Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography

Yu Liu,Yanni He,Jingjiao Xu,Meijun Zhou,Ning Zhang,Jiayao Shi,Hongmei Liu

doi:10.1186/s12884-020-03315-x

Abstract

BackgroundFour-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients’ clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy.MethodsThis was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization (WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy.Result(s)One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy.Conclusion(s)This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8–9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .

Highlights

Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception
In order to determine the spontaneous conception of infertile women after 4D-HyCoSy, it was necessary to select patients who conformed to two major criteria: 1. the patient’s husband showed no evident cause for infertility [16]
No clinical interventions (IVF or hysteroscopy and laparoscopic surgery) were given after 4D-HyCoSy. To conform to these criteria, the exclusion criteria were as follows: women did not conceive without contraception less than a year (35 patients), semen abnormalities or no semen examination (213 patients), hydrosalpinx by ultrasound examination (29 patients), hysteroscopy and laparoscopic surgery (103 patients) or in vitro fertilization (IVF) (4 patients) within a year after 4D-HyCoSy, According to the exclusion criteria, 327 patients were enrolled in our follow-up study (Fig. 1)

Summary

Introduction

Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. Conventional twodimensional hysterosalpingo-contrast sonography (2DHyCoSy) has limitations in that signals from the total length of the tube and full contour of the uterine cavity have rarely been depicted in a single scanning plane because of tubal tortuosity and limited detection angles of the ultrasound beam [9, 10]. With the introduction of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy), a diagnostic accuracy of 87.5–92.9% [2, 3, 11],the use of ultrasound in reproductive field has gradually increased. As opposed to 2D-HyCoSy and three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy), 4D-HyCoSy enables observation of the entire course of fallopian tube contrast development rather than an instant capture [2, 12,13,14]

Methods

Results

Conclusion