Conventional Hysterosalpingography Research Articles

Study of Saline Infusion Sonography and Hysterosalpingography to See the Tubal Patency in the Infertile Women

Background: Infertility is a global issue in reproductive health. Etiology Of infertility is multifactorial and fallopian tube abnormality being one of the most important causes accounts for up to 40%of female infertility. Saline infusion sonography (SIS) is gaining popularity and being widely practiced and accepted as a screening tool in assessing tubal patency. Objectives: To compare the efficacy of tubal patency test with saline infusion sonography and hysterosalpingography in infertile women. Methods: It is a quasi-experimental study. 120 consecutive infertile women in 25-40 years, who are ovulating spontaneously or by ovulation induction who was needed tubal assessment included here. 60 patients went for saline infusion sonography, 60 went for hysterosalphingography which was allocated by lottery. Result: Main outcome was find out the diagnostic accuracy of saline infusion sonography over conventional hysterosalpingography for evaluation of tubal patency. Tubal patency confirmed by SIS 54(89.99%) had at least one tube patent. Tubal block 6(10.01%). HSG bilateral tubal patency 40(66.67%), bilateral tubal block 15(25.00%), unilateral block 5(8.33%). SIS had sensitivity 86% specificity 97%, positive predictive value 97% and negative predictive value 83% in tubal patency. Conclusion: SIS employed as a screening procedure to pick up subjects needing HSG and laparoscopy Low risk subjects for tubal factors in infertility, sonohysterosulphingography can be. It is simple, relatively less expensive, minimally invasive procedure. J Com Med Col Teachers Asso Jan 2023; 27(1): 27-33

Efficacy and Safety Analysis of Modified HSG for Infertile Patients

Objective: To test the efficacy and safety of modified hysterosalpingography (HSG) for infertile patients.Altogether 110 infertile cases from March 2018 to July 2020 were grouped into the observation group (OG, 58 cases) and the control group (CG, 52 cases) according to different therapies. The OG was treated with modified HSG, while the CG was treated with conventional HSG. The tubal patency after treatment, sex hormone levels before and after therapy [including luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2)], changes in uterine volume and endometrial thickness before and after therapy were tested and compared between the CG and the OG. The individuals were followed up for one year, and the pregnancy success rate was recorded. Finally, the adverse reactions of the CG and the OG after treatment were recorded and compared.After treatment, the sex hormone level, tubal patency, uterine volume and endometrial thickness of the CG and the OG were markedly elevated, but the improvement of the OG was more obvious than that of the CG. Follow-up analysis revealed that the pregnancy success rate of theOG was markedly higher than that of theCG, and the incidence of adverse reactions in OG was markedly lower than that in CG.The modified HSG can effectively improve the pregnancy situation of patients and has higher safety compared with the traditional HSG, so it is worth popularizing in clinic.

Conventional and magnetic resonance hysterosalpingography in assessing tubal patency-A comparative study.

Context:Tubal factors, one of the leading causes of female infertility, have been conventionally evaluated by hysterosalpingography (HSG). The role of magnetic resonance imaging (MRI) in assessing female infertility is gaining importance because of its inherent efficiency in detecting structural abnormalities. Magnetic resonance hysterosalpingography (MR HSG) is less invasive and avoids exposure of ovaries to ionizing radiation. Its utility is extrapolated to visualize fallopian tubes.Aims:To assess the diagnostic accuracies of dynamic MR HSG and conventional HSG (cHSG) in identifying tubal patency in women with infertility using diagnostic laparoscopy (DL) as gold standard.Materials and Methods:A prospective study of 40 patients was conducted over a period of 6 months. The patients were subjected to MR HSG followed by cHSG during the preovulatory period. If tubes were blocked, the patients were subjected to DL in the next menstrual cycle. If the tubes were patent and there was failure of conception, they were subjected to DL in the interval of 3 months.Results:Twenty-four patients had bilateral tubal spill which was confirmed using cHSG and DL. One patient had discordant MR HSG and cHSG results and six patients had discordant MR HSG and DL results. No statistical difference was observed between MR HSG and cHSG.Conclusion:Pelvic MRI is an inevitable tool in infertility evaluation. MR HSG can be used in addition as it avoids exposure of the reproductive organs to radiation and has the same efficacy as cHSG.

