Hysterosalpingography Procedures Research Articles

Hysterosalpingography Investigation Versus Patients’ Radiation Dose Risk

Background: Hysterosalpingography (HSG) is a useful radiographic investigation involving the use of contrast medium for the management of infertility in females. It is however, not only a costly procedure but it is also a semi-invasive procedure and carries some radiation risks. One principle of radiation protection is justification of practice which means that the overall benefit of the procedure should outweigh the radiation risks. The aim of this study was to determine justification of HSG procedure by assessing the rate and pattern of pregnancy success among infertile women who underwent HSG procedures at a tertiary hospital in South Eastern Nigeria between 2016 and 2020. Methods: a retrospective cross-sectional study of a sample of 222 women, aged 20-46years (mean 32,55 ±8,16years) who underwent HSG examination at the hospital between 2016 and 2020 was made. The data of eligible subjects were collected from the archives of radiology department of the hospital. Results: The result showed that 121 (54,5 %) out of 222 of the patients achieved pregnancy with proper follow up infertility management. Of the 121, 48(39,67 %) were in the 25-29 years age group and 35(28,93 %) in the 30-34years age group. The commonest pathology found was uterine fibroid 71(32,0 %), followed by tubal blockage, 42(18,92 %) while the least occurring pathology was salpingitis isthmica nodosa 1(0,45 %). Conclusion: there was a strong positive correlation between the age of patient, the HSG findings and the rate of pregnancy success. The procedure is justified in all the age groups except for the >45years group

Diagnostic Approaches in Nuclear Medicine for Reproductive Health Assessment: Hysterosalpingography in Radiology versus hysterosalpingoscintigraphy.

Infertility is a significant aspect of reproductive health and evaluating degree of tubal pathology is essential for determining appropriate management plans. To assess the role of hysterosalpingoscintigraphy (HSSG) as a tubal patency test in nuclear medicine and compare it with hysterosalpingography (HSG) in radiology in infertile women and study pain perception in both tests as well. A prospective study was conducted on 50 infertility patients undergoing infertility evaluation at a tertiary care hospital. Both HSG and HSSG procedures were performed during proliferative phase of menstrual cycle. Our study demonstrated the potential of HSSG as a tool for evaluating tubal patency in infertility workup. It showed good accuracy in detecting tubal patency compared to HSG. HSG is a radiological procedure valued for its ability to provide detailed anatomical information of uterus and patency of fallopian tubes. In contrast, HSSG provides dynamic information on the functional aspects of the reproductive system using nuclear medicine techniques. Both HSG and HSSG are vital tools in the diagnostic armamentarium for assessing female reproductive health, offering complementary information that aids in comprehensive patient management.

Evaluation of Cytogenetic Damage Induced during Hysterosalpingography Procedure: A Cross-sectional Study

Introduction: Hysterosalpingography (HSG) is a radiographic procedure used to visualise the fallopian tubes and uterine cavity by injecting a contrast medium, commonly employed for diagnosing infertility cases. However, due to the associated radiographic and fluoroscopic exposure, there is an increased risk of chromosomal damage to the gonads. Aim: To investigate the impact of radiographic and fluoroscopic exposure on chromosomal integrity in peripheral blood lymphocytes using the Cytokinesis Blocked Micronucleus (CBMN) assay. Materials and Methods: This cross-sectional time-bound study included 10 patients (n=10) scheduled for HSG procedures at the Department of Radiology, Justice KS Hegde Hospital, Mangaluru, Karnataka, India from April 2021 to March 2022. Following radiation exposure, the CBMN assay was conducted to evaluate chromosomal damage in both test and control group blood samples. Blood samples from healthy donors were divided into three cryo vials, with one serving as the control and the remaining two exposed to radiation at the entrance and exit areas during the HSG procedure. The data were expressed as mean±Standard Deviation (SD). A p-value <0.05 was considered statistically significant. The analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: A statistically significant (p<0.05) increase in biological damage was observed when comparing the Micronucleus (MN) frequency of the test groups (entrance=0.022±0.005 and exit group=0.0172±0.005) with the control group (0.006±0.003). Additionally, a decrease in MN frequency was noticed within the test groups, particularly in the exit group, although the results were not statistically significant (p=0.066). Conclusion: The HSG is an effective clinical diagnostic technique. However, the present study indicates a potential risk of chromosomal damage associated with the procedure, emphasising the need for judicious use of radiation exposure during HSG.

