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Mody P, Salazar G, Kohi MP. Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility. Semin Intervent Radiol 2023; 40:379-383. [PMID: 37575349 PMCID: PMC10415059 DOI: 10.1055/s-0043-1771042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress.
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Affiliation(s)
- Priya Mody
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maureen P. Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Muacevic A, Adler JR. A Review of Tubal Factors Affecting Fertility and its Management. Cureus 2022; 14:e30990. [PMID: 36475176 PMCID: PMC9717713 DOI: 10.7759/cureus.30990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023] Open
Abstract
Infertility is a problem that affects both developed and developing countries today. Many couples choose to have financial stability before conception, irrespective of age. Tubal blockage accounts for 30%-40% of a woman's fertility. Congenital abnormalities, acute and persistent inflammatory diseases, endometriosis, and different pathologies are associated with infertility and cause partial or complete obstruction of the fallopian tubes. Approximately 30% of women experience infertility due to fallopian tube illness, with 10%-25% of these women experiencing proximal fallopian tube obstruction. The fallopian tube is an integral part of the union of sperm, and its normal function is a prerequisite for natural conception. Tubal obstruction is a common cause of infertility. These patients are keen to unblock their blocked fallopian tubes and restore reproductive function. Accurate diagnosis and optimal treatment options are essential for treating infertility.
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Serrano González L, Pérez-Medina T, Bueno Olalla B, Royuela A, De La Cuesta MDLR, Saéz de la Mata D, Domínguez-Franjo E, Calles-Sastre L, Engels V. Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study. BMC Womens Health 2022; 22:41. [PMID: 35152893 PMCID: PMC9909448 DOI: 10.1186/s12905-022-01606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/25/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In 60% of sterile couples a female factor is present, with these being tubal factors in 30-50% of cases. A tubal patency test is also required in women without a male partner undergoing fertility treatment. Thus, an accurate, safe and tolerable technique should be available. The aim of this study is to determine and to compare hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingography (HSG) tolerability in terms of pain and anxiety. METHODS This is a prospective real-world setting multicentre study conducted in two tertiary hospitals in Madrid. 210 infertile women/women without a male partner looking to get pregnant were recruited; 111 for the HyFoSy group and 99 for the HSG group. Tolerability was measured in terms of anxiety by the State Trait Anxiety Inventory (STAI) and pain by the Visual Analogue Scale (VAS). RESULTS Median VAS score in HyFoSy group was 2 (P25; P75: 1; 3) versus 5 (4; 8) in HSG group, p < 0.001. The median State-STAI score in the HSG group was 18 points (10; 26) versus 10 (7; 16) in the HyFoSy group (p < 0.001); the median Trait-STAI score in the HSG group was 15 (11; 21) versus 13 (9; 17) in the HyFoSy group (p = 0.044). CONCLUSIONS HyFoSy shows higher tolerability to both: pain and anxiety. It is related to less pain and less post-test anxiety than HSG.
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Affiliation(s)
- Lucía Serrano González
- Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222, Majadahonda, Madrid, Spain. .,Department of Gynaecology and Obstetrics, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034, Madrid, Madrid, Spain.
| | - Tirso Pérez-Medina
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - Beatriz Bueno Olalla
- Department of Gynaecology and Obstetrics, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Ana Royuela
- grid.466571.70000 0004 1756 6246Biostatistics Unit, Biomedical Research Institute Puerta de Hierro-Segovia de Arana (CIBERESP) ES, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - María de los Reyes De La Cuesta
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - David Saéz de la Mata
- Department of Gynaecology and Obstetrics, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Esther Domínguez-Franjo
- Department of Radio Diagnosis, Infanta Sofía University Hospital, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid Spain
| | - Laura Calles-Sastre
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
| | - Virginia Engels
- grid.411171.30000 0004 0425 3881Department of Gynaecology and Obstetrics, Puerta de Hierro Majadahonda University Hospital, Joaquín Rodrigo St, 1, 28222 Majadahonda, Madrid Spain
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Abstract
We present an overview of the common types of tubal patency tests, with a focus on hysterosalpingo-foam sonography (HyFoSy). Current evidence suggests that HyFoSy is an accurate alternative to X-ray hysterosalpingography (HSG) for outpatient tubal evaluation in women who are at low risk for tubal disease. It may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. A hyperechogenic medium may enhance contrast visualization and enable clearer delineation of tubal anatomy. This may enhance confidence in the diagnosis of tubal patency, reduce false occlusion results, and improve the diagnostic yield of the test. It would be reasonable to deduce that HyFoSy would have similar performance characteristics as HyCoSy with other positive contrast agents. The available evidence supports the accuracy of HyFoSy compared to other forms of tubal investigation. We suggest a decision-making pathway based on the most current professional recommendations and available evidence. However, in this article, we do not provide a definitive exposition of the methods used for investigating tubal patency. Rather, we explore the contexts in which the various investigations are most and least suitable, and identify their strengths and limitations. Finally, we also discuss challenges encountered when performing tubal contrast sonography in clinical practice, including the problem of false occlusion results.
