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Authors: J Preston Parry, MD, MPH; Daniel Riche, PharmD; John Rushing, MD; Brittany Linton, RN; Vicki Butler, RN; Steven R Lindheim, MD Abstract: Objective: To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG). Design: Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its registration number with clinicaltrials.gov is NCT02005263 and its UMMC IRB protocol number is 2013-0230. Setting: Academic hospital Patient(s): Women undergoing office hysteroscopy and ultrasound, with a subset also having HSG Intervention(s): Air infusion into saline during office hysteroscopy Main Outcome Measure(s): The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG. Result(s): When performed as described, this office technique has 98.3-100% sensitivity to tubal occlusion and 83.7% specificity. Gentle technique is central to accurate outcomes, which is facilitated through use of a small caliber (less than 3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG (RR = 110, p value less than 0.0001). Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique. Conclusion(s): Air infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility.