Fallopian Tube Patency Research Articles

When a balloon catheter or tenaculum is required for cervical traction during hysterosalpingography

The aim of this study was to define the actual rate of the traction needed and the balloon catheter or tenaculum requirement for hysterosalpingography (HSG) examinations, and to investigate the correlation between pain scores with the type of traction, operator, parity or the type of infertility. 788 patients undergoing HSG participated in the trial. The HSG examinations were completed in 58% of the patients (458) without any traction. Traction was needed in 42% of patients, those with the balloon catheter in 26.9%, and those with the tenaculum only at 15%. Patients with balloon catheter traction had similar pain scores to those using tenaculum traction. The pain scores changed according to the operator. HSG examinations should be performed step-by-step and the need for traction evaluated during the procedure. IMPACT STATEMENT What is already known on this subject? HSG is a technique to evaluate fallopian tube patency and other potential intrauterine pathology in infertile women. What do the results of this study add? Traction was not needed in more than half of the HSG examinations. The pain due to the balloon catheter and tenaculum is similar. What the implications are of these findings for clinical practice and/or further research? HSG examinations should be performed step-by-step by checking the need for traction. Traction with the balloon catheter prevents the uterine spasm, infection and bleeding complications during or after the HSG.

Research progress of Chinese medicine in the treatment of HyCoSy diagnosis of infertility

Infertility is defined as having sex without contraception for more than 12 months without becoming pregnant. The incidence of infertility is high. Once the disease occurs, it will not only affect the physical and mental health of women, but also affect the harmony of their families. Fallopian tube obstruction is the main factor causing infertility. In the past, X-ray hysterosalpingography was used to evaluate the patency of fallopian tube. In recent years, contrast-enhanced ultrasound technology has become more and more mature. It has the advantages of safety, accuracy, non-invasive, and reproducibility in evaluating fallopian tube patency, and is conducive to real-time observation of uterine cavity morphology, which has been widely used in the diagnosis and treatment of infertility. To evaluate the efficacy of Hysterosalpingo contrast sonography (Hysterosalpingo contrast sonography, hysterosalpingo contrast sonography, hysterosalpingo contrast sonography, hysterosalpingo contrast sonography, The improvement of adverse reactions such as pain caused by HyCoSy) in the diagnosis of infertility, and whether there are significant differences in the benefits brought by Hycosy compared with single moxa salt pack hot compress and conventional drugs for pain relief. This article reviews the research progress of Chinese and western medicine related to HyCoSy in the diagnosis of infertility in recent years, so as to provide some reference for clinicians.

Value of Early Laparoscopic Exploration for Primary Infertile Patients with Patent Fallopian Tubes Complicated with Pelvic Effusion.

BACKGROUND Endometriosis is a progressive disease, and early detection and early treatment are particularly important. The purpose of this study was to investigate the effect of the timing of laparoscopy on the spontaneous pregnancy rate of primary infertile patients complicated with pelvic effusion within 6 months after surgery. MATERIAL AND METHODS We enrolled 330 primary infertile patients with pelvic effusion and bilateral patent fallopian tubes. They were divided into 3 groups based on retrospective analysis of clinical data. Study Group 1 underwent laparoscopy 1 month after hysterosalpingography (HSG), Study Group 2 received laparoscopy after trying to conceive for 3 months, and the Control Group did not undergo laparoscopy. According to the specific conditions during laparoscopy, repair and plastic surgery of fallopian tube, electrocautery of endometriosis and uterine suspension were performed. The main observation indicators were proportions of retrograde menstruation, peritoneal endometriosis, and tubal adhesions in laparoscopy groups, and spontaneous pregnancy rates within 6 months. RESULTS The proportions of retrograde menstruation were 92.2% and 93.1% in Study Group 1 and Study Group 2, respectively, with no statistical significance. The proportions of peritoneal endometriosis were 51.0% and 64.7%, with a statistically significant difference. The proportions of tubal adhesions were 31.4% and 36.2%, with no statistical significance. The pregnancy rates within 6 months were 73.9%, 52.6%, and 13.1%, with a statistically significant difference for pairwise comparisons. CONCLUSIONS The pregnancy rate of primary infertile patients with patent fallopian tubes complicated with pelvic effusion can be significantly improved through early laparoscopic surgery (exploration and treatment).

8356 Robotic Surgery: Pelvic Mass Excision, Resection of Non-Communicating Uterine Horn, and Fulguration of Endometriosis

<h3>Study Objective</h3> To demonstrate surgical techniques for approaching an advanced case of endometriosis in a patient with a congenital uterine anomaly, large pelvic mass, and severe adhesive disease. <h3>Design</h3> A step-by-step explanation of the surgery. <h3>Setting</h3> Community Based Teaching Hospital, Operating Room. <h3>Patients or Participants</h3> 33-yo G0 with known unicornuate uterus with non-communicating uterine horn, dysmenorrhea, suspected endometriosis, infertility, congenital absence of right kidney. <h3>Interventions</h3> Chromotubation was first performed to evaluate if the patient had patent fallopian tubes. The pelvic mass was then decompressed and drained revealing multiple right ovarian cysts. Anatomical landmarks were identified with a retroperitoneal dissection and extensive lysis of adhesions. The bladder was backfilled intermittently to help identify surgical planes. A Keith needle was temporarily placed in the abdomen to elevate the pelvic mass and aid in visualization. The pelvic mass and non-communicating uterine horn were resected. Hemostasis was achieved with electrocautery and suturing. Endometriotic implants in the pelvis and diaphragm were fulgurated and an appendectomy was performed due to extensive damage from endometriosis. All specimens were placed in a bag and removed through the umbilical port site. Post-operatively, the patient was started on progesterone therapy. <h3>Measurements and Main Results</h3> Successful completion of surgery, no complications, the patient reported improvement in her symptoms. <h3>Conclusion</h3> When dealing with severe adhesive disease, abnormal anatomy, and limited space due to a pelvic mass it is key to approach these cases in a stepwise fashion. Visualization can be optimized via temporary measures such as using a Keith needle. If irregular anatomy is noted, landmarks can be identified via the retroperitoneal dissection.

7344 Effect of Unilateral Hydrosalpinx on Chances of Spontaneous Conception

<h3>Study Objective</h3> The aim of the study is to present a successful surgical management of a case of unilateral hydrosalpinx resulting after cesarean delivery that appeared to have interfered with spontaneous conception from a healthy patent contralateral fallopian tube. <h3>Design</h3> Case report with 6-month post-operative follow-up. <h3>Setting</h3> Operative laparoscopy was done in a teaching hospital operation room with the patient in dorsal lithotomy position. <h3>Patients or Participants</h3> 30 years- old female with a history of primary cesarean section which was complicated by postoperative infection. She presented with a history of secondary infertility of 5 years duration and was found to have a right hydrosalpinx and a patent left fallopian tube on hysterosalpingogram. <h3>Interventions</h3> Minimally invasive preservation of the left fallopian tube was done by performing neosalpingostomy instead of salpingectomy. <h3>Measurements and Main Results</h3> The patient conceived spontaneously after two <i>months,</i> and she is currently at 14 weeks gestation. <h3>Conclusion</h3> Minimally invasive neosalpingostomy in selected patients with unilateral hydrosalpinx can increase the chances of spontaneous pregnancy by eliminating the unfavorable effect of the hydrosalpinx.

