Tuboperitoneal Factors Research Articles

Pattern of hysterosalpingographic findings among women with infertility in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Hysterosalpingography (HSG) is a radiological procedure that is routinely done for female fertility workup in most clinical settings. Hysterosalpingography (HSG) is primarily done to assess tubal patency, but it can detect cervical, uterine, and peritoneal diseases. As such, it remains a valuable tool in the evaluation of female infertility in our environment, where the high prevalence of infertility has been largely attributed to tubo-peritoneal factors. It was a retrospective cross-sectional descriptive study. A total of 215 HSG reports of women with infertility at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were reviewed retrospectively. Data on sociodemographic profile, reproductive profile, infertility profile, and HSG reports were obtained from the case records and archives of the Department of Radiology on a proforma. The obtained data was analyzed using SPSS version 20. Most of the clients were within the age range of 35 to 44 years. Secondary infertility accounted for 58.6% of cases of infertility. Abnormal HSG was reported in 70.2% of cases. Tuboperitoneal pathology was the most common abnormality, detected in 46% of cases. Uterine and cervical pathologies were seen in 38.1 and 15.3% of cases, respectively. A total of 116 (53.9%) of the cases had a combination of abnormalities. Abnormal HSG was significantly associated with secondary infertility and a history of induced abortion (p=0.006 and ˂0.001, respectively). Tuboperitoneal pathologies are still a common cause of infertility in our environment. HSG remains a valid tool for female infertility workup.

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as the Gold Standard

Objective: To evaluate the diagnostic validity of Sonosalphingography as a tubal patency test in infertile women using laparoscopy as gold standard. Methodology: This study was carried out at the Shifa International Hospital Islamabad, and the duration of this study was from January 2021 to June 2021. We used the WHO method for sample size by taking the prevalence of tuboperitoneal factors as 30%, sensitivity 72.9%, specificity 81.22%, margin of error 12%, and 95% confidence interval. It was a cross-sectional study that lasted for 6 months and assessed a total of 178 patients. Additionally, a non-probability, sequential sampling strategy was utilized to acquire the sample. Results: Our patients aged between 18-45 years, out of which 30% of the participants aged 18 to 25 years, 55% were between 26 and 35 years, and 15% were between 36 and 45 years. Standard deviation was 1.26, with a mean age of 27. The data collected from both the diagnostic tests was analyzed, diagnostic accuracy of Sonosalphingography was calculated as a sensitivity of 81%, specificity of 76%, positive predictive value of 90%, negative predictive value of 60%, and diagnostic accuracy of 79%. Conclusion: According to the results of our study, Sonosalphingography is a very helpful supplemental diagnostic tool for evaluating tubal disease in patients with infertility, though direct laparoscopic assessment is the gold standard. Sonosalphingography and laparoscopy can be used to evaluate patients with secondary infertility. This spares the patient from being exposed to radiations and the discomfort of contrast administration in HSG. Keywords: Diagnostic Accuracy, Sonosalphingography, Tubal Patency, Infertility, Laparoscopy

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Patency in Women with Infertility Taking Laparoscopy as Gold Standard

Background: Infertility is defined as the failure to conceive after 1 year of unprotected sexual intercourse in women less than 35 years of age and 6 months in women older than 35 years [1, 2]. It affects 10 to 15 % of the couples [1]. Abnormalities of fallopian tubes account for 35 to 40 % of the cases of infertility [3]. Sonosalpingography is a non-invasive, safe and cost- effective diagnostic technique which provides reliable diagnosis of tubal patency [4]. Objective: To evaluate the diagnostic validity of Sonosalpingography as a tubal patency test in infertile women using laparoscopy as gold standard. Methodology: This study was carried out at the Radiology Departments of Khyber Teaching Hospital and Kuwait Teaching Hospital in Peshawar. We used the WHO method for sample size by taking the prevalence of tuboperitoneal factors as 30%, sensitivity 72.9%, specificity 81.22%, margin of error 12%, and 95% confidence interval. It was a cross-sectional study that lasted for 6 months and assessed a total of 178 patients. Additionally, a non-probability, sequential sampling strategy was utilized to acquire the sample. Results: Our patients aged between 18-45 years, out of which 30% of the participants aged 18 to 25years, 55% were between 26 and 35years, and 15% were between 36 and 45years. Standard deviation was 1.26, with a mean age of 27. The data collected from both the diagnostic tests was analyzed, diagnostic accuracy of Sonosalpingography was calculated as a sensitivity of 81%, specificity of 76%, positive predictive value of 90%, negative predictive value of 60%, and diagnostic accuracy of 79%. Conclusion: According to the results of our study, sonosalpingography is a very helpful supplemental diagnostic tool for evaluating tubal disease in patients with infertility, though direct laparoscopic assessment is the gold standard. Sonosalpingography and laparoscopy can be used to evaluate patients with secondary infertility. This spares the patient from being exposed to radiations and the discomfort of contrast administration in HSG. Keywords: Diagnostic Accuracy, Sonosalpingography, Tubal Patency, Infertility, Laparoscopy