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Affiliation(s)
- Hemashree Rajesh
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Serene Liqing Lim
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
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Torok P. A Novel Method of Selective Chromopertubation at Office Hysteroscopy. ACTA ACUST UNITED AC 2016. [DOI: 10.17352/jgro.000013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wang Y, Qian L. Three- or four-dimensional hysterosalpingo contrast sonography for diagnosing tubal patency in infertile females: a systematic review with meta-analysis. Br J Radiol 2016; 89:20151013. [PMID: 27109737 DOI: 10.1259/bjr.20151013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess the diagnostic value of three-dimensional (3D) or four-dimensional (4D) hysterosalpingo contrast sonography (HyCoSy) for detecting tubal patency in infertile females. METHODS A comprehensive search was conducted to identify related research. The pooled results were calculated by diagnostic meta-analysis with bivariate mixed-effects binary regression. Subgroup analyses and publication bias were further performed. RESULTS 23 studies, including 1153 females with 2259 detected fallopian tubes, were identified. The pooled estimates of sensitivity and specificity were 0.92 [95% confidence interval (CI): 0.90-0.94, I(2) = 36.68] and 0.91 (95% CI: 0.89-0.93, I(2) = 38.99), respectively. The area under the receiver-operating characteristic curve was 0.97 (95% CI: 0.95-0.98). No publication bias was observed. CONCLUSION 3D/4D HyCoSy is an accurate test for diagnosing tubal patency in infertile females. ADVANCES IN KNOWLEDGE 3D/4D HyCoSy is an accurate test for diagnosing tubal patency in females suffering from infertility, whilst overcoming some main limitations of other methods. 3D/4D HyCoSy is recommended as a fundamental test for female infertility.
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Affiliation(s)
- Yuelong Wang
- Department of Ultrasound, Beijing Friendship Hospital affiliated to Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital affiliated to Capital Medical University, Beijing, China
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Yu J, Cai M, Liang W, Deng Z, Xie Y. Diagnostic efficacy of 3-D hysterosalpingo-contrast sonography in the detection of tubal occlusion: Systematic meta-analysis. J Obstet Gynaecol Res 2015; 41:1418-25. [PMID: 26098684 DOI: 10.1111/jog.12728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/01/2015] [Accepted: 03/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jiangxiu Yu
- Department of Ultrasound Medicine; Third Affiliated Hospital of Guangzhou Medical University; Guangzhou Guangdong China
| | - Mingjin Cai
- Department of Radiology; Third Affiliated Hospital of Guangzhou Medical University; Guangzhou Guangdong China
| | - Weixiang Liang
- Department of Ultrasound Medicine; Third Affiliated Hospital of Guangzhou Medical University; Guangzhou Guangdong China
| | - Zhifeng Deng
- Department of Intervention Radiology; Affiliated Baoan Hospital of Nanfang Medical University; Shenzhen Guangdong China
| | - Yinong Xie
- Department of Ultrasound Medicine; Third Affiliated Hospital of Guangzhou Medical University; Guangzhou Guangdong China
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Lo Monte G, Capobianco G, Piva I, Caserta D, Dessole S, Marci R. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point! Arch Gynecol Obstet 2014; 291:19-30. [DOI: 10.1007/s00404-014-3465-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022]
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Sladkevicius P, Zannoni L, Valentin L. B-flow ultrasound facilitates visualization of contrast medium during hysterosalpingo-contrast sonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:221-227. [PMID: 24375819 DOI: 10.1002/uog.13290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/24/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess if B-flow ultrasound improves visualization of flow of contrast medium in the Fallopian tubes during hysterosalpingo-contrast sonography (HyCoSy) compared with grayscale ultrasound. METHODS This prospective observational study included 160 women referred for HyCoSy as part of infertility work-up between January 2011 and September 2012. In each woman, at the same session, HyCoSy was performed first using saline with air and then using Sonovue®, and for each contrast medium, grayscale ultrasound was first used and then B-flow ultrasound was used. Flow of contrast was observed in three parts of each tube: intramural, middle and distal. RESULTS In 129 (81%) women, flow of Sonovue was observed in the intramural part of both tubes and in the pouch of Douglas when using grayscale ultrasound. In these women, flow of Sonovue was seen in the middle part of 70% of the 258 tubes when using grayscale ultrasound and in 93% when using B-flow ultrasound; and in the distal part in 81% when using grayscale ultrasound and in 98% when using B-flow ultrasound. When using air and saline, flow was seen in the intramural part of 90% and 93% of the tubes, in the middle part in 54% and 72%, and in the distal part in 66% and 90%, using grayscale ultrasound and B-flow ultrasound, respectively. CONCLUSION B-flow ultrasound facilitates detection of flow of contrast in the middle and distal parts of the tubes at HyCoSy, especially when a mixture of saline and air is used as contrast medium.
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Affiliation(s)
- P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
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Braidy C, Nazac A, Legendre G, Capmas P, Fernandez H. [Comparison of fertiloscopy versus laparoscopy in the exploration of the infertility: analysis of the literature]. ACTA ACUST UNITED AC 2014; 43:488-95. [PMID: 24767305 DOI: 10.1016/j.jgyn.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fertiloscopy is a recent technique designed to explore the tubo-ovarian axis in unexplained infertility. It is a simple outpatient technique, allowing to perform operative procedures, but its position relative to laparoscopy is yet to be defined. MATERIAL AND METHODS A thorough and extensive bibliographical search was undertaken to fully embrace the question, challenging Medline at the National Library of Medicine, Cochrane Library, National Guideline Clearinghouse, Health Technology Assessment Database. All the retrieved articles were classified as either descriptive or comparative studies and evaluated on a set of criteria. RESULTS Most of the papers described case series coming from a few teams, focusing mainly on the technical aspect of the procedure, like the access rate to the posterior cul-de-sac, the success rate in visualizing the pelvis, the complications rate (mainly rectal perforation), and its operative performance in drilling ovaries for resistant polycystic ovarian syndrome. Comparative studies numbered six trials. They all followed the same design, fertiloscopy preceding conventional laparoscopy in patients taken as their own control. The concordance rate between the two modalities reaches 80% in terms of tubal pathology, adherences and endometriosis, with an estimated reduction of laparoscopies varying from 40% to 93%. CONCLUSION The current literature shows a concordance between fertiloscopy and conventional laparoscopic findings for certain parameters in cases of tubal pathology, adherences and endometriosis. The relative positions of these two modalities in unexplained infertility still remain elusive.
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Affiliation(s)
- C Braidy
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A Nazac
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Legendre
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P Capmas
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Fernandez
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm U1018, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Intérêt de la fertiloscopie dans la prise en charge de l’infertilité : étude rétrospective, à propos de 262 cas. ACTA ACUST UNITED AC 2014; 42:97-103. [DOI: 10.1016/j.gyobfe.2013.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Indexed: 11/22/2022]
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Kumakiri J, Takeuchi H, Kitade M, Kikuchi I, Kumakiri Y, Kuroda K, Jinushi M, Takeda S. Safe primary approach using a micro-laparoscope via the posterior vaginal fornix for patients with previous upper laparotomy: A report of five cases. J Obstet Gynaecol Res 2010; 36:195-8. [DOI: 10.1111/j.1447-0756.2009.01095.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Exacoustos C, Zupi E, Szabolcs B, Amoroso C, Di Giovanni A, Romanini ME, Arduini D. Contrast-Tuned Imaging and Second-Generation Contrast Agent SonoVue: A New Ultrasound Approach to Evaluation of Tubal Patency. J Minim Invasive Gynecol 2009; 16:437-44. [DOI: 10.1016/j.jmig.2009.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 03/09/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Reyftmann L, Dechanet C, Amar-Hoffet A, Flandrin A, Hédon B, Dechaud H. [Surgery for infertility]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38 Spec No 1-2:F35-F42. [PMID: 19268223 DOI: 10.1016/s0368-2315(09)70230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- L Reyftmann
- Service de gynécologie obstétrique et département de médecine et biologie de la reproduction, CHU A.-de-Villeneuve, Montpellier.