Robotic Fallopian Tubo-Uterine Implantation

<h3>Study Objective</h3> The objective of this video is to demonstrate the robotic and hysteroscopic surgical technique for implanting the distal fallopian tube to the proximal uterine cornua in a patient with bilateral fallopian tubal occlusion. This is an alternative option to surgically manage infertility other than via in vitro fertilization. <h3>Design</h3> Surgical video recording of hysteroscopic and robotic steps to implant the fallopian tube to the uterine cornua, with fallopian tube patency confirmation. <h3>Setting</h3> Operating Room. <h3>Patients or Participants</h3> 33-year-old G0 female with bilateral proximal fallopian tube occlusion and suspected endometriosis. She declined in vitro fertilization and desired surgical management. <h3>Interventions</h3> Robotic fallopian tube implantation at the uterine cornua using hysteroscopic assistance and chromopertubation confirming tubal patency. <h3>Measurements and Main Results</h3> Fallopian tube anastomosis is an option for patients who desire a surgical option to help achieve fertility with tubal factor infertility. This technique can achieve up to 80% success rate in pregnancy. With appropriate counseling, patients should be given this option when discussing tubal factor infertility. <h3>Conclusion</h3> Fallopian tube anastomosis can be a more cost-effective option than in vitro fertilization if a patient only has tubal factor infertility or does not desire to undergo assisted reproductive technologies with IVF. This approach is efficient and effective to treat tubal factor infertility and patency of the tube is confirmed during the procedure. Patients can begin trying for pregnancy shortly after their first post operative visit.

The Prevalence of Fallopian Tube Occlusion in Women with Polycystic Ovary Syndrome Seems Similar to Non-Subfertile Women: A Retrospective Cohort Study.

There are limited data on how non-infectious risk factors influence tubal patency in women with subfertility. With hormonal shifts influencing tubal secretions, it has been argued that subfertile women with polycystic ovary syndrome (PCOS) have lower tubal patency. In a retrospective study, 216 women, who underwent diagnostic evaluation for PCOS and infertility, were included. Fallopian tube patency was tested using HSG, HyCoSy, and laparoscopic chromopertubation in 171 (79.2%), 28 (13.0%), and 17 (7.9%), respectively. Bilateral patency was found in 193 women (89.4%), unilateral patency in 13 (6.0%) and bilateral occlusion in 10 (4.6%) patients. Women with PCOS phenotypes C (odds ratio, OR 0.179, 95% CI: 0.039–0.828) and D (OR 0.256, 95% CI: 0.069–0.947) demonstrated lower risks for Fallopian tube occlusion. In conclusion, our data suggest that about 5% of infertile women with PCOS also have bilateral tubal occlusion, which seems similar to the rate in non-subfertile women. With 11% of participants having unilateral or bilateral tubal occlusion, this should reassure women with PCOS that their hormonal challenges do not seem to increase their risk for tubal factor subfertility.

Probability of Pregnancy With Mono vs Multiple Folliculogenesis in Women With Unexplained Infertility.

Ovarian stimulation (OS) increases pregnancy rates but can cause multiple folliculogenesis and multiple pregnancy. To determine whether the probability of pregnancy differs in OS cycles with mono- vs multifolliculogenesis in women with unexplained infertility (UI). Secondary analysis of a multicenter, randomized controlled trial: Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation with 3 treatment arms: gonadotropins, clomiphene, or letrozole, combined with intrauterine insemination. Women were categorized as having either 1 or ≥ 2 mature follicles (≥ 16 mm). Relative risk (RR) and 95% CIs for clinical pregnancy and live birth by number of follicles were estimated using generalized linear models adjusted for age, body mass index, years of infertility, and history of prior live birth. 12 US-based clinical sites. Normally cycling women aged 18 to 40 years with a normal uterine cavity and at least 1 patent fallopian tube. Male partners with ≥ 5 million total motile sperm. Gonadotropins, clomiphene, or letrozole with insemination. Clinical pregnancy rates (CPR) and live birth rates (LBR). A single mature follicle > 16 mm resulted in lower CPR (RR, 0.70; 95% CI, 0.54-0.90) and LBR (RR, 0.67; 95% CI, 0.51-0.89) compared with ≥ 2 mature follicles. When stratified by treatment modality, no association of follicle number with CPR or LBR was observed for letrozole or clomiphene, but women using gonadotropins had lower CPR and LBR with monofolliculogenesis. In couples undergoing gonadotropin treatment for UI, monofolliculogenesis following OS is related to a lower rate of live birth.

P-732 Definitions and diagnostic criteria for unexplained infertility (UI) – a systematic review

Abstract Study question What are the various inclusion criteria for the definition of unexplained infertility used for recruitment to clinical trials, and is there homogeneity of these definitions? Summary answer There is a need to standardise the definition of unexplained infertility when recruiting for clinical trials to optimise interpretation of results and allow appropriate meta-analysis. What is known already Unexplained infertility (UI) is a diagnosis of exclusion. The pathology underlying this diagnosis is likely to include different subtle contributing factors. Unfortunately there is no universally accepted definition of unexplained infertility. NICE in the UK, and ACOG/ASRM both have lists of recommended investigations but no specific minimum standards to define UI. Even the ICMART definition is ambiguous, describing ‘apparently normal’ ovarian function and ejaculate. This may lead to heterogeneity between inclusion criteria in relevant research studies. This introduces selection bias and renders meta-analysis of trial results less meaningful. A single definition would improve the quality of research for this important diagnosis. Study design, size, duration A systematic review of primary research investigating definitions of unexplained infertility in humans. A thorough search of online databases Medline and Embase was performed from inception to November 2021. A bespoke Excel spreadsheet was used to collect data for baseline study characteristics and outcome data. Results are reported as percentages. Participants/materials, setting, methods The search strategy included all primary research on heterosexual couple unexplained infertility in human participants. Papers with specified inclusion criteria were included and no date or language restrictions were applied. From 663 results, title and abstract screening identified 83 duplicates and 6 studies unsuitable for the review. A further 275 papers were excluded after full-text screening. 241 papers remained and their inclusion criteria recorded and analysed. Main results and the role of chance Only 35.7% of papers specified duration of infertility. Timescales varied from 1 year (46.5%), 2 years (39.5%) or 3 years (14%). 85% papers specified that semen analysis should be ‘normal’. Of these, 40% used the most recent WHO criteria. No other national or international criteria for grading semen analysis was identified. 90% studies required fallopian tube patency as an inclusion criteria. Of these, 65.4% specified bilateral patency. Methods for demonstrating patency included hysterosalpingogram (HSG) (15.7%), laparoscopy (18.4%), a combination of either (29.5%) or both (24.4%) of these or hystero-contrast-salpingography (0.9%). 11.5% papers did not specify an imaging modality. 48.5% included studies mentioned uterine cavity assessment, 65% of these using HSG to assess the cavity, other methods mentioned include ultrasound (26.5%) or hysteroscopy (15.4%). Only 5.4% papers required either exclusion of or evidence of only minimal endometriosis 80.5% of included papers required evidence of regular ovulation. 58.7% used luteal serum progesterone levels, 41.2% required regular cycles (patient-reported) and 17.5% used basal body temperature pattern assessment. Other methods mentioned by a minority of papers include endometrial biopsy, ultrasound follicular tracking, serum and urinary luteinising hormone levels. 44% studies required normal endocrine profiles of which 66% measured prolactin and FSH and 50% measured thyroid function. Limitations, reasons for caution The strength of this study is that we included all primary research papers studying unexplained infertility with no time limitations. Included studies originated from across the world. This is a thorough representation of criteria used across all clinical trials for unexplained infertility. Wider implications of the findings Only 63/241 (26%) studies included duration of infertility, tubal patency, proof of ovulation and semen analysis in their inclusion criteria. This demonstrates the need for standardisation of the definition of unexplained infertility. If future research can apply the same inclusion criteria this will reduce selection bias and allow appropriate meta-analysis. Trial registration number NA

Lipiodol flushing under ultrasound guidance at time of hystero-salpingo contrast sonography (HyCoSy): A retrospective observational study.

Up to 30% of female infertility can be attributed to tubal abnormalities. Assessment of fallopian tube patency forms a component of the basic assessment of infertility. Tubal patency can be checked through hysterosalpingogram (HSG) under radiologic guidance with oil- or water-based contrast medium (OBCM or WBCM), or hystero-salpingo contrast sonography (HyCoSy) under ultrasound guidance with WBCM. Tubal flushing with OBCM has been shown to improve fertility rates. To study the feasibility and tolerability of performing Lipiodol (ethiodised oil) flush concurrently with HyCoSy. To examine the in vivo sonographic visibility of Lipiodol vs normal saline. Retrospective observational study of patients with subfertility referred for Lipiodol flushing under ultrasound guidance between August 2017-September 2020 at six private ultrasound practices in Sydney, Australia. There were 412 patients who were referred for Lipiodol flushing. Of these, 86 patients did not have concurrent Lipiodol flush at HyCoSy performed due to strict exclusion criteria. Of the 326 patients who proceeded with Lipiodol flushing at HyCoSy, all cases were successful, with no cases of extravasation. There were no major complications. In vivo sonographic visualisation of Lipiodol was similar to that of the commonly used agitated 0.9% saline (n=20; mean visibility score 4.3 ± 0.9 vs 4.0 ± 1.2). Our study has shown that Lipiodol flushing at time of HyCoSy as a single procedure is feasible and tolerable to patients. Flushing with Lipioidol during HyCoSy is likely as sonographically visible as 0.9% saline.

Could laparoscopic cystectomy improve intrauterine insemination with controlled ovarian hyperstimulation outcomes in women with endometrioma?

To clarify the effects of laparoscopic cystectomy of endometriomas on intrauterine insemination with controlled ovarian hyperstimulation (COH + IUI) success in women with the disease. We performed a retrospective study with endometrioma patients having at least one patent fallopian tube. The study group consisted of 57 infertile patients with a history of laparoscopic cystectomy who underwent 83 COH + IUI cycles. The control group consisted of 88 patients with endometrioma who underwent 161 COH + IUI cycles without surgery. The total number of antral follicles was significantly lower in the study group than in the control group (10.1 ± 5.1 vs 11.9 ± 5.0; p = 0.008). No significant difference was observed in the clinical pregnancy and live birth rates per cycle ((9.6% vs 7.6%; p=0.7175 OR: 1.195% CI: 0.6-2.1) and (7.2% vs 6.2%; p = 0.9544 OR: 1.1 95% CI: 0.5-2.1), respectively) between the operated and non-operated groups. The results of the study show that the presence of an endometrioma with at least one patent fallopian tube does not require any cystectomy before COH+IUI treatment because no improvement was observed in the treatment outcomes of the patients who underwent preceding surgery. We conclude that an operation may be taken into consideration when malignancy cannot be ruled out or severe pelvic pain related to endometrioma cannot be relieved.

Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility

Hysterosalpingo-contrast sonography (HyCoSy) is the preferred method for evaluating fallopian tubal patency, and it is associated with improved rates of natural pregnancy among infertile patients. However, the mechanism underlying the improvement in pregnancy rates following HyCoSy remains unclear. This study aimed to investigate the effect of HyCoSy examination on endometrial receptivity as well as pregnancy rates among infertile women. This prospective study included 120 women with unexplained infertility who visited our department between June 2018 and February 2021. These patients were classified into the study group (n = 60) and the control group (n = 60) depending on their willingness to undergo three-dimensional HyCoSy in the present cycle (study group) or 6months later (control group). Endometrial characteristics, including endometrial thickness and pattern as well as the endometrial blood flow distribution pattern, were measured twice by transvaginal Doppler ultrasonography in the preovulatory phase before and after HyCoSy examination. Participants were followed for 6months to observe the outcome of spontaneous conception. Compared with the control group, the study group had a significantly higher cumulative pregnancy rate at 6months after HyCoSy (21.6% [13/60] vs 5.0% [3/60], P = 0.007). More patients in the study group showed improved endometrial blood flow distribution (P = 0.021, χ2 = 7.699), but no differences in endometrial thickness and pattern were observed between the groups (P > 0.05). HyCoSy examination may improve endometrial perfusion and has a therapeutic effect on improving spontaneous pregnancy among women with unexplained infertility.

Unicornuate Uterus with Noncommunicating Rudimentary Horn (Class U4aC0V0/ESHRE/ESGE Classification) and a Communicating Bladder Endometriotic Nodule

To describe the diagnostic workup and laparoscopic management of a noncommunicating left uterine rudimentary horn (class U4aC0V0 European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) with communicating endometriotic bladder nodule. Step-by-step description of the surgical treatment. A 33-year-old woman with unicornuate uterus and a left-side noncommunicating rudimentary horn affected by primary infertility, mild dysmenorrhea (visual analog scale score 6), severe catamenial dysuria (visual analog scale score 10), and catamenial hematuria. Noncommunicating rudimentary horns are rare Müllerian anomalies present in 20% to 25% of women with a unicornuate uterus. It is associated with severe dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes and usually presents with cyclic pelvic pain that starts early after the menarche. Endometriotic bladder nodules are present in 1% to 2% of patients with endometriosis. In the literature, there are no reported cases of noncommunicating rudimentary horn with communicating endometriotic bladder nodules. Surgical excision of the rudimentary horn is the treatment of choice. In our case, the 2-dimensional/3-dimensional ultrasound revealed a right unicornuate uterus with a left noncommunicating rudimentary horn with hematometra. The uterine fundus presented «gamma sign» vascularization. In addition, a bladder endometriotic nodule (16×15 mm) communicating with hematometra was displayed. Magnetic resonance imaging demonstrated no additional malformations. Diagnostic hysteroscopy revealed a single cervix without vaginal malformation and small right uterine cavity with single tubal ostium. At laparoscopy, using hysteroscopic transillumination, a clear plane of dissection was identified between the rudimentary horn and the uterus confirming the presence of a noncommunicating horn. Evaluation of the abdominal cavity showed bilateral normal adnexa with normal ovaries. Chromopertubation showed a patent right Fallopian tube and obstructed left tube. A left salpingectomy using bipolar and the ultrasonic energy was performed. The utero-ovarian ligament was transected, and the left ovary was preserved. The left ovary was suspended at the pelvic wall, the retroperitoneum was opened, the ureter was identified, and the left uterine artery was temporary occluded. The left round ligament was transected and the left paravesical space was developed. With a lateromedial approach, we opened the vesicouterine septum to dissect the bladder from the rudimentary horn. The endometriotic bladder nodule was gently detached from the uterine horn with a lateromedial approach. The left uterine artery was coagulated and dissected at level of the cervix. A solution of vasopressin was injected between the uterine horn and the uterus. Resection of the rudimentary horn was performed. The peritoneum was closed. The temporary occlusion of the uterine artery was removed. The specimen was placed in a bag and removed using an extracorporeal tissue extraction technique. The late clinical presentation of our patient with only mild dysmenorrhea could be explained by the drainage of the hematometra from the noncommunicating horn into the endometriotic bladder nodule. The bladder symptoms in patients with Müllerian anomalies should be carefully investigated. The laparoscopic removal of rudimentary horn with mobilization of communicating bladder nodule when present is a safe and feasible method to improve symptomatology.

Is Hysterosalpingo-Contrast Sonography (HyCoSy) Using Sulfur Hexafluoride Microbubbles (SonoVue) Sufficient for the Assessment of Fallopian Tube Patency? A Systematic Review and Meta-Analysis.