Effects of virtual reality and nature sounds on pain and anxiety during hysterosalpingography: a randomized controlled trial.

The objective of this study was to determine the effects of listening to nature sounds alone and virtual reality plus listening to nature sounds on pain and anxiety in hysterosalpingography. This three-arm parallel randomized controlled trial included 135 (45 in each group) women who underwent hysterosalpingography in Turkey. The virtual reality+nature sounds group viewed a nature video with virtual reality glasses and listened to nature sounds during hysterosalpingography, whereas the nature sounds group only listened to nature sounds. The control group received only routine care. During hysterosalpingography, women in virtual reality+nature sounds group experienced less pain than those in control group (p=0.009). After hysterosalpingography, pain levels were lower in both virtual reality+nature sounds group and nature sounds group than in control group (p=0.000 and p=0.000, respectively), anxiety levels were lower in virtual reality+nature sounds group than in nature sounds group and control group (p=0.018 and p=0.000, respectively), and anxiety levels were lower in nature sounds group than in control group (p=0.013). Virtual reality with nature content plus listening to nature sounds and only listening to nature sounds are effective in reducing pain and anxiety related to hysterosalpingography procedures in women. Compared with only listening to nature sounds, virtual reality plus listening to nature sounds further reduced hysterosalpingography-related pain and anxiety.

Use of Hysterosalpingo-Foam Sonography for Assessment of the Efficacy of Essure Hysteroscopic Sterilization.

Hysterosalpingo-foam sonography (HyFoSy) has been suggested to be a possible less invasive alternative to hysterosalpingography (HSG), which is the reference standard for confirmation of tubal occlusion after Essure (Bayer AG, Leverkusen, Germany) hysteroscopic sterilization. The purpose of our study was to evaluate the accuracy of HyFoSy compared to HSG for confirmation of tubal occlusion after Essure hysteroscopic sterilization. A prospective study included 90 patients who underwent Essure hysteroscopic sterilization. Twelve weeks after the sterilization, 2-dimensional transvaginal ultrasonography was performed to assess the microinsert position and was followed by HyFoSy and HSG for evaluation of tubal occlusion. Patients with patent fallopian tubes on HSG were scheduled for additional HSG procedures at 3-month intervals until tubal occlusion was documented. Of 90 enrolled patients, 86 patients with 170 fallopian tubes underwent the complete imaging protocol. Tubal occlusion was evaluated by HyFoSy as an index test and HSG as a reference standard. The accuracy of HyFoSy was 97.1% (95% confidence interval [CI], 93%-99%). The sensitivity and specificity were 100% (95% CI, 97%-100%) and 54.6% (95% CI, 23%-83%), whereas the positive and negative predictive values were 97.0% (95% CI, 93%-99%) and 100% (95% CI, 42%-100%), respectively. No long-term complications were reported for HyFoSy or HSG. Given that the concordance rate for tubal occlusion between HyFoSy and HSG was not 100%, an occluded fallopian tube on HyFoSy should be confirmed by HSG, which remains the reference standard for confirmation of tubal occlusion after Essure hysteroscopic sterilization.

Monte Carlo based estimation of organ and effective doses to patients undergoing hysterosalpingography and retrograde urethrography fluoroscopy procedures