Ayurvedic Management of Recurrent Pregnancy Loss Due to Diminished Ovarian Reserve- A Case Report

The problem of infertility is increasing day by day due to current scenario of fast stressful and imbalanced life style. Infertility is defined as the failure to conceive after one year of regular unprotected coitus. Conception depends on the fertility potential of both the male and female partner. Ovulatory dysfunction, tubo-peritoneal factors, uterine factors, cervical and immunological factors, low ovarian reserve etc. contribute to female infertility or delayed conception. Ayurveda classics discussed the topic elaborately under the heading Vandhyata along with its Nidana (etiology), Samprapthi (etiopathogenesis), Bheda (types) and Chikitsa (treatments). According to Ayurveda infertility refers to the biological inability of a women of reproductive age group to conceive and unable to carry pregnancy to full term. Normal status of Garbha sambhava samagri, normal fuction of Vata, and Soumanasya are inevitable for Garbhadharana. This is a case report of 24year old female suffered from infertility due to recurrent pregnancy loss. Patient has hypothyroidism, diminished ovarian reserve and low AMH. Ayurveda IP and OP management including Ama pachana, Agni deepana, Sodhana karma, Samana karma etc., were adopted and patient conceived and delivered a healthy child. This article presented with recurrent pregnancy loss due to ovarian and uterine factors along with treatment approach in a view to explore for future research

Effects of a Polymorphism in the Promoter Region of the Follicle-Stimulating Hormone Subunit Beta (FSHB) Gene on Female Reproductive Outcomes

Follicle-stimulating hormone (FSH) is essential to the hypothalamic-pituitary-gonadal axis, playing a key role in human reproduction. It is a heterodimer comprised of a hormone-specific β-chain (FSH-β) that is associated with an α-chain. It exerts its biological activities by binding to the FSH receptor (FSHR). The β-subunit, which is encoded by the FSHB gene, is responsible for ensuring binding specificity to the FSHR. There is a promoter polymorphism in this gene, c.-211G>T (rs10835638), upstream of the transcription start site; and in vitro studies have reported that the T allele decreases FSHB transcription in gonadotrophic cells. Investigate the possible effects of the FSHB c.-211G/T polymorphism on hormonal profile and in in vitro fertilization (IVF)/intracytoplasmic sperm injection outcomes in normoovulatory Brazilian women. A cross-sectional study of 140 women (median age = 33 years [CI: 32-34]) with infertility mainly caused by male (n = 85) or tuboperitoneal (n = 55) factors. In this study we evaluated FSH, estradiol, luteinizing hormone (LH), progesterone, prolactin and anti-Mullerian hormone levels, and antral follicle counting (AFC). Genotyping was performed using the TaqMan real-time polymerase chain reaction methodology. The wild-type allele G was found in 86.4% and the polymorphic allele T in 13.6% of the women respectively. The TT genotype was not found in any women. Women carrying the GT genotype had a poorer response more frequently to controlled ovarian hyperstimulation when compared to individuals with the GG genotype (47.4% vs. 26.5%, p = 0.010), higher LH levels (3.1 IU/mL vs. 2.4 IU/mL, p = <0.001), lower AFC (8.0 vs. 10.0, p = 0.03), oocytes retrieved (3.0 vs. 5.0, p = 0.03), MII (3.0 vs. 4.0, p = 0.02), and embryos (2.0 vs. 3.0, p = 0.02). Despite these findings, no difference was observed in pregnancy rate. Our findings suggest that the FSHB c.-211G/T polymorphism may modestly alter some aspects of the female reproductive system, but they are not associated with significantly different IVF outcomes.

Comparison of Hysterosalpingography and Laparoscopy in Diagnosis of Tubal Occlusion

Background: Infertility is one of the most common conditions confronting Gynecologists and tubal factor is one of the most common causes of infertility. Hysterosalpingography and laparoscopy are used as methods for diagnosis of tubal patency in infertility. HSG is an OPD procedure and, for many years has been used as an invaluable procedure for diagnosis of tubal patency and intrauterine pathology in infertility. Laparoscopy is an invasive procedure and is used for evaluation of tuboperitoneal factors. Aims and objectives: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology in infertility in comparison to laparoscopy Methods: 60 patients of infertility were evaluated in the department of Gynecology and obstetrics, Government Lalla Ded Hospital ,Srinagar from April 2013 to August 2014. A prospective cross sectional study was performed. HSG was performed in the pre-ovulatory phase .Laparoscopy was performed under general anesthesia at least three months after HSG in the premenstrual phase. Diagnostic laparoscopy was considered as the reference standard in detecting tubal blockade and findings of hysterosalpingography were compared with laparoscopy. Results: All the patients in the study group were complaining of infertility. The total number of patients in this study was 60 in which 41 were in primary infertility group and 19 were in secondary infertility group. The age of patients was between 21 and 39 years. The average duration of primary infertility was 4.08 years and secondary infertility was 5.15 years. The sensitivity of HSG was 90.91% (95%CI: 76.43-96.86) and specificity was 77.78% (95%CI 59.24-89.39) with positive predictive value of 83.33% (95%CI 68.11-92.13) and negative predictive value of 87.50% (95%CI 69.0- 95.66),when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. The further advantage of laparoscopy is the possibility of visualization of some other pelvic abnormalities which may be the cause of infertility. In our study, in patients with tubal block, adnexal adhesions were found in 15 (45%), endometriosis in 8(25%) and suspected intratubal block in 10(30%). Conclusion: HSG is the first step diagnostic test for assessment of fallopian tubes. Although laparoscopy is more invasive than HSG, laparoscopy with chromotubation is the gold standard for diagnosis of tubal block, and for identifying periadnexal adhesions and endometriosis and thus to guide appropriate therapy.

Various factors for infertility in infertility clinic, Gynae Unit-I, Services Hospital, Lahore

The prevalence of various infertility factors in 683 case of infertility coming from various parts of country were studied at infertility clinic gynae unit-I Services Hospital, Lahore from June 1999 to December, 2003. Factors like age, type, duration of infertility were assessed of 683 cases, only 90 cases (13.2%) had complete follow up while 222 patients (32.5%) had incomplete follow up and 371 (54.3%) cases had only one booking visit. The various investigations performed to evaluate infertility factors are discussed in detail. The results are grouped into male and female factors and unexplained infertility. The male factor included semen abnormalities and coital problems while the female causes are grouped into ovulatory disorders, tuboperitoneal factors. The study revealed that ovulatory dysfunction was the most common factor and accounted for 40% (274) cases, followed by tuboperitoneal factor 32.7% (223 cases) and male factor was present in 22.3% (141patients). The prevalence of all these factors in o ur study correlated with prevalence quoted in literature.

FACTOR TUBÁRICO Y PERITONEAL DIAGNÓSTICO Y TRATAMIENTO

El factor tuboperitoneal afecta a más de 25 % de la población estéril. Durante los últimos 35 años, su tratamiento fue quirúrgico, tanto laparoscópico como laparotómico, obteniéndose resultados más que aceptables. Los éxitos en tratamientos con cirugía están ligados estrechamente al buen diagnóstico. La vigencia de la histerosalpingografía y de la laparoscopia está aún presente, pero ninguna toma el aspecto fisiomorfológico de la trompa, solo si es permeable o no. La salpingoscopia acerca un nuevo elemento para poder evaluar si el epitelio tubárico podrá tener posibilidades de actuar normalmente o no. Por último, se debe destacar el hecho de que pacientes con factores tuboperitoneales severos, o aquellos que fracasaron en su intento quirúrgico o que tienen una edad superior a los 38 años no deberían perder valioso tiempo a la espera de un resultado posquirúrgico, sino que deberían ser dirigidos hacia una fertilización in vitro lo antes posible.

Study of Combined Laparoscopic and Hysteroscopic Findings in 100 Cases of Infertility

ABSTRACT Objectives To study the role of combined diagnostic laparoscopy and hysteroscopy in evaluation of female infertility. To find out different factors associated with infertility. To provide concurrent therapeutic management. Materials and methods A total of 100 women underwent combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy during the period from January 2015 to December 2015 in the Obstetrics and Gynecology Department, Umaid Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India. Results Age ranged from 21 to 38 years, and mean age was 25.98 years. Abnormal laparoscopic findings were noted in 41% cases, abnormal hysteroscopy seen in 24% cases, and 17% cases showed abnormality in both. Bilateral tubal patency was demonstrated in 81% cases. Tubal blockage was bilateral in 5% and unilateral in 9% cases. In 2% cases, bilateral block with beaded appearance found suggestive of tuberculosis. Of total 100 cases, 12% cases were found to have endometriosis, 8% had polycystic ovarian syndrome (PCOS), chocolate cyst was found in 5% cases, and 7% had functional cyst of ovary. Pelvic adhesions were found in 15% patients. Myomas were found in 8% cases. Endometrial polyps were revealed in 5% and Asherman’s syndrome in 6% patients. Combined laparoscopy and hysteroscopy was diagnostic in 17% of cases, 41% were diagnosed through laparoscopy alone, 24% through hysteroscopy alone, while in 18% cases findings were normal. In our study, tuboperitoneal factors were responsible for infertility in 40% cases, ovarian factors in 26% cases, and PCOS in 8% cases. Conclusion In our study, 74% of the cases had some form of tubo-ovarian pathology, which makes laparoscopy an essential tool of infertility workup. Although hysteroscopy alone was diagnostic in 30% of cases, its simultaneous use with laparoscopy provides cost-effective, comprehensive, and single setup diagnostic aid in these kinds of patients. How to cite this article Jodha BS, Chawla P. Study of Combined Laparoscopic and Hysteroscopic Findings in 100 Cases of Infertility. Int J Gynecol Endsc 2017;1(1):5-10.

Surgical treatment of ectopic pregnancy associated with predisposing factors of tuboperitoneal infertility

Objective: We sought to study the advantages of laparoscopic conservative treatment and pelvic reproductive surgery in patients with ectopic pregnancy and predisposing factors of tuboperitoneal infertility. Material and methods: Patients who had undergone laparoscopic treatment for ectopic pregnancy were considered, with factors for tuboperitoneal infertility, while patients who underwent previous salpingectomy or assisted reproductive technology were excluded. The groups treated by salpingotomy (conservative) or salpingectomy (radical) were compared in terms of spontaneous intrauterine pregnancy rate, cumulative one-year pregnancy rate and recurrence of ectopic pregnancy. We considered patients treated with adhesiolysis, fimbrioplasty, and neosalpingostomy for tubal pathology as part of the fertility surgery group. Results: Among 41 considered patients, 21 (51%) underwent conservative laparoscopic management of ectopic pregnancy. Twenty patients (49%) had salpingectomy. Despite the treatment of tuboperitoneal infertility factors in both groups, the pregnancy rate was significantly higher in the conservative group than in the radical one (76% vs 25%, p < 0.05). The overall cumulative rate of ectopic pregnancy recurrence was 22% and no significant difference was found between conservative and radical treatment (p 0.645). Conclusions:Salpingotomy should be preferred in all patients with ectopic pregnancy associated with factors of tuboperitoneal infertility. Infertility surgery clearly cannot help patients treated with salpingectomy, who obtain lower spontaneous pregnancy rates than those of the conservative group.

Hysterosalpingiographic Findings Among Infertile Women in Uyo, South-Eastern Nigeria

Infertility is the most· common reason for gynaecological consultation in Nigeria and tubo-peritoneal factors are its leading cause. Hysterosalpingography has been advocated as the primary procedure for assessing tubal patency in infertile patients. This study evaluates hysterosalpingiographic findings among infertile women in Uyo, South Eastern Nigeria. Five hundred and eighty infertile patients aged between 18 and 42 years had hysterosalpingiography performed on them in the Radiology department of the University of Uyo Teaching Hospital, and a private radiological center both in Uyo,A a Ibom State Nigeriabetween 1st January 200 and 31st December 2005. Tubal occlusion was the most common pathology revealed in 45.5% of the patients followed by peritoneal adhesions (30.7%). One hundred and fifty patients (26.6%) had uterine fibroids, 22.8% had intrauterine synaechiae, 14.1% had hydrosalpinges and 1.0% of the patients had cervical incompetence. Only two patients had congenital anomalies ofthe uterus. Tubal occlusion and peritoneal adhesions were the most common pathological findings on hysterosalpingography. In our environment hysterosalpingography still remains an invaluable tool for assessing tubal patency in infertile patients.

