True, true, and unrelated: tubal patency, tubal architecture, and tubal function - Fertility and Sterility

“To understand the actual world as it is, not as we should wish it to be, is the beginning of wisdom.” — Bertrand Russell The September 1968 issue of Fertility and Sterility contains the article, “Revised PSP test for tubal patency by Williams and Gering (1x1Williams, D.W. and Gering, H.S. Revised PSP test for tubal patency. Fertil Steril. 1968; 19: 821–825 Abstract | Full Text PDF | PubMed | Scopus (2) | Google ScholarSee all References)(1). In this article the authors describe the use of the phenosulfonphthalein (PSP) test for evaluation of tubal patency. The original test was first described by Speck in 1948 and subsequently refined with the hopes of enhancing sensitivity (2x2Speck, G. Phenolsulfonphthalein as a test for the determination of tubal patency. Am J Obstet Gynecol. 1948; 55: 1048–1050 Abstract | Full Text PDF | PubMed | Scopus (4) | Google ScholarSee all References)(2). The PSP test is performed by injection of dye through the cervix into the uterine cavity. If the fallopian tubes are patent, the dye spills into the peritoneal cavity, is absorbed and excreted through the kidneys and the dye changes the color of the urine. The amount of dye absorbed is quantified by visual inspection of the urine and compared to known standards using a colorimeter. Dye will not be present in the urine if the fallopian tubes are obstructed. In this manuscript, twenty-seven patients were studied and the PSP test was compared to the gold-standard hysterosalpingogram (HSG). Twenty-three patients had infertility and four patients were examined for patency following a tubal ligation. Only 56% of patients had concordant results between PSP and HSG. Several patients with tubal damage had absorption of PSP, and it was speculated that dye was absorbed in the tubal mucosa of those with tubal damage. Despite the authors' efforts to refine the test by reduction in the amount of dye injected and standardization of time allowed for injection, the accuracy of the test was not improved. Fifty years later, HSG is still considered to be the best non-invasive test for evaluation of tubal architecture and patency. Other tests such as hysterosalpingo-foam sonography and hysterosalpingo-contrast sonography have become more widespread due to decreased patient discomfort, avoidance of radiation exposure, and enhanced provider efficiency (3x3Ludwin, I., Ludwin, A., Wiechec, M., Nocun, A., Banas, T., Basta, P. et al. Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye. Hum Reprod. 2017; 32: