1
|
Chen M, Huang S, Song C, Chen X, Chen J, Bu G, Zhang H, Huang W, Fu J, Xu E. Value of painless transvaginal four-dimensional hysterosalpingo contrast sonography in reducing venous intravasation: a comparative study. J Ultrasound 2024; 27:511-517. [PMID: 38219240 PMCID: PMC11333643 DOI: 10.1007/s40477-023-00847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/11/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE To investigate the value of painless transvaginal four-dimensional hysterosalpingo contrast sonography (TV 4-D HyCoSy) in reducing venous intravasation and its influencing factors through a retrospective comparative study on conventional TV 4-D HyCoSy. MATERIALS AND METHODS A total of 451 patients were enrolled in this study from Jan. 2019 to Oct. 2021. There were 249 patients in the painless TV 4-D HyCoSy group and 202 patients in the conventional TV 4-D HyCoSy group. The incidence of venous intravasation and its related influencing factors were analyzed and compared between these two groups. The difficulty of image evaluation for the diagnosis was also compared. RESULTS There was no significant difference in the baseline characteristics between the painless group and the conventional group (p > 0.05). Compared with the conventional group, the painless group had a lower incidence of venous intravasation (16.9 vs. 24.8%; p = 0.039). Painless TV 4-D HyCoSy was more effective in reducing venous intravasation in patients with primary infertility (p = 0.032) without a history of pelvic surgery (p = 0.008) or ectopic pregnancy (p = 0.018). Logistic regression analysis demonstrated that painless TV 4-D HyCoSy and endometrial thickness > 5 mm were protective factors for venous intravasation. Moreover, the diagnostic procedure was easier in the painless group than in the conventional group (p = 0.002). CONCLUSIONS Painless TV 4D-HyCoSy may be an effective mode in reducing the incidence of venous intravasation and improving the diagnosis of patency of fallopian tubes.
Collapse
Affiliation(s)
- Mengjie Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Shiying Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Changlin Song
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaomin Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Jiajia Chen
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Guojuan Bu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Huiying Zhang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Wanling Huang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China
| | - Juan Fu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518033, China.
| |
Collapse
|
2
|
Li Y, Chen X, Wang Q, Wang J. Factors Influencing the Visualization of Fallopian Tubes in Hysterosalpingo-Contrast Sonography (HyCoSy)-The Value of Multimodal HyCoSy in Visualizing the Fallopian Tubes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39031455 DOI: 10.1002/jum.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/28/2024] [Accepted: 07/01/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) can non-invasively evaluate the patency of the fallopian tubes and is increasingly used in clinical practice. However, some factors may lead to false-positive diagnoses. This study aims to analyze the factors affecting clear imaging of the fallopian tubes in 4D-HyCoSy and explore methods to improve the quality of fallopian tube imaging. METHODS A total of 118 patients were enrolled in this retrospective study. After injecting the SonoVue into the uterine cavity, three modes of HyCoSy were completed in sequence: 4D-HyCoSy, 2D-HyCoSy, and second harmonic imaging (SHI). Participants were divided into two groups: the easy visualization group (fallopian tubes could be visualized using only 4D-HyCoSy) and the difficult visualization group (a multimodal combination was required for visualization). The position of the uterus, the relationship between the ovaries and the uterus, endometrial thickness, time of catheterization in the uterine cavity, presence or absence of lesions in the uterine cavity, whether intestinal gas covers the fallopian tubes and the imaging effect of different modes on the fallopian tubes was analyzed, to determine the key factors affecting the clear imaging of the fallopian tubes. RESULTS The positional relationship between the ovary and the uterus (OR = 4.711, 95% CI: 1.322-19.77, P = 0.023), the positioning of the uterus (OR = 3.843, 95% CI: 1.129-15.26, P = 0.04), endometrial thickness (OR = 3.985, 95% CI: 1.168-15.99, P = 0.036), and the duration of intrauterine catheter placement (OR = 3.547, 95% CI: 1.042-13.52, P = 0.05) were independent factors that affecting difficulty in visualizing the fallopian tubes. CONCLUSION Uterine position, the positional relationship between the ovary and the uterus, endometrial thickness, and the time of catheter insertion are factors that affect visualizing the fallopian tubes during 4D-HyCoSy. The combination of multimodal imaging, especially the combination of 4D-HyCoSy with SHI mode, can help improve the quality of fallopian tube visualization.
Collapse
Affiliation(s)
- Yan Li
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Xiaoyi Chen
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Qin Wang
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Jingping Wang
- Department of Ultrasound, The First Clinical Medical College of Anhui University of Traditional Chinese Medicine, Anhui, China
| |
Collapse
|
3
|
Bisogni F, Galanti F, Riccio S, Ghanitab S, Polletta S, Annesi V, Antonaci D, Rago A, Schiavi MC, Spina V, Rago R. Spontaneous Pregnancy after 4D-Hysterosalpingo-Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility. Case Rep Obstet Gynecol 2024; 2024:7774854. [PMID: 38962290 PMCID: PMC11222004 DOI: 10.1155/2024/7774854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 07/05/2024] Open
Abstract
Infertility is increasing worldwide, as well as in Italy, and fallopian tube pathology represents one of the most impacting causes of infertility for multiple women. Indeed, tubal patency assessment is a crucial step in medical evaluation for women attending an in vitro fertilization (IVF) center. Currently, different methods for tubal investigation are available, such as chromosalpingoscopy, hysterosalpingography (HSG), and hysterosalpingo-contrast sonography (HyCoSy). This diagnostic exam is performed by ultrasonography and an air-water-based contrast agent represented by air-water, or foam solution (HyFoSy). An additional side benefit of these assessment tests is a fertility-enhancing effect, thanks to a positive effect defined as "tubal flushing," which in current literature is more strongly associated with HyFoSy with respect to HyCoSy. In this report, we present a case of a 34-year-old woman presented to our attention at the Reproductive and Physiopathology Unit of Sandro Pertini Hospital, Rome, in 2023, with unexplained infertility for 3.1 years of free sexual intercourse with a partner who did not report sperm abnormalities. Subsequently, in this exam, the woman spontaneously conceived in the same menstrual cycle that the 4D-HyCoSy was performed, without any additional fertility enhancement interventions. In this case report, we also include an updating review of the current literature regarding the insurgence of spontaneous pregnancy after this technique in order to explore the physiopathological and etiopathogenetic mechanisms underlying the achievement of spontaneous pregnancy and to confront our case with other recent works published. According to our clinical experience and the current literature, 4D-HyCoSy is the easiest, safest, and cheapest diagnostic exam for investigating tubal patency, which can lead to medical success in some cases of "unexplained infertility" as the achievement of a spontaneous pregnancy.
Collapse
Affiliation(s)
- Francesco Bisogni
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | - Francesco Galanti
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | - Serena Riccio
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | - Simona Ghanitab
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | | | | | - Domenico Antonaci
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | - Andrea Rago
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| | | | - Vincenzo Spina
- Protection of Maternal and Child Health Unit, Rieti, Italy
| | - Rocco Rago
- Reproductive Physiopathology and Andrology UnitSandro Pertini Hospital, Rome, Italy
| |
Collapse
|
4
|
Yang P, Zhong Y, Zhang C, Zhang Y, Fan X, Shi H. Contrast Agent Reflux in Transvaginal 4-D Hysterosalpingo-Contrast Sonography: Influencing Factors and Coping Strategies. Ultrasound Q 2024; 40:61-65. [PMID: 37771069 DOI: 10.1097/ruq.0000000000000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Transvaginal 4-D hysterosalpingo-contrast sonography (TV 4-D HyCoSy) plays an important role in the detection and diagnosis of clinical female infertility. The purposes of this study were to analyze the influencing factors of TV 4murD HyCoSy complicated with contrast agent reflux and to provide evidence for clinical diagnosis and treatment. Female patients diagnosed as infertility by transvaginal hysterosalpingography from January 2021 to December 2022 were included. The characteristics of patients with and without contrast agent reflux were evaluated. Pearson correlation and logistic regression were conducted to analyze the related factors affecting the occurrence of contrast reflux. A total of 416 patients undergoing TV 4-D HyCoSy were included, and the incidence of contrast agent reflux in patients undergoing TV 4-D HyCoSy was 38.94%. Pearson correlation analysis results indicated that history of uterine cavity operation ( r = 0.556), adenomyosis of uterus ( r = 0.584), examination on less than 5 days after menstruation ( r = 0.602), endometrial thickness ( r = 0.566), and endometrial polyps ( r = 0.575) are all correlated with contrast agent reflux in patients undergoing 4-D HyCoSy (all P < 0.05). Logistic regression analysis showed that history of uterine cavity operation (odds ratio [OR], 1.109; 95% confidence interval [CI], 1.012-1.872), adenomyosis of uterus (OR, 2.026; 95% CI, 1.864-2.425), examination on less than 5 days after menstruation (OR, 2.465; 95% CI, 2.118-2.851), endometrial thickness less than 6 mm (OR, 2.866; 95% CI, 2.095-2.957), and endometrial polyps (OR, 1.587; 95% CI, 1.137-1.744) were the influencing factors of contrast agent reflux in patients undergoing (all P < 0.05). The incidence of contrast agent reflux in TV 4-D HyCoSy is high, and there are many influencing factors. Clinical medical workers should take early measures based on these influencing factors to reduce the contrast agent reflux.