Contrast investigations of hysterosalpingography (HSG) and retrograde urethrography (RUG) fluoroscopy procedures remain the dominant diagnostic tools for the investigation of infertility in females and urethral strictures in males, respectively, owing to the scarcity and high cost of services of alternative diagnostic technologies. In light of the radiological risks associated with contrast based investigations of the genitourinary tract systems, there is a need to assess the magnitude of radiation burden imparted to patients undergoing HSG and RUG fluoroscopy procedures in Tanzania. The air kerma area product (KAP), fluoroscopy time, number of images, organ dose and effective dose to patients undergoing HSG and RUG procedures were obtained from four hospitals. The KAP was measured using a flat transmission ionization chamber, while the organ and effective doses were estimated using the knowledge of the patient characteristics, patient related exposure parameters, geometry of examination, KAP and Monte Carlo calculations (PCXMC). The median values of KAP for the HSG and RUG were 2.2Gycm2 and 3.3Gycm2, respectively. The median organ doses in the present study for the ovaries, urinary bladder and uterus for the HSG procedures, were 1.0mGy, 4.0mGy and 1.6mGy, respectively, while for urinary bladder and testes of the RUG were 3.4mGy and 5.9mGy, respectively. The median values of effective doses for the HSG and RUG procedures were 0.65mSv and 0.59mSv, respectively. The median values of effective dose per hospital for the HSG and RUG procedures had a range of 1.6–2.8mSv and 1.9–5.6mSv, respectively, while the overall differences between individual effective doses across the four hospitals varied by factors of up to 22.0 and 46.7, respectively for the HSG and RUG procedures. The proposed diagnostic reference levels (DRLs) for the HSG and RUG were for KAP 2.8Gycm2 and 3.9Gycm2, for fluoroscopy time 0.8min and 0.9min, and for number of images 5 and 4, respectively. The suggested DRLs for the HSG and RUG procedures may be used by the radiology departments in Tanzania for management of attained dose levels until the national DRLs are established.

Venous Intravasation as a Complication and Potential Pitfall During Hysterosalpingography: Re-Emerging Study with a Novel Classification

Objectives:Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation.Materials and Methods:This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software.Results:Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation.Conclusions:Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.

Cancer incidence risks to patients due to hysterosalpingography.

Cancer incidence estimates and dosimetry of 120 patients undergoing hysterosalpingography (HSG) without screening at five rural hospitals and with screening using image intensifier-TV at an urban hospital have been studied. Free in air kerma measurements were taken for patient dosimetry. Using PCXMC version 1.5, organ and effective doses to patients were estimated. Incidence of cancer of the ovary, colon, bladder and uterus due to radiation exposure were estimated using biological effects of ionising radiation committee VII excess relative risk models. The effective dose to patients was estimated to be 0.20 ± 0.03 mSv and 0.06 ± 0.01 mSv for procedures with and without screening, respectively. The average number of exposures for both procedures, 2.5, and screening time of 48.1 s were recorded. Screening time contributed majority of the patient doses due to HSG; therefore, it should be optimised as much as possible. Of all the cancers considered, the incidence of cancer of the bladder for patients undergoing HSG procedures is more probable.

The Effect of Flurbiprofen as Prophylactic Analgesic before Hysterosalpingography

Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

Radiation dose and risk assessment in hysterosalpingography

Hysterosalpingography is an important diagnostic method for the evaluation of the female reproductive tract involving the exposure of patients to ionizing radiation. The irradiation of ovaries is unavoidable and radiation exposure of the patient and the associated radiological risk for the foetus and born child during the period of growth should be considered, as well. The purpose of this work is to evaluate organ and patient doses and radiation risks during hysterosalpingography procedures performed in a dedicated gynecological hospital. The entrance surface air kerma was measured for a total of 31 patients during hysterosalpingography. Based on the results obtained, the radiogenic risk for hereditary effects and cancer induction was estimated. The patient dose levels are in the range of 3-15 mGy, with a median value of 10 mGy, in terms of entrance surface air kerma. Estimated median ovarian and uterus doses are 1.7 and 2.3 mGy, respectively. The risk for fatal cancer and hereditary effects is estimated to be 5.5?10-5 and 3.4 ?10-6, respectively. Although low compared to the natural incidence of genetic effects and cancer, it can be elevated in cases of prolonged or repeated procedures or procedures where the non-optimized protocol is used.

