The introduction of a foreign object or material through the cervical canal into the uterine cavity was considered a dangerous thing to do at the time that Isidor Rubin1 first thought that it might be a way of demonstrating tubal patency. Even such a simple procedure as sounding the uterus was judged by many eminent gynecologists of that day to be a violation of acceptable medical practice. The endometrial cavity was considered sacrosanct.
Nevertheless, Rubin was concerned because, other than by laparotomy, there was no reasonably good method to determine whether the tubes were open or closed. The conscientious physician was extremely reluctant to recommend abdominal surgery for this sole purpose because of the grave risks involved.
Female infertility in those days was considered to be primarily a problem of cervical obstruction. The Pozzi operation, a type of tracheloplasty, was in vogue if there was, on pelvic examination, no