Comparative Analysis of Saline Sonohysterosalpingography to Hysterosalpingography in the Diagnosis of Utero-Tubal Pathology amongst Infertile Women at the University of Port Harcourt Teaching Hospital

Background: The evaluation of the uterus and its tubes cannot be overemphasized in the management of infertile women. Transvaginal saline sonohysterosalpingography (SHG) is another novel method with certain advantages for uterine and tubal assessment in women. Objective: To determine the accuracy of saline SHG findings by comparing it with conventional Hysterosalpingography (HSG) findings in infertile women. Result: The concordance between saline sonohysterosalpingography and hysterosalpingography for the diagnosis of submucous fibroids, uterine adhesions and tubal patency in this study was over 94%. The saline SHG had sensitivity and specificity of 93.8% and 94.1% respectively for diagnosis of uterine fibroids (submucous) and a sensitivity and specificity of 62.5% and 98.9% in the diagnosis of intrauterine adhesions. It also had a sensitivity and specificity of 98.9% and 78.6% respectively in the detection of patent fallopian tubes. Conclusion: The ability of saline SHG to diagnose uterine pathology and tubal patency was comparable to that of conventional HSG. Saline SHG has the potential to replace HSG as the first-line test for the evaluation of uterine or tubal disease in infertile women.

A comparative study of conventional and magnetic resonance hysterosalpingography in assessing tubal patency at a tertiary care center

A comparative study of conventional and magnetic resonance hysterosalpingography in assessing tubal patency at a tertiary care center

Magnetic resonance hysterosalpingography in diagnostic work-up of female infertility - comparison with conventional hysterosalpingography: a randomised study.

To compare diagnostic accuracy of MR-hysterosalpingography (MR-HSG) and conventional hysterosalpingography (X-HSG) in the evaluation of female infertility. Forty women received prospectively both X-HSG, the gold standard technique, and MR-HSG on the same day but the order in which they were conducted was randomised. A 1.5 Tesla MRI was performed with classical sequences for pelvic analysis and an additional 3D T1-weighted sequence with intra-uterine injection of gadolinium. Two radiologists independently interpreted X-HSG and MR-HSG according to randomisation, blinded to the other results. They both then performed a second interpretation of MR-HSG blinded to the first reading with a minimum time delay of 1 week. Diagnostic performance of MR-HSG for analysis of tubal and intracavity abnormalities was evaluated by calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Twenty-six patients were included. Diagnostic performance of MR-HSG was: Se: 91.7% (95% CI 61.5-99.8); Sp: 92.9% (95% CI 66.1-99.8) ; PPV: 91.7% (95% CI 61.5-99.8); NPV: 92.9% (95% CI 66.1-99.8). Pain analysis showed a significant statistical difference between the two procedures: average VAS for X-HSG was 4.43 (95% CI 3.50-5.36) versus 3.46 (95% CI 2.62-4.31) for MR-HSG, p=0,01. Intra- and inter-rater agreements for detection of tubal or intracavity abnormalities were 0.92 (95% CI 0.78-1.00) and 0.76 (95% CI 0.52-1.00). MR-HSG is a well-tolerated technique demonstrating high accuracy in investigating tubal patency and intra-uterine abnormalities for diagnostic work-up of female infertility. • MR-hysterosalpingography is an innovative technique. • Hysterosalpingography can be used to investigate tubal patency and intracavity abnormalities. • Hysterosalpingography is a potential 'one-stop-shop' imaging technique for a single comprehensive examination of female infertility.

Assessment of tubal patency in infertile women: can HyCoSy be performed in place of Hysterosalpingography?

