title: Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure.
abstract: OBJECTIVE
  To evaluate the accuracy of hysterosalpingography (HSG) in patients who underwent concomitant radiofrequency endometrial ablation and hysteroscopic sterilization.
  
  
  METHODS
  This historical cohort study was conducted at a midwestern academic medical center. A total of 186 women (94 with combined procedure and 92 with sterilization alone) were identified as having undergone intervention between January 1, 2003, and June 30, 2011. Two reviewers blinded to the surgical procedure interpreted the standard clinically indicated HSGs in each group.
  
  
  RESULTS
  The primary outcome assessed was the inability to rely on the microinserts for contraception based on HSG interpretation using manufacturers' guidelines (unsatisfactory HSG). Position of the devices and occlusion of tubes were assessed on all 3-month and, when available, all 6-month repeat HSGs. At the 3-month HSG, 5 of 76 (6.6%, 95% confidence interval [CI] 2.2-14.7%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.3%, 95% CI 10.1-29.3%) in the combined group (P=.03). After accounting for the seven patients who underwent repeat HSG at 6 months, 3 of 76 (3.95%, 95% CI 0.8-11.1%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.31%, 95% CI 10.1-29.3%) in the combined group (P=.005).
  
  
  CONCLUSIONS
  After completing all clinically indicated HSGs, patients who undergo concomitant radiofrequency endometrial ablation and hysteroscopic sterilization have an approximate fivefold increase (odds ratio 5.45, 95% CI 1.48-20.0) in the rate of unsatisfactory HSG for purposes of documenting tubal occlusion.
  
  
  METHODS
  II.
authors.affiliation: Departments of Obstetrics and Gynecology, Surgery, and Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
authors.forename: Darci J
authors.initials: DJ
authors.lastname: Wall
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Breitkopf
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Creedon
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D055356:Endometrial Ablation Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D015907:Hysteroscopy / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013245:Sterilization, Reproductive / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome