. 120 (2): p. 251-265. Gleicher, N., et al., The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies. Hum Reprod, 1993. 8 (8): p. 1264-71. Wesselink, A.K., et al., Age and fecundability in a North American preconception cohort study. Am J Obstet Gynecol, 2017. 217 (6): p. 667.e1-667.e8. Gnoth, C., et al., Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod, 2003. 18 (9): p. 1959-66. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Sep, 2025 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 28 Jun, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviewers invited by journal 23 Jun, 2025 Editor assigned by journal 02 Jun, 2025 Submission checks completed at journal 30 May, 2025 First submitted to journal 30 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6781800","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475671164,"identity":"b8d9e519-7b3c-4159-bbbb-c48dce578d45","order_by":0,"name":"Franziska Bormann","email":"","orcid":"","institution":"Karl Landsteiner University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Franziska","middleName":"","lastName":"Bormann","suffix":""},{"id":475671165,"identity":"c8fac651-e01e-4a8d-8898-3acc3c50c6fa","order_by":1,"name":"Marlene Hager","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Marlene","middleName":"","lastName":"Hager","suffix":""},{"id":475671166,"identity":"7c53c2ff-de19-4d2a-86a6-284b7c72f362","order_by":2,"name":"Sophie Luise Thieme","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Sophie","middleName":"Luise","lastName":"Thieme","suffix":""},{"id":475671167,"identity":"54eeb158-ceba-408b-8095-78a794225d32","order_by":3,"name":"John Preston Parry","email":"","orcid":"","institution":"Parryscope and Positive Steps Fertility","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"Preston","lastName":"Parry","suffix":""},{"id":475671168,"identity":"517da715-c6a9-4447-81fd-05f17cac97a7","order_by":4,"name":"Johannes Ott","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIUlEQVRIie3RMWvCQBTA8XcEdElwDYj6FQwBaak1XyVHwC526ObQIRK4LLFdzbfIFDpGHtTl6HyggyB0FlwihVojGdLmCh073J8bLnf8eAcBUKn+YcTXK1/74qBY7t+IRmaLGslkqEIC/UKqSYgWzpeHh5ehA83n1e52Muwk64CZ2+kGWmFGDnvJw6I3rx3zMfV1JMF9OraTzZKZLn8Hk7uaKZlCFpN+22DogukVBGkiKDsvBBAAvxD7w2An50Ku01NJPhF6ArRcTgbnKRnxC0LSrCQ+Ql9AQzol4oMbg3mU6WjF89SzY0HD3H1F3eKUXfE6scLIXhts5LSas+3+mI46T+JuZ+WP2O2uEMVUQvxy0/h5U/9HZT3ZoUqlUqm+9QVLt3GhBiPPtAAAAABJRU5ErkJggg==","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":true,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Ott","suffix":""}],"badges":[],"createdAt":"2025-05-30 06:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6781800/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6781800/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-025-08186-1","type":"published","date":"2025-09-23T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92430562,"identity":"a27827e1-3fe2-460c-8df1-b03f0cafdd73","added_by":"auto","created_at":"2025-09-29 16:05:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":666909,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6781800/v1/3a76a331-742e-4bb6-aa46-4e5744ab7a51.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influence of Discordant Tubal Blockage on Clinical Pregnancy Rates: A Retrospective Cohort Study","fulltext":[{"header":"Key message ","content":"\u003cp\u003eClinical pregnancy was found in 18 (47.4%, n=38) women with patent fallopian tubes and in 8 (21.1%, n=38) women with discordant tubal blockage after 6 months of follow-up.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eIn 2023 the WHO acknowledged that one in six reproductive adults will experience infertility [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This high prevalence reflects its relevance and speaks to the need for effective procreative care. Tubal factor infertility (TFI) plays a role in 25% of infertile women according to recent data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], which is in line with the prevalence of 25\u0026ndash;30% reported by a study from 1989 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Common methods of assessing tubal patency include hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), laparoscopic chromopertubation, and, increasingly, hysteroscopic assessment. HSG and HyCoSy are less invasive techniques since no surgery is required. Laparoscopy with chromopertubation is considered the gold standard, but given the typical effectiveness of screening methods, it is primarily performed for superimposed additional indications.