Bender and colleagues found that relationships between levels of chlamydia infection and complication rates of pelvic inflammatory disease and ectopic pregnancy between and within countries over time were not straightforward1. Many women diagnosed with a chlamydial infection are anxious about future fertility. Fertiloscopy is a novel procedure to assess fallopian tube function and may be a suitable alternative to the gold standard diagnostic of laparoscopy2. It is done under local anaesthetic and may involve transvaginal hydrolaparoscopy, methylene blue dye test, salpingoscopy, microsalpingoscopy and hysteroscopy. The main feature of fertiloscopy is the ability of an optical device to be introduced into the tubal ostium to bilaterally explore the tubal mucosa. Optical magnification allows the assessment of the functional capability of the fallopian tubes to be made. This may guide decisions about referral for other treatments such as in vitro fertilisation2. Little is known about women's attitudes towards fertiloscopy compared with other methods of assessing tubal patency: hysterosalpingogram (HSG), hysterosalpingo contrast-sonography (HyCoSy) or laparoscopy.

In December 2010 for a medical student research project we conducted a community-based questionnaire survey of female patients' opinions regarding these four methods of imaging to determine uterine tubal patency. Following ethical review by the St. George's course organiser, an information sheet and a questionnaire were given to consecutive female patients aged between 15- 45 all attending a General Practice in Cricklewood, North London. Patients who agreed to complete the questionnaire were also given four information cards which described each method of assessing tubal patency, including possible advantages and disadvantages. An accompanying simple diagram of the female reproductive tract was given as an aid. For the 20% of patients who could not read or write English the investigator (AJ) explained the questions and the four methods to them. The completed questionnaires were returned to the investigator and the data were entered and analysed using SPSS.

The response rate was 94% (64/68) and the average age of responders was 30 years old (range 16 to 45). Out of 64 respondents, 45% described themselves as Asian, 37.7% White, 10% Black, 4.7% mixed, and 2.6% other ethnic groups. Six participants (9%) reported that they had had a chlamydia infection in the past.

The most preferred method to test tubal patency was fertiloscopy (32%, n=20). The main reasons given were that the procedure was relatively quick, no post surgery scars, and this method was the only one which enabled visualisation of the interior of the fallopian tubes. The least preferred method was laparoscopy (53%, n=34) as this caused post operative scars, and required general anaesthetic. Although most women had heard about chlamydia and knew it could be asymptomatic and prevented by using condoms, nearly a quarter (23%, n=15) of this group of mainly Asian women had never heard of chlamydia.

We agree with Bender et al.1 that development and validation of indicators of chlamydia -related complications should be pursued. Fertiloscopy appeared to be acceptable to women in this study and might be more widely used to assess fertility, but more research should be done on the opinions of women who have undergone the procedure. These findings could also be useful in the design of a pilot study for a trial of chlamydia screening using tubal patency as an outcome measure.

Acknowledgements We thank the Chichele road GP surgery in Cricklewood, North West London for allowing us to conduct the study.

Anushree Jagadambe, Dr. Pippa Oakeshott, Dr. Phillip Hay and Dr. Kamal Ojha Population Health Sciences and Education, St George's University of London, London, SW17 ORE, UK Correspondence to: A Jagadambe Email: m0701746@sgul.ac.uk

References

1. Bender N, Herrmann B, Andersen B.et al. Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross- national study. Sex Transm Infect 2011;87: 601-608

2. Fertiloscopy in the management of female infertility [web page online]. [cited 2011 Nov 16]; Available from: URL:http://hcp.obgyn.net/laparoscopy/content/article/1760982/1891840

Conflict of Interest:

None declared