This study aimed to evaluate the diagnostic value of HyCoSy using sulfur hexafluoride microbubbles for fallopian tubal patency assessment in infertile females. Twenty-four studies, including 1358 females with 2661 detected fallopian tubes published from January 2003 to May 2019, were identified. The pooled sensitivity was 93% (95% CI: 90-95%), while the specificity was 90% (95% CI: 87-92%). The area under the receiver-operating characteristic curve was 0.96 (95% CI: 94-98%). The specificity of the four-dimensional HyCoSy subgroup was higher than the 2D/3D subgroup; an increased dose of contrast agent did not affect the specificity, with only a slightly reduced sensitivity.

Development of a Nomogram for Predicting Intravasation Before Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography

BackgroundIntravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) may lead to false-negative results in tubal patency evaluation. Although the influencing factors associated with intravasation have been investigated, some factors are only identified during 4D-HyCoSy, thus currently no studies on preventing intravasation. However, several preprocedural features can be collected in advance, which may be valuable in predicting intravasation.ObjectiveThe purpose of this study is to establish a nomogram incorporating the preprocedural features to predict the risk of intravasation before TVS 4D-HyCoSy.MethodsThe data of 276 infertile women with patent fallopian tubes were analyzed retrospectively. They were assigned to the study group (n = 62) and the control group (n = 214) according to the development of intravasation. The preprocedural characteristics were collected to investigate the predictors independently associated with intravasation, which were then served as the construction of a nomogram. The performance of the nomogram was verified internally.ResultsHistory of uterine curettage (OR = 2.341, P = 0.009), endometrial thickness (OR = 0.587, P < 0.001), and examination schedule (OR = 0.790, P = 0.024) were found to be the independent influencing factors associated with intravasation. The established nomogram incorporating these preprocedural features was useful for predicting the risk of intravasation prior to 4D-HyCoSy. It yielded net benefits when the predicted probability was less than 50%.ConclusionThe nomogram incorporating the preprocedural characteristics achieved a net benefit for clinical decision-making when the estimated risk was less than 50%. It is recommended to change the examination schedule for patients with an estimated risk greater than 50% and perform 4D-HyCoSy when the risk is less than 50%.

Study on Compliance Rate and Sensitivity of Transvaginal Uterine Fallopian Ography in the Evaluation of Fallopian Tube Patency

Study on Compliance Rate and Sensitivity of Transvaginal Uterine Fallopian Ography in the Evaluation of Fallopian Tube Patency

Fallopian tube patency diagnosed by laparoscopic chromopertubation in women with polycystic ovarian syndrome and non-subfertile controls: a retrospective case-control study

Background: Hyperandrogenism has been associated with tubal dysfunction. Previous studies have not used non-subfertile controls when assessing hyperandrogenic women through laparoscopic chromopertubation (LC), the gold standard for tubal patency testing. Methods: The objective of this retrospective study was to compare the results of LC between women with medication-resistant anovulatory polycystic ovary syndrome (PCOS, n = 202) and non-subfertile women with ovarian cysts (controls, n = 48). Results: There were no statistically significant differences between PCOS women and controls for the prevalence of bilateral tubal occlusion (2.5% versus 4.2%, respectively; p = 1.000) or overall rates for occlusion (7.4% of tubes assessed versus 6.3%, respectively; p = 0.828). More PCOS patients needed high pressure chromopertubation to demonstrate bilateral tubal patency than controls (12.4% versus 2.1%; p = 0.036). In the PCOS group, patients needing higher pressure to achieve patency demonstrated higher testosterone levels than women requiring typical pressure (0.66 ± 0.17 versus 0.47 ± 0.24 ng/mL; p = 0.001). Conclusions: For women with ovarian cysts and without subfertility, six percent of all Fallopian tubes are occluded. PCOS patients have similar rates of tubal occlusion, making these women a reasonable but more available control group for LC studies. Higher total testosterone levels were associated with higher LC pressures to demonstrate bilateral patency.

Perfecting hysterosalpingography: Limitations to the use of disposable balloon catheter and its solution.