\u003c/p\u003e \u003cp\u003eThe impact of contradictory results between screening and diagnostic tests on fecundity was previously assessed by Gleicher et al., in 1993, leaving data on this issue sparse. Though typically described as tubal spasm, technically this is primarily myometrial contraction around the tube, even though the tube does have muscle [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Such spasms have been documented during both HSG [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and laparoscopic chromopertubation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Notably, pain with dilation and technique can amplify myometrial spasm, which explains why patients with pelvic pathology (adhesions, endometriosis) are more susceptible to tenderness which can drive spasm even with gentle technique. Moreover, chlamydia cervicitis structuring the cervix, coupled with tubal stricture associated with previous infection, can make for more painful introduction of media, given that entry requires high pressure due to difficult egression (through occlusion of outflow). This means that while treatment can have false positives, previous infection can increase the risk for a spasm, suggesting full occlusion which may not be present, but also being a proxy for intraluminal damage. To enlarge our study population, we decided to compare patients with patent tubes according to HSG/HyCoSy and chromopertubation with patients showing signs for DTB after HSG/HyCoSy and chromopertubation.\u003c/p\u003e \u003cp\u003eDoctors at the Medical University of Vienna reported cases with subjectively elevated flushing pressures during chromopertubation. This phenomenon was also described by a study in 2004 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], which strengthens the significance of elevated flushing pressure, probably being associated with poor pregnancy rates. Recent reliable data remains limited, even though discordance between screening and diagnostic testing remains an important issue. Our retrospective study further explores how discordant findings impact fecundity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient population\u003c/h2\u003e \u003cp\u003eThis retrospective study included 78 infertile women, ages 18 to 40, who underwent tubal patency testing via HSG or HyCoSy, followed by laparoscopic chromopertubation at the Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Austria, between January 2016 and June 2024. In women of Group A, HSG or HyCoSy demonstrated bilateral tubal patency, which was confirmed by laparoscopic chromopertubation subsequently. In women of Group B, contradictory results were identified: bilateral tubal occlusion had been diagnosed using HSG or HyCoSy, whereas subsequent laparoscopic chromopertubation showed bilateral tubal patency.\u003c/p\u003e \u003cp\u003eThe following exclusion criteria were applied: uni- or bilateral hydrosalpinx; uterine fibroids; polycystic ovary syndrome (PCOS); oligo- or amenorrhea, shortened menstrual cycles\u0026thinsp;\u0026lt;\u0026thinsp;24 days; ASRM stage 3 and 4 endometriosis; previous unilateral or bilateral salpingectomy; planned intrauterine insemination or IVF or ovarian stimulation/ovulation induction; women with partners with abnormal semen analysis results. Notably, all women were advised to start trying to conceive subsequent to the operation.\u003c/p\u003e \u003cp\u003eThe study was approved by the Ethics Committee of the Medical University of Vienna on July 7th, 2023. (IRB number: 1395/2023).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size analysis\u003c/h3\u003e\n\u003cp\u003eAssuming an absolute difference of 30 percent between the two groups for clinical pregnancy rates within 6 months after the operation (40% in Group A, 10% in Group B), a sample size of 38 patients per group is necessary to achieve statistical significance at p\u0026thinsp;=\u0026thinsp;0.05, with a power of 80% after correction of Fleiss.\u003c/p\u003e\n\u003ch3\u003eParameters analyzed\u003c/h3\u003e\n\u003cp\u003eData acquisition was conducted using AKIM Software (version 7, SAP Software Solutions Austria, Vienna, Austria; SAP-based patient management system at the Medical University of Vienna). The main outcome parameter was clinical pregnancy after six months of regular, unprotected sexual intercourse. In addition, we also included the following data: results of tubal patency testing; age at surgery; body mass index (BMI); infertility type (primary versus secondary); the indication for laparoscopy (preliminary concern for tubal occlusion, suspicion of endometriosis, presence of ovarian cysts, unexplained infertility); and whether endometriosis was diagnosed using laparoscopy. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eAssessment of tubal patency\u003c/h3\u003e\n\u003cp\u003eThe following techniques were used to assess tubal patency for the patients included in this study: HSG and HyCoSy were performed by experienced clinicians according to international standards [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Laparoscopic chromopertubation was carried out as reported previously [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]: The surgical assessment of tubal patency was performed under general anesthesia, and either executed or supervised by experienced specialists in infertility surgery. For this procedure, a Spackman uterine manipulator with clamp fixation and a rubber cone (18 mm diameter) (reference number 1264; WISAPR Medical Technology GmbH, Brunnthal/Hofolding, Brunnthal, Germany) was inserted through the cervix, positioning the tip one centimeter from the uterine fundus. Chromopertubation was conducted using a syringe containing 50 mL of a diluted indigo carmine blue dye solution (Amino AG, Gebenstorf, Switzerland) to assess tubal patency. All women included with endometriosis revealed superficial peritoneal lesions only, and endometriosis was removed completely in all cases.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed with the SPSS software package, version 28.0.1.0 (SPSS, Chicago). Numerical variables are reported as median and interquartile ranges (IQR), and categorical variables as numbers (frequency). Groups were compared using analyses of variances (ANOVA) for numerical parameters, and Fisher\u0026rsquo;s exact tests for categorical parameters. To test factors associated with the chance for a clinical pregnancy, univariable ,followed by multivariable, binary logistic regression models were used. Only parameters which were statistically significant in the univariable approach were entered into the multivariable model. This analysis used odds ratios (OR) with 95% confidence intervals (95% CI). Differences were considered significant if \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAn overview of basic patient characteristics, which also include the indications for laparoscopy and the final diagnosis of endometriosis, is provided for both study groups in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No significant differences were found. Notably, endometriosis was detected laparoscopically in 44.7% of Group A patients and 42.1% of Group B patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eBasic characteristics of group A and group B patients\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.0 (28.5;33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.4 (22.8;33.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.7 (19.9;26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5 (20.0;26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary infertility\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndications for laparoscopy\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePreliminary concern for tubal occlusion\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSuspicion of endometriosis\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOvarian cyst\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnexplained infertility\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinal diagnosis of endometriosis\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are provided as \u003csup\u003e1\u003c/sup\u003e median (IQR) for numeric parameters or \u003csup\u003e2\u003c/sup\u003e n (%) for categorical parameters, \u003csup\u003e3\u003c/sup\u003e Multiple mentions possible\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter six months of regular menstrual cycles, clinical pregnancy was found more often in women of Group A (bilateral tubal patency in both HSG/HyCoSy and chromopertubation: 18/38, 47.4%) than in Group B patients (bilateral tubal occlusion in HSG/HyCoSy followed by bilateral tubal patency in chromopertubation: 8/38, 21.1%; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.029). Predictive factors for clinical pregnancy were tested in a univariate, followed by a multivariate, binary logistic regression model (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In both models, a lower age (OR 0.877, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.024 and OR 0.856, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.013, respectively) and Group A (OR 3.375, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.018 and OR 4.210, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.010, respectively) were significantly associated with a higher chance for clinical pregnancy.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePredictive factors for clinical pregnancy: results of a univariable flowed by a multivariable regression model\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical pregnancy\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo clinical pregnancy\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;50)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eUnivariable model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMultivariable model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.2 (26.8;31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0 (28.6;34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.877 (0.783;0.983)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.856 (0.758;0.967)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7 (19.3;27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.5 (20.5;26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.016 (0.915;1.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary infertility\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (80.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.326 (0.411;4.280)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEndometriosis\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.574 (0.215;1.528)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGroup A\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.375 (1.233;9.237)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.210 (1.412;12.556)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eData are provided as \u003csup\u003e1\u003c/sup\u003e median (IQR) for numeric parameters or \u003csup\u003e2\u003c/sup\u003e n (%) for categorical parameters\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThese research findings fundamentally call in to question the widespread practice of telling patients that they are fine and it was simply tubal spasm if they have tubal occlusion at screening, followed by patency at laparoscopy. This study found significant differences between the two cohorts in the likelihood of achieving natural pregnancy after a 6-month follow-up period. Patients with consistently patent fallopian tubes in both preoperative HyCoSy/HSG and laparoscopic chromopertubation yielded higher pregnancy rates compared to patients with DTB. While this finding may seem intuitive, it has not been thoroughly examined in previous research. DTB may represent a substantially compromised form of tubal patency, negatively affecting fertility. The impact of DTB on pregnancy rates was particularly striking, as women with patent tubes had a pregnancy rate of 47.4% (18/38), more than twice as high as the 21.1% (8/38) observed in the DTB group.\u003c/p\u003e \u003cp\u003eThough the magnitude of difference with short-term follow-up is striking, in some ways the findings should not be. The concept of tubal disease as \u0026ldquo;patent\u0026rdquo; or \u0026ldquo;non-patent\u0026rdquo; is reductive and oversimplifying. Rather than as a pipe, as so many describe the Fallopian tubes, a conveyor belt is a more apt analogy given ciliary function. We have previously shown that inflammatory states such as endometritis increase intraluminal damage, as well as that up to 95% of occlusion is proximal or full length and not just purely distal [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Cannulation and more aggressive measures cannot restore ciliary function when repairing intrinsic and not just extrinsic damage (peritubal adhesions and phimosis). Moreover, if under anesthesia at laparoscopy one can use greater supraphysiologic pressures for chromopertubation than a conscious patient would tolerate with a screening test, technical patency does not necessarily reflect a normal tube or normal fecundity. Accordingly, we need to shift the paradigm for when occlusion is suggested at HSG or HyCoSy from one of open or closed, instead to one of a proxy for the degree of risk of tubal inefficiency lowering fecundity with spontaneous or non-ART-assisted conception.\u003c/p\u003e \u003cp\u003eAnother factor significantly associated with lower pregnancy rates was younger age. Younger women had a higher chance of becoming pregnant within six months of follow-up. The median age of women who conceived was 29.2 years, compared to 32.0 years in those who did not. In a univariable model, the p-value was 0.024, while in a multivariable model, it was 0.013, indicating even greater relevance. The essence of this finding is not new, but it is reassuring that the study reaffirmed core biologic principles, where earlier in the reproductive years there is higher fecundity, consistent with a lower probability of age-associated aneuploidy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA key objective of our study was to compare our findings with those of Gleicher et al. (1993), whose study served as the motivation for our retrospective analysis. Gleicher reported an absolute 10 percentage point difference in pregnancy rates (39% vs. 29%) between their study groups [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, beyond their having a longer duration of follow-up, a methodological distinction must be made between the two studies. In our research, the control group consisted of women with consistently patent tubes, whereas Gleicher\u0026rsquo;s control group included patients who had undergone tubal cannulation after occlusion. This calls attention to two core issues relating to tubal \u0026ldquo;occlusion\u0026rdquo; on screening and cannulation. The first is that cannulation does not \u0026ldquo;repair the hair\u0026rdquo;, where ciliary damage will persist even with successful cannulation. This likely explains why there was only a subtle increase in fecundity when cannulation was successfully achieved. Second, the yield of cannulation is often less dependent on inherent technique, but rather on the probability of inaccuracy with the initial screening test. Other research showing high success with cannulation was more likely attributable to higher rates of spasm, through REI fellows performing HSG with suboptimal technique, where subsequent fertility was through normal tubes and not improved through cannulation per se (Parry, personal communication).\u003c/p\u003e \u003cp\u003eThere are several core reasons why misleading occlusion at HSG may be associated with lower fecundity despite technical patency. As noted before, patency does not automatically translate to ciliary function. Moreover, pelvic sensitivity to pain may reflect a predisposition to inflammatory states, such as endometriosis, pelvic inflammatory disease-associated adhesions, endometritis, adhesions after ruptured appendicitis, and more. Accordingly, pain-induced uterine spasm occluding the tubes may be a proxy for pathology, independently creating risk for subfertility. Moreover, though contrast dye and air bubbles can fit through a narrow tubal lumen, if there is stricture from previous damage, this could require more force to demonstrate patency, resulting in pain that, in turn, results in spasm again creating a false positive suggestive of total occlusion instead of partial. All of these considerations call in to question ultimately the yield of diagnostic laparoscopy when there is occlusion suggested by screening tests. Diagnostic laparoscopy may demonstrate technical patency, which matters, but if fecundity is greatly reduced even with patency, given the costs and surgical delays inherent to laparoscopy, some patients may get better value in using copay/deductibles towards oral medication and insemination instead of laparoscopy. In other words, for some, exploring assisted conception may offer a better balance than surgical confirmation to guide next steps.\u003c/p\u003e \u003cp\u003eThe small sample size might be seen as a study limitation. Initially, we had based our sample size calculation on the assumption of a 30 percentage point difference in pregnancy rates between the groups (40% versus 10%). While the actual difference turned out to be slightly smaller, at 26 percentage points, it still represents a substantial and clinically meaningful gap. Even in the small multivariable analysis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), where the data were corrected for age, DTB remained a significant predictive parameter for pregnancy, with an OR of 4.210 (IQR: 1.412\u0026ndash;12.556; \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.010).\u003c/p\u003e \u003cp\u003eNotably, many women in both groups revealed other female factors for sub-/infertility, first and foremost endometriosis and ovarian cysts (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which explains the moderate pregnancy rate of 47% after six months. For comparison, a North American study from 2017 reported that women aged 31\u0026ndash;33 years generally have a 61% chance of becoming pregnant within six months and 77% within 12 months [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. According to European data from 2003, the pregnancy rate among truly fertile couples, using natural-family-planning applications, was 88% after six months of follow-up and 98% after 12 months [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It can be seen as a potential limitation, as we did not compare otherwise completely healthy DTB patients with the general fertile population. Empirically, many women who have bilateral tubal blockage in HyCoSy/HSG chose to undergo IVF directly and, thus, cases of DTB are quite rare, probably due to underdiagnosis. However, given the fact that the rates of endometriosis and ovarian cysts did not differ between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) this should only be a minor limitation. On a related note, many with DTB in our patient base had unilateral occlusion, which still matters, and while incorporating them in to this study would have increased sample size, it would have made for less clean results.