Collapse
Affiliation(s)
- Ping Yang
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Yue Zhong
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Chao Zhang
- Department of Cardiovascular Medicine, The First People's Hospital of Neijiang, Neijiang, China
| | - Yaping Zhang
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Xu Fan
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Hong Shi
- Department of Ultrasound, The First People's Hospital of Neijiang
| |
Collapse
|
5
|
Xu Z, Wang Y, Sun J, Chen S, Yan Z, Lin C, Shu J. Evaluation of tubal patency by hysterosalpingo-contrast Sonography (HyCoSy): Controversies, dilemmas and considerations. Heliyon 2023; 9:e17461. [PMID: 37539233 PMCID: PMC10395035 DOI: 10.1016/j.heliyon.2023.e17461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Evaluation of tubal patency is one of the vital steps in the process of female infertility management. Hysterosalpingo-contrast Sonography (HyCoSy) has become the first-line recommendation for evaluating tubal patency. However, there remain some controversies and dilemmas relevant to the evaluation of tubal patency by HyCosy, with no effective solution has been proposed or no consensus has been reached. Herein, combined with previous research and clinical experience, we conclude and analyze these controversies and dilemmas, aiming at offering our perspective on the opportunities and challenges which are faced by HyCosy.
Collapse
Affiliation(s)
- Zining Xu
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yaoting Wang
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Sun
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuangxi Chen
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zou Yan
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chen Lin
- Reproductive Medicine Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jing Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
Jin BB, Ma Y, Zhao XH, Teng YL, Zhu SY. Risk Factors of Contrast Agent Intravasation With Sulfur Hexafluoride Microbubble During Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1587-1594. [PMID: 36637120 DOI: 10.1002/jum.16179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To analyze the risk factors of sulfur hexafluoride microbubble contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy), and to explore a simple prediction model by the obvious clinical history. METHODS This was a retrospective study included 299 infertility women who had undergone HyCoSy examination from July 1, 2018 to June 31, 2019. The factors were recorded, including age, endometrial thickness, balloon length, infertility type, history of intrauterine surgery, history of pelvic surgery, and tubal patency. The method of multivariate logistic regression analysis was adopted to analyze the risk factors affecting the contrast agent intravasation, and the receiver operating characteristic curves were plotted to test their efficacy. RESULTS Secondary infertility, a history of intrauterine surgery, thin endometrial thickness, and tubal obstruction were all risk factors of the occurrence of intravasation (P < .05). And the area under the receiver operating characteristic curves of the multifactor-combined prediction model of the intravasation was significantly larger than that of single-factor. CONCLUSIONS Sonographers and gynecologists should be familiar with the risk factors of intravasation and select the appropriate timing of HyCoSy toward reducing the occurrence of intravasation and other complications after thoroughly explaining and communicating with the patients.
