Hysterosalpingo-contrast sonography for infertility investigation

Application of 3D-HyCoSy in the diagnosis of oviduct obstruction

The aim of the study was to analyze the application value of three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in the diagnosis of oviduct obstruction. Fifty-two patients with infertility and oviduct obstruction were continuously selected and treated with 3D-HyCoSy and CLP (CLP). It was found that according to CLP diagnosis, 40 oviducts were obstructed, 30 were partially obstructed, 12 were tortuous and 22 were completely obstructed. The 40 cases were unilaterally pathological, 24 were bilaterally pathological, 10 were diagnosed as congenital dysplasia, 35 were diagnosed as inflammation and 19 were diagnosed as tumor and cyst. Based on the diagnostic criteria of CLP, the diagnostic sensitivity, specificity, positive predictive values and negative predictive values of 3D-HyCoSy was 82.4, 88.3, 77.9 and 90.2%, respectively. The contrast agent flow time of oviduct obstruction (tortuosity and complete obstruction) as diagnosed by 3D-HyCoSy was significantly prolonged when compared with that of partial oviduct obstruction (P<0.05), and flow time of inflammation as diagnosed thereby was longer than that of congenital dysplasia, tumor and cyst. Following the diagnosis of inflammation, the shape of the contrast agent was tenuous, swollen, angled, rigid and distorted and the occurrence rate of inflammation was significantly higher (P<0.05). In conclusion, the diagnostic effect of 3D-HyCoSy on oviduct obstruction was more accurate and can show different features when diagnosing different types of inflammation, thus having a certain value for identifying the inflammation.

Imitating a stress response: a new hypothesis about the innate immune system's role in pregnancy

Recent research challenges long-held hypotheses about mechanisms through which pregnancy induces maternal immune suppression or tolerance of the embryo/fetus. It is now understood that normal pregnancy engages the immune system and that the immune milieu changes with advancing gestation. We suggest that pregnancy mimics the innate immune system's response to stress, causing a sterile inflammatory response that is necessary for successful reproduction. The relationship between external stressors and immunomodulation in pregnancy has been acknowledged, but the specific mechanisms are still being explicated. Implantation and the first trimester are times of immune activation and intensive inflammation in the uterine environment. A period of immune quiescence during the second trimester allows for the growth and development of the maturing fetus. Labor is also an inflammatory event. The length of gestation and timing of parturition can be influenced by environmental stressors. These stressors affect pregnancy through neuroendocrine interaction with the immune system, specifically through the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-ovarian axis. Trophoblastic cells that constitute the maternal-fetal interface appear to harness the maternal immune system to promote and maximize the reproductive success of the mother and fetus. Pregnancy is a time of upregulated innate immune responses and decreased adaptive, cell-mediated responses. The inflammatory processes of pregnancy resemble an immune response to brief naturalistic stressors: there is a shift from T helper (Th) 1 to T helper (Th) 2 dominant adaptive immunity with a concomitant shift in cytokine production, decreased proliferation of T cells, and decreased cytotoxicity of natural killer (NK) cells. Inclusion of both murine and human studies, allows an exploration of insights into how trophoblasts influence the activity of the maternal innate immune system during gestation.

Comparison of the pain experienced by infertile women undergoing hysterosalpingo contrast sonography or radiographic hysterosalpingography

OBJECTIVE

To evaluate the pain and cause of pain experienced by women undergoing hysterosalpingography (HSG) and contrast hysterosalpingo sonography (HyCoSy) with air in a saline solution for the assessment of uterine and tubal patency.

METHOD

In this prospective study, 121 infertile women undergoing these 2 procedures measured the pain incurred using a digital/analog scale (1-10). We looked for correlations between pain level and variables pertaining to the procedures. Vagal effects and their persistence were also recorded.

RESULTS

The pain was less during HSG (median, 5) than during HyCoSy (median, 7). It was greater than menstrual pain for 38.8% of participants during HSG and for 70.5% of participants during HyCoSy. There was no correlation between pain and difficult catheter passage, degree of tubal obstruction, volume of contrast medium injected, or presence of IgG antibodies to Chlamydia when these variables were studied for HyCoSy alone. However, the strong correlation between pain score and volume of contrast medium injected during each procedure seems to explain the significantly higher pain levels during HyCoSy (P<0.001). In 65.3% and 57.8% of participants, respectively, the pain disappeared immediately after the HSG or HyCoSy. Only mild vagal effects were recorded following both procedures, in 0.8% of participants after HSG and 2.5% of participants after HyCoSy.

CONCLUSION

Hysterosalpingo contrast sonography is similar to HSG regarding rapidity of pain disappearance, and infrequency and moderation of vagal effects, but the level of pain is slightly higher, probably due to the greater volume of medium injected.