Sunday, March 22, 2009


Picture:Uterine tube insufflation [Rubin test]
On the right both tube are patent.
On the middle one tube is occluded and another is patent.
Onthe bottom side is lateral or side view with stethoscop on the
top-right side.
Source:Ralph C.Benson.OBSTETRICS AND GYNECOLOGY, Oregon, 1971, p 670-671.

Successful treatment of infertility is possible only if an early and accurate diagnosis can be established. This requires an energetic and systematic approach by the clinician and the cooperation of both partners over a period of at least 3 months, with 4 office visits for the wife and 2-3 for the husband, both partners usually can be evaluated and the cause of infertility determined. Obscure or multiple causes of infertility may require more time and special technique of investigation.
The initial evaluation include discussion on the appropriate timing of intercourse, semen analysis in the male, confirmation of ovulation in the female, and, in majority of situations documentation of tuba uterine patency in the female.
A history of regular, cyclic, predictable, spontaneous menses usually indicates ovulatory cycles, which may be confirmed by urinary ovulation predictor kids, basal body temperature [BBT] graphs, or plasma progesterone measurements during the luteal phase of the cycle.

Tubal insufflation [Rubin test] for female examination.
The test is a safe office procedure in properly selected patients if CO2 [carbon dioxide] is employed and if the pressure is kept below 200 mm Hg [mercury]. Tubal insufflation [TI] at or about the time of ovulation is most likely to be revealing and successful. Auscultation over the lower abdomen with stethoscop during insufflation may disclose the whistle of gas passing through one tubal ostium or the other.
TI is indicated in the investigation of:
1.Primary or secondary infertility and
2.As a means of nonoperative tubolysis well after subsidence of salpingitis, appendicitis etc.
If tests of tubal patency were unsatisfactory, hysterosalpingography is done. The uterus and uterine tube fill slowly with the contrast media, the film after injection of radiopaque fluid may reveal the patent or and occluded tube.
Utero-tubal insufflation in infertile patients has both diagnostic and therapeutic value. Reported successful TI is known to enhance the likelihood of pregnancy.
Contraindications of TI are pregnancy, recent genital tract infection, uterine bleeding, recent dilatation and curettage or other uterine surgery, and serious cardiopulmonary disease
The woman receives a complete physical and pelvic examination.

The husband’s general physical examination, with emphasis on the genital and rectal examination, is done next. Penile, urethral, testicular, epididymal , and prostatic abnormalities are sought. Spermatozoal analysis is repeated on the third visit if the previous study was abnormal.
Testicular biopsy is indicated if oligospermia or azoospermia [very low sperm count analysis] is present.


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