Avaliação da concordância diagnóstica entre métodos não invasivos e endoscopia na investigação de infertilidade

OBJETIVO: avaliar a concordância entre os métodos não invasivos - queixa de dor pélvica, ultra-sonografia transvaginal (US-TV) e histerossalpingografia (HSG) e a endoscopia ginecológica no diagnóstico de fatores tubo-peritoneais responsáveis por infertilidade conjugal. MÉTODOS: foi realizado estudo do tipo corte transversal incluindo 149 pacientes inférteis submetidas à avaliação clínica, ultra-sonografia transvaginal, histerossonografia, histeroscopia e laparoscopia. Na avaliação de dor pélvica foram consideradas anormais a queixa de dor pélvica tipo dispareunia, dismenorréia ou dor acíclica e dor à mobilização do colo uterino e palpação de anexos. O exame ultra-sonográfico foi considerado alterado com os achados de alterações morfológicas anexiais ou uterinas (hidrossalpinge, miomas ou malformações uterinas). A histerossalpingografia foi considerada anormal na presença de alteração anatômica tubária e obstrução unilateral ou bilateral. Avaliou-se a concordância diagnóstica individual entre os diversos métodos não invasivos e a endoscopia por meio da análise kappa. RESULTADOS: a concordância entre dor pélvica, US-TV e HSG e avaliação endoscópica foi, respectivamente, de 46,3% (kapa=0,092; IC 95%: -0,043 a 0,228), 24% (kapa=-0,052; IC 95%: -0,148 a 0,043) e 46% (kapa=0,092; IC 95%: -0,043 a 0,228). Quando se considerou pelo menos um método não invasivo positivo, a concordância com a avaliação endoscópica foi de 63% (kapa=-0,014; IC 95%: -0,227 a 0,199). A sensibilidade e especificidade em predizer achados na endoscopia foram de 39,5 e 80% na presença de dor pélvica, de 14,5 e 72% na presença de alteração na US-TV, de 39,5 e 80% na presença de alteração na HSG e de 70,2 e 28% na presença de ao menos uma alteração na avaliação não invasiva. CONCLUSÃO: há fraca concordância diagnóstica entre os diversos métodos não invasivos e a endoscopia na investigação de infertilidade conjugal secundária a fatores tubo-peritoneais.

Eco in infertility. Inspection of pregnancy and delivery

During the period from 1996 to 2002, the IVF department of the Family Planning and Reproduction Center carried out IVF treatment in 2218 infertile patients. Based on many years of experience, the results of using this method are summarized, taking into account the modifications made to it, developed by the staff of the Center. Specific recommendations for the use of endosurgical methods for restoring natural fertility and IVF in cases of female infertility associated with tuboperitoneal factors and myoma are presented. The course of pregnancy and childbirth in patients with IVF programs has been analyzed and approaches have been outlined to reduce their reproductive losses.

Laparoscopy findings in infertile women

The results of 308 laparoscopies performed in infertile women were evaluated retrospectively. In 185 patients (60%) the laparoscopy was the last step in otherwise negative infertility evaluations (unexplained infertility). In 123 patients (40%) history or preliminary studies gave indirect evidence of possible pelvic disease. In the group of unexplained infertility laparoscopic abnormalities could be found in 50%. In 25% a tuboperitoneal factor and in 20% an endometriosis were found. Primary and secondary infertility showed the same percentage of normal findings with a higher incidence of tuboperitoneal factors in secondary infertility. In the group with indirect evidence of possible pelvic disease the incidence of positive laparoscopic findings was as high as 77%. Previous adnexitis or clinical suspicion of endometriosis (40 patients), previous pelvic operation (60 patients) and pathologic hysterosalpingographic findings (33 patients) proved to be approximately of equal prognostic value.