Objective: To determine the advantages and accuracy of hysterosalpingo-contrastsonography (HyCoSy) in the assessment of tubal patency with regards to conventional hysterosalpingography (HSG). Study design : Interventional study. Setting: The study was conducted at Lady Willingdon Hospital Lahore. Study Period: One year, from November 2003 to October 2004. Patients and methods: Thirty infertile women were examined with hysterosalpingo-contrastsonography (HyCoSy) using air and saline as contrast medium. The results were compared with those obtained from conventional hysterosalpingography.(HSG). Results: Altogether 30 patients were included in the study. They were examined with both HyCoSy and conventional hysterosalpingography (HSG) and the results were calculated. Of the patients investigated by salpingo -contrastsonography, 22 were found to have patent tubes whereas 8 were having blocked tubes. Unilaterality or bilaterality could not be detected by this method. Bilateral tubal patency was found by hysterosalpingography in 22 cases. Unilateral tubal patency was found in 5 cases. Bilateral tubal occlusion was detected in 3 cases using either technique .Sensitivity and specificity of HyCoSy was 90.9% and 89.4% respectively. Positive predictive value was 83.3% and negative predictive value was 55.55%. Conclusion: The outcome of the study shows that HyCoSy with the combination of air and saline is cost effective, reliable and safe method and can replace conventional hystero salpingography as base line investigation of infertility on out patient basis.

A comparative study of saline infused sonohysterography and conventional hysterosalpingography in the evaluation of female infertility

Background and Objectives: Recognition of the causes of infertility, appropriate timely evaluation, and treatment with good outcome is the goal of the treating physician. Saline infused sonohysterography (SIS) is a cost-effective, safe, noninvasive, and a rapid procedure to visualize the female pelvic organs in the evaluation of infertility. The purpose of this study is to compare the diagnostic accuracy and the advantages of saline infused sonohysterography (SIS) over conventional hysterosalpingography (HSG). Materials and Methods: Thirty-five women who presented to the gynecology department between November 2005 and September 2007 for evaluation of infertility were included in the study. After taking informed consent, all the women were subjected to SIS, followed by conventional HSG on the next day. The study was conducted between 7 th and 11 th day of the menstrual cycle. Results of the two procedures were compared. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of SIS in detecting tubal patency was 94.28%, 75%, 97.05%, and 50%, respectively. SIS was found to be superior to conventional HSG in the evaluation of uterine and ovarian factors of female infertility in the present study. SIS was also found to be cost-effective and less time-consuming than conventional HSG. Interpretation and Conclusion: SIS can be used as a simple, noninvasive, cost-effective primary diagnostic tool in the evaluation of female infertility and should be used in conjunction with conventional HSG in the evaluation of tubal, cervical, uterine, and ovarian factors of infertility to avoid unnecessary invasive diagnostic procedures.

Effective and ovarian dose in PA conventional and rotational 3D hysterosalpingography examinations

The purpose of this study was to compare effective and ovarian doses (E and OD, respectively) in hysterosalpingography (HSG) examinations performed with conventional posterioanterior (PA) projections and rotational 3D (3D) techniques. 29 HSG examinations (11 conventional and 18 3D), were performed using a digital C-arm angiographic system. In the conventional technique, we used posterioanterior (PA) instead of an anterioposterior (AP) projection normally used according to the international literature. All information concerning exposure conditions for each patient, were recorded. Thermoluminescent dosimeters (TLDs) were attached on the skin of each patient over the ovaries. In conventional HSGs, average values were for Dose Area Product (DAP) 0.41 Gycm2, for Effective Dose (E) 0.15 mSv and for Ovarian Dose (OD) 0.24 mGy. In 3D-HSGs, they were 14.4 Gycm2, 2.29 mSv and 3.96 mGy correspondingly. Patient doses in 3D-HSGs are of the same order of magnitude with those reported in the literature for conventional technique. However, they are larger compared to the conventional HSG performed with the technique we use in this specific X-ray system. E and OD are much lower with our technique where PA projection and the specific C-arm system are used in comparison with the corresponding values published in the literature for the conventional technique where the AP projection is used.

Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be further assessed. dMR-HSG with cervical cannulation and intracavitary gadolinium injection is feasible and allows assessment of the uterus, the fallopian tubes, and extra-uterine pelvic structures, while avoiding all ionizing radiation in infertile women aiming at pregnancy.

Virtual Hysterosalpingography: A New Multidetector CT Technique for Evaluating the Female Reproductive System

Recent advances in reproductive medicine have generated a demand for more accurate imaging methods for identifying the specific cause of female infertility and other gynecologic disorders. Virtual hysterosalpingography is an emerging modality in which aspects of the established technique of hysterosalpingography are combined with the cutting-edge technology of multidetector computed tomography (CT) to allow a comprehensive and highly accurate evaluation of both the female reproductive system and the pelvic anatomy generally. Unlike ultrasonography (US) and magnetic resonance (MR) imaging, multidetector CT is capable of depicting both the external and internal surfaces of the uterus, fallopian tubes, and other pelvic organs, providing high-resolution data that are suitable for two- and three-dimensional reconstructions and virtual endoscopic views. Thus, virtual hysterosalpingography may prove to be superior to other noninvasive modalities for evaluating tubal patency. Moreover, in comparison with conventional hysterosalpingography, which may involve cervical clamping, virtual hysterosalpingography is painless. Because of the health risks associated with ionizing radiation, the use of another modality (eg, MR imaging, US) may be preferred if the presence of a focal uterine lesion is strongly suspected. However, virtual hysterosalpingography with multidetector CT may provide a diagnostic advantage in complex cases.

MR Hysterosalpingography Compared With Conventional Hysterosalpingography

MR Hysterosalpingography Compared With Conventional HysterosalpingographyJames E. SilberzweigAudio Available | Share

Radiologische versus sonographische Tubendarstellung

Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.

Clinical use of 64-row multislice computed tomography hysterosalpingography in the evaluation of female factor infertility

To evaluate the potential clinical value of 64-row multislice computed tomography hysterosalpingography (MSCT-H) in the evaluation of female patients with a diagnosis of infertility and compare it with the use of standard X-ray hysterosalpingography (HSG). Comparative prospective study. Outpatient Imaging Diagnostic Centre, Diagnóstico Maipú, Buenos Aires, Argentina, and a university-affiliated fertility institute (Centro de Estudios en Ginecología y Reproducción, Buenos Aires, Argentina). Twenty-two female patients with a diagnosis of infertility. Sixty-four-row MSCT-H and conventional X-ray HSG. Diagnostic accuracy of MSCT-H for the evaluation of cervical, uterine, and tubal pathology. We found that 64-row MSCT-H was useful in identifying female reproductive tract abnormalities, showing in the per patient analysis a sensitivity of 100% and a specificity of 85.71%. This new procedure can be performed without a tenaculum, making it well tolerated. Clinical complications did not occur in any of the patients participating in the study. Sixty-four-row MSCT-H is a valuable alternative diagnostic technique in the infertility workup algorithm for the evaluation of the female reproductive tract.

O-120: Virtual hysterosalpingography:A novel painless technique for the study of the female reproductive tract in infertile patients

O-120: Virtual hysterosalpingography:A novel painless technique for the study of the female reproductive tract in infertile patients

Three-dimensional dynamic MR hysterosalpingography: a preliminary report.