Efficacy ofFallopian tubecatheterization for treatment of infertility

Material and Methods: - Fluoroscopic transcervical fallopian tube catheterization was performed in two hundred and four patient with infertility in whom proximal tubal obstruction was documented by at least two hysterosalpingography procedures. Bilateral block in 147 and unilateral block was seen in 57 cases. All patients were submitted to selective salpingography, patients were followed up for six months at bimonthly interval. Results: - H.S.G revealed proximal tube obstruction in total of 264 tubes of these 258 tubes were successfully cannulated complete tubal patency was achieved in 249 cases. In 12 Cases recanalization was incomplete and hydrosalpinx was seen in 7 tubes. In six months follow up 72 out of 200 patients had pregnancy confirmed by material urine test for pregnancy and subsequent ultrasound examination. All pregnancies were intra uterine. Conclusion: - Fallopian tube catheterization is an effective procedure for infertility caused by proximal tubal obstruction.

Avulsion of the uterine cervix complicating hysterosalpingography in a hypo-oestrogenic woman

Hysterosalpingography (HSG) is used increasingly as a diagnostic tool in many developing countries. HSG serves as a valuable firstline screening test for the evaluation of infertile women and it may obviate the need for the more traumatic laparoscopy and dye test. The sensitivity of HSG for demonstrating abnormalities of the upper reproductive tract (uterus and tubes) has been reported to be as high as 90%. One important advantage of HSG over laparoscopy is its lower rate of complications especially in developing countries where competency in diagnostic laparoscopy has not been developed to any considerable extent. Indeed reports of complications resulting from HSG procedures are minor and few in the world literature. We report here a case of complete avulsion of the uterine cervix as a severe complication of HSG in a woman with evidence of hypooestrogenism. To date we have no evidence that such a complication of HSG has ever been reported in the literature. We believe that low oestrogen levels could render the cervical tissues susceptible to this rare complication of HSG. (excerpt)

Radiogenic risks from hysterosalpingography.

The aim of this study was to determine ovarian dose, effective dose and associated radiogenic risks from hysterosalpingography (HSG), and to provide data for the estimation of radiogenic risks related to HSG studies performed in any laboratory. The fluoroscopy time, number of radiographs taken and entrance surface dose were measured in a series of 78 consecutive patients undergoing HSG as part of their infertility work-up. Organ-dose values per radiograph and per minute of fluoroscopy were separately determined using an anthropomorphic phantom and thermoluminescence dosimetry. The radiogenic risk for deleterious effects on a possible future embryo and the radiogenic risk for cancer induction on the patient undergoing HSG were estimated. The average HSG procedure in our laboratory involves a mean fluoroscopic time of 0.3 min and a mean number of radiographs of 3.2. The dose to female gonads from an average HSG procedure was 2.7 mGy and the patient effective dose was 1.2 mSv. The risk for radiogenic anomalies in a future embryo of the woman undergoing an average HSG procedure and the risk for radiogenic fatal cancer induction in the exposed woman were estimated to be less than 10(-3) of the correspondent nominal risks. Radiation risks from a typical HSG are low, but they may be elevated if fluoroscopic and/or radiographic exposures are prolonged for any reason. Present data allow the estimation of radiogenic risks associated with HSG procedures performed in other laboratories with use of different equipment, screening time and number of radiographs taken.

Evaluation of the femtest device pre-and tost-sterilization

A study was conducted at the Universidad Austral, Valdivia, Chile, School of Medicine, to evaluate the safety, ease of use and effectiveness of the FemTest device ★ ★ FemTest is a registered trademark of BioNexus, Inc. Raleigh, NC. (FT), a new instrument to evaluate tubal patency. A total of 110 interval women were admitted to the trial between February 1985 and August 1986, all of whom wanted to be sterilized. The mean age of the women was 32.2 years and the mean number of live births was 3.1. Women underwent FT and hysterosalpingography (HSG) procedures pre- and post-sterilization in order to compare the results. Sixty-seven women were surgically sterilized and forty-three women were sterilized with transcervical application of methylcyanoacrilate. Complications and complaints experienced by the study participants included mild to moderate discomfort during FT procedures. Assessment of patient discomfort was not done during the HSG procedures. FT and HSG findings agreed in 97.2% of the women prior to sterilization. The simplicity and effectiveness of the FT procedure suggests it will be an excellent method to test for tubal patency after a nonsurgical female sterilization procedure.