To revive the use of the Kahn Uterine Trigger Cannula to overcome limitations associated with technical difficulties during hysterosalpingography (HSG) using the disposable balloon HSG catheter. A case series was conducted of 17 patients who encountered technically difficult or incomplete HSG study while using a disposable HSG balloon catheter, also leading to false-positive findings. Nine patients underwent a repeat HSG using a Kahn Uterine Trigger Cannula (Group 1). Eight patients underwent diagnostic laparoscopy and tubal perfusion testing using a Kahn Uterine Trigger Cannula (Group 2). The findings for each group in comparison to their initial HSG results using the disposable balloon HSG catheter are described. All patients were noted to have patent fallopian tubes using a Kahn Uterine Trigger Cannula on repeat HSG or tubal perfusion testing during laparoscopy. Providers who perform HSG studies should be familiar with the value of a Kahn Uterine Trigger Cannula when the traditional use of disposable HSG balloon catheter fails due to technical difficulty or incomplete study. The use of the Kahn Uterine Trigger Cannula in such situations can prevent inaccurate assessment and unnecessary interventions.

Improvement of fertility outcomes using dexamethasone / antibiotic adjuvant therapy following hysterosalpingography in infertile females: A randomised trial.

Objectives:To evaluate the benefit of modified hydrotubation with dexamethasone and antibiotics after hysterosalpingography in improving pregnancy rates in women with infertility issue.Methods:This retrospective study conducted at County Emergency Clinical Hospital Oradea, Bihor, Romania, between January 2017 and December 2019. One hundred twenty infertile females were investigated, as part of their evaluation, Hysterosalpingography was performed. After the investigation 97 patients had taken utero-tubal instillations with (Ceftriaxone 1 gr. [Cefort] and 4 mg of Dexamethasone, Lidocaine 1% 10 ml, and a Sodium chloride 0.9% 10 ml), and 23 patients were included in the control group which didn’t receive utero-tubal instillations. Number of obtained pregnancies by natural way over the next year was compared in the two groups.Results:From all participants in this study, 30 women became pregnant during the study. In addition, 29 out of 30 pregnant women had taken hydrotubation procedure. The significant statistical difference was observed between the groups p=0.011 (p<0.05), and the odd ratio was less than one (OR=9.3, 95%, CI: 1,207 to 72.926). We also found an indirect correlation between abortion in the past and the pregnancy ratio (r=-0.21).Conclusion:The results of the study demonstrated that the application of modified hydrotubation with the administration of dexamethasone and antibiotics in patients who had at least one patent fallopian tubes, can increase the chance of fertility.

Therapeutic Mechanism and Clinical Observation of Traditional Chinese Medicine Combined with Interventional Recanalization for Tubal Infertility.

To observe the clinical effect of traditional Chinese medicine (TCM) combined with interventional recanalization therapy in the treatment of tubal obstructive infertility, first, different treatment approaches were used on rabbits, and transmission electron microscopy (TEM) indicated that interventional recanalization combined with TCM can significantly ameliorate the pathological condition of the fallopian tube after treatment. Moreover, ELISA disclosed that the treatment could significantly reduce the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) and increase the expression of interleukin-10 (IL-10), which demonstrated that TCM therapy can help against inflammation of the fallopian tubes. PCR array analysis revealed that BMP4, BMPR1A, SMAD2, SMAD3, SMAD4, and KLF10 expressions were upregulated, and SMAD7 expression was downregulated, proving that combined treatment could influence gene expression in the TGF-β family and further regulate the secretion of proteins in SMADs. In addition, a clinical study recorded the fallopian tube patency rate of 165 patients after 12 months. The recanalization rates in the two groups were 81.9% and 53.1%, with the higher rates in the combined medicine enema group. All these findings implied that interventional recanalization combined with TCM preparation has a stronger effect. The mechanism probably involves effects on the expression of genes in the TGF-β/SMAD and BMP/SMAD signaling pathways, with simultaneous regulation of inflammatory factors, thereby improving the ovarian environment and increasing pregnancy rates.