Collapse
Affiliation(s)
- Bin-Bin Jin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Ma
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiu-Hua Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Ling Teng
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shang-Yong Zhu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
7
|
Qu E, Zhang M, Ju J, Chen Y, Lin X, Zhang X. Is Hysterosalpingo-Contrast Sonography (HyCoSy) Using Sulfur Hexafluoride Microbubbles (SonoVue) Sufficient for the Assessment of Fallopian Tube Patency? A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:7-15. [PMID: 35441714 DOI: 10.1002/jum.15988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/27/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinxiu Ju
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Chen
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Lin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
8
|
Qiang Y, Wu Y, Cai T. Clinical Significance of Increasing Pressure Curve's Slope When Injecting Ultrasound Contrast Agent During Evaluation of Fallopian Tubal Patency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2329-2338. [PMID: 33421176 DOI: 10.1002/jum.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the association between Fallopian tubal patency and the slope of the increasing pressure curve for ultrasound contrast agent. MATERIALS AND METHODS A total of 136 patients underwent transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D HyCoSy) between August 2015 and January 2016. We divided the patients into 3 groups according to different Fallopian tubal patency status: 71 patients (48.97%) in bilateral tubal patency group, 45 (31.03%) in unilateral tubal patency group, and 20 in bilateral tubal nonpatent group. The ultrasound contrast agent was injected and the pressure curve was recorded automatically in real time using a liquid-injecting machine that traces it as a pressure curve. The slopes of the different groups are compared through independent sample t test. RESULTS The slopes of the 3 groups were 1.242 ± 0.572, 1.472 ± 0.638, and 2.068 ± 1.236 kPa/s. A correlation was observed between the slope of the increasing pressure curve and tubal patency (R = 0.287, P < .05). The slopes differed significantly between the bilateral tubal patency group and bilateral tubal nonpatent group (P = .001) and between the unilateral tubal patency group and bilateral tubal nonpatent group (P = .012). However, the difference between the bilateral tubal patency and unilateral tubal patency groups was not significant (P = .266). CONCLUSION The increase of the injecting pressure curve's slope for contrast agent during 4D HyCoSy is associated with the nonpatent degree of the tube. This condition can be used as an objective index of tubal patency and can be a reference in diagnosis and treatment.
Collapse
Affiliation(s)
- Ye Qiang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Yiyun Wu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Ting Cai
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| |
Collapse
|
9
|
Boned-López J, Alcázar JL, Errasti T, Ruiz-Zambrana A, Rodriguez I, Pascual MA, Guerriero S. Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 304:1389-1398. [PMID: 34417840 DOI: 10.1007/s00404-021-06188-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. DESIGN Systematic review and meta-analysis. PATIENTS Women undergoing HyCoSy due to infertility. INTERVENTIONS Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. MAIN OUTCOME MEASURES Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. RESULTS Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. CONCLUSIONS HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.
Collapse
Affiliation(s)
- Jordi Boned-López
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain.
| | - Tania Errasti
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Alvaro Ruiz-Zambrana
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Ignacio Rodriguez
- Epidemiology and Statistics Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - María Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| |
Collapse
|
10
|
AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E39-E45. [PMID: 33665889 DOI: 10.1002/jum.15670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
|
11
|
Zhang N, Liu Y, He Y, Shi J, Zhou M, Liu H. Transvaginal four-dimensional hysterosalpingo-contrast sonography: Pain perception and factors influencing pain severity. J Obstet Gynaecol Res 2020; 47:302-310. [PMID: 33107172 DOI: 10.1111/jog.14538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/23/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
AIM The purpose is to investigate pain perception during transvaginal four-dimensional hysterosalpingo-contrast sonography (TV 4D-HyCoSy) and factors influencing pain severity. METHODS This was a retrospective study included 340 women who underwent TV 4D-HyCoSy examination from January 2016 to October 2017. The factors were recorded, including age, childbearing history, infertility type, history of pelvic inflammation, pelvic surgery, history of uterine manipulation, history of ectopic pregnancy, atropine delivery mode, uterine position, uterine malformation, uterine lesion, fibroid, intrauterine adhesion, polycystic ovary, endometrial implantation cyst, dysmenorrhea score, the degree of patency of fallopian tube and contrast agents dosage. Pain was evaluated during and after TV 4D-HyCoSy. The time point of peak pain was evaluated and the influencing factors of moderate/severe pain were analyzed. RESULTS The highest pain occurred at contrast instillation. The independent influencing factors of moderate/severe pain were age (P = 0.021), dysmenorrhea score (P = 0.003) and tubal patency (P < 0.001). Further analysis showed that age affected the pain score when TV 4D-HyCoSy started and the peak pain occurred. Dysmenorrhea score and tubal patency affect the pain score at most time points. CONCLUSION Age, dysmenorrhea score and tubal patency are factors influencing the severity of pain during TV 4D-HyCoSy.