\u003c/p\u003e \u003cp\u003eIt is also noteworthy that our DTB patients presented with tubal occlusion during the initial assessment (HyCoSy/HSG), whereas tubal patency was found during the second examination (chromopertubation). Had this sequence been reversed, the findings would have been less compelling, in our view. This is because clinicians would intuitively interpret newly patent tubes following prior occlusion as a positive outcome, suggesting restored or intact tubal function. A transition from patency to occlusion, on the other hand, is more likely to raise doubts and prompt further diagnostic consideration. This is why our findings are particularly relevant: they help identify a subset of patients with tubal infertility that could otherwise be overlooked due to a seemingly favorable finding of tubal patency at the time of chromopertubation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our findings provide distinct insights into the detrimental impact of DTB on female fertility and emphasize the need for further research into the underlying mechanisms of tubal dysfunction. With a 26-percentage-point difference in pregnancy rates between DTB patients and the control group, we identified clinically relevant associations. The detection of tubal patency following a previous diagnosis of occlusion should be interpreted with caution. Although natural conception can occur in women with DTB, especially in younger women, patients should be informed that they could still be in need for IVF in the future. A pregnancy rate of 21.1% over six months indicates pronounced below-average fertility [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Further studies are needed to uncover the causes and maybe develop potential treatments for DTB.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor\u0026rsquo;s Contributions: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProtocol/project development: J. Ott, M. Hager, S. Thieme, J. Parry, F. Bormann\u003c/p\u003e\n\u003cp\u003eData collection or management: J. Ott, S. Thieme\u003c/p\u003e\n\u003cp\u003eData analysis: J. Ott, M. Hager\u003c/p\u003e\n\u003cp\u003eData interpretation: F. Bormann, J. Parry, J. Ott,\u003c/p\u003e\n\u003cp\u003eFunding acquisition: none\u003c/p\u003e\n\u003cp\u003eMethodology: J. Ott, M. Hager, F. Bormann\u003c/p\u003e\n\u003cp\u003eProject administration: J. Ott\u003c/p\u003e\n\u003cp\u003eValidation: J. Ott, J. Parry\u003c/p\u003e\n\u003cp\u003eVisualization: J. Ott\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting - original draft: F. Bormann, J. Ott\u003c/p\u003e\n\u003cp\u003eWriting - review and editing: F. Bormann, M. Hager, S. Thieme, J. Parry, J. Ott\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. \u003cem\u003e1 in 6 people globally affected by infertility\u003c/em\u003e. 2023; Available from: https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility#:~:text=Around%2017.5%25%20of%20the%20adult,prevalence%20of%20infertility%20between%20regions.\u003c/li\u003e\n\u003cli\u003eMayrhofer, D., et al., \u003cem\u003eIncidence and Causes of Tubal Occlusion in Infertility: A Retrospective Cohort Study.\u003c/em\u003e J Clin Med, 2024. \u003cstrong\u003e13\u003c/strong\u003e(13).\u003c/li\u003e\n\u003cli\u003eSerafini, P.a.B., J., \u003cem\u003eDiagnosis of female infertility.\u003c/em\u003e the journal of reproductive medicine, 1989.\u003c/li\u003e\n\u003cli\u003eGrigovich, M., et al., \u003cem\u003eEvaluating Fallopian Tube Patency: What the Radiologist Needs to Know.\u003c/em\u003e RadioGraphics, 2021. \u003cstrong\u003e41\u003c/strong\u003e(6): p. 1876-18961.\u003c/li\u003e\n\u003cli\u003eMayrhofer, D., et al., \u003cem\u003eAre the Stage and the Incidental Finding of Endometriosis Associated with Fallopian Tube Occlusion? A Retrospective Cohort Study on Laparoscopic Chromopertubation in Infertile Women.\u003c/em\u003e J Clin Med, 2022. \u003cstrong\u003e11\u003c/strong\u003e(13).\u003c/li\u003e\n\u003cli\u003eKurz, C., et al., \u003cem\u003eIs there a fallopian tube sphincter that causes tubal spasm? An anatomic pilot study in transmen.\u003c/em\u003e Fertil Steril, 2023. \u003cstrong\u003e119\u003c/strong\u003e(5): p. 883-885.\u003c/li\u003e\n\u003cli\u003eMayer C, D.P., \u003cem\u003eHysterosalpingogram.\u003c/em\u003e StatPearls, 2023.\u003c/li\u003e\n\u003cli\u003eHager, M., et al., \u003cem\u003eDetection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion.\u003c/em\u003e Arch Gynecol Obstet, 2021. \u003cstrong\u003e304\u003c/strong\u003e(4): p. 1073-1080.\u003c/li\u003e\n\u003cli\u003ePapaioannou, S., \u003cem\u003eA hypothesis for the pathogenesis and natural history of proximal tubal blockage.\u003c/em\u003e Hum Reprod, 2004. \u003cstrong\u003e19\u003c/strong\u003e(3): p. 481-5.\u003c/li\u003e\n\u003cli\u003eBaramki, T.A., \u003cem\u003eHysterosalpingography.\u003c/em\u003e Fertil Steril, 2005. \u003cstrong\u003e83\u003c/strong\u003e(6): p. 1595-606.\u003c/li\u003e\n\u003cli\u003eLo Monte, G., et al., \u003cem\u003eHysterosalpingo contrast sonography (HyCoSy): let\u0026apos;s make the point!\u003c/em\u003e Arch Gynecol Obstet, 2015. \u003cstrong\u003e291\u003c/strong\u003e(1): p. 19-30.\u003c/li\u003e\n\u003cli\u003eHolzer, I., et al., \u003cem\u003eIs Chronic Endometritis Associated with Tubal Infertility? A Prospective Cohort Study.\u003c/em\u003e J Minim Invasive Gynecol, 2021. \u003cstrong\u003e28\u003c/strong\u003e(11): p. 1876-1881.\u003c/li\u003e\n\u003cli\u003eGhobrial, S., et al., \u003cem\u003eThe Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study.\u003c/em\u003e J Clin Med, 2022. \u003cstrong\u003e11\u003c/strong\u003e(19).