The aim of this study was to evaluate the feasibility of three-dimensional dynamic MR hysterosalpingography (3D MR HSG) for visualization of the cavum uteri and demonstration of bilateral fallopian tube patency as an alternative to conventional hysterosalpingography. Five infertile female patients underwent 3D dynamic MR HSG prior to conventional hysterosalpingography. The MR protocol consisted of axial T1-weighted spin-echo (SE), axial/coronal T2-weighted fast SE (FSE), and 3D MR angiography sequences before, during, and after injection of a diluted gadolinium solution into the cavum uteri via a balloon catheter. Positioning of the catheter was feasible in all patients. In one patient the catheter slipped out during MRI and in one patient the catheter was placed far in the cavum uteri. In three patients catheter position was optimal at the level of the cervical canal. Evaluation of pelvic anatomy, myometrium, and ovaries was possible in all patients on the basis of T1-weighted SE and T2-weighted FSE. Three-dimensional visualization of the dilated cavum uteri was possible in four patients. In these four patients 3D MR HSG also proved bilateral fallopian tube patency which was confirmed in each patient by conventional hysterosalpingography. Three-dimensional MR HSG is feasible and further research should be done to determine if this technique can evolve into an alternative technique to conventional hysterosalpingography with the advantages of no radiation and additional visualization of the uterus wall and ovaries.

F07Hysterosonosalpingography – a new concept of diagnostic procedures in gynaecology

BackgroundThe aim of this study is to find the effectiveness of hysterosonosalpingography in the diagnosis of the endometrial pathology and in the study of tubal patency.MethodWe have studied 550 cases backwards. The women enrolled came from four departments of our Hospital: Menopause (n = 206), Reproductive Medicine (n = 195), General Gynaecology (n = 125) and Senology − Women on Tamoxifen (n = 24). We have analysed epidemiological data, Transvaginal Sonography and hysterosonosalpingography findings, as well as the conventional Hysterosalpingography, Laparoscopic, Hysteroscopic and histological data. We have looked for the concordance rate between the hysterosonosalpingography and the other diagnostic procedures.Results Main findings: Round hyporeflective broad‐based structures representing polyps or submucosal myomas, thin endometrium, floating thin or rigid strips, subseptate uterus, unobstructed tubes, uni or bilateral tubal occlusions. High concordance rate (from 85% to 95%) was verified between the hysterosonosalpingography and the classic diagnostic proceedings.ConclusionHysterosonosalpingography is a good and valuable complement of Transvaginal Sonography in the endometrial study. It makes possible appropriate preoperative triage to hysteroscopy. It may be also a first class exam of screening infertility. The success of this technique led us to include it at the diagnostic protocols in our Hospital.

Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

Introduction: Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. Methods and patients: One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. Results: When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. Conclusion: There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology.

A second hysterosalpingography reduces the use of selective technique for treatment of a proximal tubal obstruction

Objective: To assess whether a second hysterosalpingography (HSG) can permit tubal patency, reducing the use of selective salpingography in patients with proximal tubal obstruction. Design: Prospective study. Setting: University hospital. Patient(s): The study population consisted of 360 infertile women. Intervention(s): In patients with unilateral or bilateral proximal tubal obstruction, a second HSG was performed after about 1 month. In those cases with persistent obstruction, an immediate selective salpingography and tubal catheterization were performed. Main Outcome Measure(s): Tubal opacification. Result(s): Forty patients underwent a second HSG procedure for proximal tubal occlusion. Among these, 24 achieved bilateral tubal patency. Thus, repetition of a conventional HSG after 1 month avoided unnecessary salpingography in 60% of patients. Conclusion(s): In infertile women with proximal tubal obstruction, we believe it is best to perform a second HSG. HSG is easy to carry out and subjects patients to a lower dosage of radiation and fewer risks than selective salpingography. The latter technique should be reserved for unsuccessful cases.

Magnetic Resonance Imaging with Gadolinium-Diethylenetriamine Pentaacetic Acid is Useful in Assessment of Tubal Patency in a Patient with Iodine-Induced Hypothyroidism

A 32-year-old woman presented for evaluation of primary infertility. Because she had a history of iodine-induced hypothyroidism, conventional hysterosalpingography was contraindicated. Tubal patency was assessed by magnetic resonance imaging (MRI) after infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Visualization of the contrast medium in the peritoneal cavity revealed tubal patency. Our case indicates that MRI with gadolinium-diethylenetriamine pentaacetic acid is a safe, simple, and easy way to confirm that at least one tube is patent when a patient is at risk for hysterosalpingography. To our knowledge, this is the first report that tubal patency was diagnosed on MRI.