Collapse
Affiliation(s)
- Ning Zhang
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Liu
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanni He
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiayao Shi
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Meijun Zhou
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hongmei Liu
- Department of Ultrasonography, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| |
Collapse
|
12
|
Liu Y, Zhang N, He Y, Shi J, Zhou M, Xu J, Liu H. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography. BMC Pregnancy Childbirth 2020; 20:638. [PMID: 33081754 PMCID: PMC7574424 DOI: 10.1186/s12884-020-03315-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients' clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy. METHODS This was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization (WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy. RESULT(S) One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy. CONCLUSION(S) This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8-9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .
Collapse
Affiliation(s)
- Yu Liu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Ning Zhang
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni He
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Jiayao Shi
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Meijun Zhou
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Jingjiao Xu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China
| | - Hongmei Liu
- Department of Ultrasound, Institute of Ultrasound in Musculoskeletal Sports Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, PR China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China.
| |
Collapse
|
13
|
Shi J, Li S, Wu H, He Y, Yi W, Xu J, Liu H, Guan Y. The Influencing Factors of Venous Intravasation During Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography With SonoVue. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2273-2280. [PMID: 31201020 DOI: 10.1016/j.ultrasmedbio.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Transvaginal 4-D hysterosalpingo-contrast sonography with SonoVue (TV 4-D HyCoSy) is the preferred imaging method for evaluating tubal patency. However, venous intravasation in 4-D HyCoSy may affect the diagnosis of tubal patency. The objective of this study was to analyze influencing factors of venous intravasation during TV 4-D HyCoSy. This study included 643 infertile patients who underwent TV 4-D HyCoSy. We analyzed the relationship between the incidence of venous intravasation and patients' basic clinical data, endometrial thickness, inspection timing (clean day of menstruation) and tubal patency. A total of 169 (26.28%) patients exhibited intravasation during TV 4-D HyCoSy. The following are risk factors for venous intravation: secondary infertility, type C + C, type B + C and type B + B in bilateral fallopian tubal patency grouping; endometrial thickness ≤5.45 mm; and taking TV 4-D HyCoSy after menstruation ≤6 d. Infertility duration, intrauterine lesions, a history of pelvic inflammatory disease and a history of pelvic surgery were uncorrelated with venous intravasation. To reduce the incidence of venous intravasation, TV 4-D HyCoSy should be performed 7-10 d after menstruation or when endometrial thickness is thicker than 5.45 mm.
Collapse
Affiliation(s)
- Jiayao Shi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Sushu Li
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China
| | - Wenhong Yi
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P.R. China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P.R.China.
| | - Ying Guan
- Department of Biostastics, Southern Medical University, Guangzhou, Guangdong, P.R. China
| |
Collapse
|
14
|
Combined Real-Time Three-Dimensional Hysterosalpingo-Contrast Sonography with B Mode Hysterosalpingo-Contrast Sonography in the Evaluation of Fallopian Tube Patency in Patients Undergoing Infertility Investigations. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9408141. [PMID: 31275995 PMCID: PMC6582904 DOI: 10.1155/2019/9408141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 12/13/2022]
Abstract
Objective This prospective study aimed to investigate the use of real-time three-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy), using contrast agent SonoVue, with B mode hysterosalpingo-contrast sonography (B mode-HyCoSy), to evaluate tubal patency and the wall of the Fallopian tubes in infertility patients. Method In total, we recruited 739 women with fertility requirements from the First Affiliated Hospital of Shantou Medical College between January 2017 and July 2018. All cases received 4D-HyCoSy using contrast agent SonoVue, immediately followed by the B mode-HyCoSy. Of these patients, 145 showed pathological findings in the Fallopian tubes during HyCoSy; 34 of these (62 Fallopian tubes) were verified by laparoscopy and the dye test against routine reference standards. Sonographic findings, along with laparoscopic findings and dye test results, were used to compare the two techniques using the Cohen kappa coefficient. We also investigated the duration of examination and pain score. Results Compared with laparoscopy and the dye test, the tubal occlusion diagnostic accordance rates for 4D-HyCoSy were 88.7% (32+23)/62, with a kappa coefficient of 0.769 and a 76.9% agreement rate. Distal occlusion diagnostic accordance rates for 4D-HyCoSy were 100% (8/8) with a k coefficient of 1.000 and a 100% agreement rate. Conclusions The use of 4D-HyCoSy, with B mode-HyCoSy, for the diagnosis of tubal patency is safe, feasible, noninvasive, and highly accurate. B mode-HyCoSy allowed us to observe tubal walls in an intuitive manner.
Collapse
|