\u003c/li\u003e\n\u003cli\u003ePiette, C., et al., \u003cem\u003eIn-vitro fertilization: influence of women\u0026apos;s age on pregnancy rates.\u003c/em\u003e Hum Reprod, 1990. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 56-9.\u003c/li\u003e\n\u003cli\u003eVitagliano, A., A. Paffoni, and P. Vigan\u0026ograve;, \u003cem\u003eDoes maternal age affect assisted reproduction technology success rates after euploid embryo transfer? A systematic review and meta-analysis.\u003c/em\u003e Fertility and Sterility, 2023. \u003cstrong\u003e120\u003c/strong\u003e(2): p. 251-265.\u003c/li\u003e\n\u003cli\u003eGleicher, N., et al., \u003cem\u003eThe multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies.\u003c/em\u003e Hum Reprod, 1993. \u003cstrong\u003e8\u003c/strong\u003e(8): p. 1264-71.\u003c/li\u003e\n\u003cli\u003eWesselink, A.K., et al., \u003cem\u003eAge and fecundability in a North American preconception cohort study.\u003c/em\u003e Am J Obstet Gynecol, 2017. \u003cstrong\u003e217\u003c/strong\u003e(6): p. 667.e1-667.e8.\u003c/li\u003e\n\u003cli\u003eGnoth, C., et al., \u003cem\u003eTime to pregnancy: results of the German prospective study and impact on the management of infertility.\u003c/em\u003e Hum Reprod, 2003. \u003cstrong\u003e18\u003c/strong\u003e(9): p. 1959-66.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Fallopian tubes, chromopertubation, laparoscopy, female infertility, pregnancy rate, discordant tubal blockage","lastPublishedDoi":"10.21203/rs.3.rs-6781800/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6781800/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e To present recent data on discordant tubal blockage (DTB), its influence on pregnancy rates, and how women should gauge their fertility when screening and diagnostic tests don’t always agree.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective cohort study included 78 infertile women, who underwent tubal patency assessment between January 2016 and June 2024 at the Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna. Tubal patency was assessed twice. Initial assessment of tubal patency had been performed by hysterosalpingo-contrast sonography (HyCoSy) or hysterosalpingography (HSG) and had suggested bilateral occlusion in the DTB group (\u003cem\u003en=\u003c/em\u003e38) and bilateral patency in controls (\u003cem\u003en=\u003c/em\u003e38). Bilateral patency was found in all patients during subsequent laparoscopic chromopertubation. The primary outcome parameter was the clinical pregnancy rate within six months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The basic patient characteristics showed no significant differences between the DTB and the control groups. Clinical pregnancy was found in 47.4% (18/38) of control patients (patent tubes) and in 21.1% (8/38) of DTB patients (\u003cem\u003ep=\u003c/em\u003e0.029) over six months of follow-up. In a multivariate model, younger age (odds ratio (OR), 0.856, \u003cem\u003ep=\u003c/em\u003e0.013) and bilateral patency (OR 4.210, \u003cem\u003ep=\u003c/em\u003e0.010) in both examinations (control group) were associated with higher clinical pregnancy rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDTB reflects lower fecundity even when subsequent patency is demonstrated. Tubal patency following prior occlusion should not be grounds for complete reassurance, and given lower odds of pregnancy, such patients may be warranted a faster transition to ART given the decreased efficacy of other methods.\u003c/p\u003e","manuscriptTitle":"Influence of Discordant Tubal Blockage on Clinical Pregnancy Rates: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 15:00:09","doi":"10.21203/rs.3.rs-6781800/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T15:00:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-28T08:48:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197118822637453553434425900421097437274","date":"2025-06-26T06:17:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-23T19:08:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T08:50:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-30T13:34:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2025-05-30T06:47:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"47704f6e-dd2c-4100-bb9d-2076015163fe","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:01:41+00:00","versionOfRecord":{"articleIdentity":"rs-6781800","link":"https://doi.org/10.1007/s00404-025-08186-1","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2025-09-23 15:57:58","publishedOnDateReadable":"September 23rd, 2025"},"versionCreatedAt":"2025-06-25 15:00:09","video":"","vorDoi":"10.1007/s00404-025-08186-1","vorDoiUrl":"https://doi.org/10.1007/s00404-025-08186-1","workflowStages":[]},"version":"v1","identity":"rs-6781800","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6781800","identity":"rs-6781800","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}