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MR Hysterosalpingography with an Angiographic Time-Resolved 3D Pulse Sequence: Assessment of Tubal Patency. AJR Am J Roentgenol 2008; 191:1381-5. [DOI: 10.2214/ajr.07.3957] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Savelli L, Pollastri P, Guerrini M, Villa G, Manuzzi L, Mabrouk M, Rossi S, Seracchioli R. Tolerability, side effects, and complications of hysterosalpingocontrast sonography (HyCoSy). Fertil Steril 2008; 92:1481-1486. [PMID: 18922518 DOI: 10.1016/j.fertnstert.2008.07.1777] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 07/20/2008] [Accepted: 07/25/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the tolerability, side effects and complications of hysterosalpingocontrast sonography (HyCoSy). DESIGN Prospective study. SETTING University hospital. PATIENT(S) 669 infertile women. INTERVENTION(S) All patients were examined with HyCoSy and monitored for 30 minutes after the procedure. A telephone interview was subsequently carried out to record possible late side effects and postprocedural complications. MAIN OUTCOME MEASURE(S) Tolerability to the procedure was evaluated by means of an 11-point (0 to 10) numeric rating scale of the pain experienced. Postprocedural fever, pelvic infections, peritonitis, hemorrhage were recorded. RESULT(S) Of 660 patients who completed the examination, 483 (73.2%) completed the telephone follow-up after a period of 14.7 +/- 9.9 months from the procedure. The mean patient age was 34.5 +/- 4.3 years, and mean infertility duration was 28.1 +/- 23.2 months. The mean numeric rating scale was 2.7 +/- 2.5, and 10 patients (2.0%) required postprocedural drug treatment for pain relief. Mild vasovagal reactions were experienced in 20 cases (4.1%), and four patients (0.8%) had a severe vasovagal reaction. No late complications were reported. No patients required hospital admission after the procedure. CONCLUSION(S) In our series, HyCoSy was a well-tolerated examination with a very low rate of side effects and no late complications that required no atropine or anti-inflammatory drugs. These data support the safety of HyCoSy when performed as described, but further work is needed to estimate the rate of late complications and side effects in other settings.
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Affiliation(s)
- Luca Savelli
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy.
| | - Paola Pollastri
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Manuela Guerrini
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Gioia Villa
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Linda Manuzzi
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Mohamed Mabrouk
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Stefania Rossi
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
| | - Renato Seracchioli
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, University of Bologna, Italy
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Hiroi H, Fujiwara T, Nakazawa M, Osuga Y, Momoeda M, Kugu K, Yano T, Tsutsumi O, Taketani Y. High incidence of tubal dysfunction is determined by laparoscopy in cases with positive Chlamydia trachomatis antibody despite negative finding in prior hysterosalpingography. Reprod Med Biol 2007; 6:39-43. [PMID: 29657552 DOI: 10.1111/j.1447-0578.2007.00163.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: Hysterosalpingography (HSG) is one of the most commonly used methods in order to evaluate the condition of fallopian tubes in infertility clinics. In the present paper, we retrospectively compared the findings of HSG and laparoscopy to elucidate the relationship between tubal dysfunction and background factors, such as Chlamydia trachomatis infection, endometriosis and previous surgery. Methods: We retrospectively reviewed clinical records of 314 patients who were examined by both HSG and laparoscopy between 1996 and 2001 in the Department of Obstetrics and Gynecology, University of Tokyo. Results: When HSG findings were evaluated in reference to those of laparoscopy, sensitivity and specificity for tubal patency were 0.63 and 0.79, respectively, whereas those for peri-tubal adhesion were 0.65 and 0.61, respectively. We compared the percentage of existence of background factors between the patients who were diagnosed as normal by both HSG and laparoscopy (Group L[+]) and those whose fallopian tubes were observed as patent by HSG, but were not patent by chromopertubation under laparoscopy (Group L[-]). The percentage of patients with positive chlamydial antibodies in Group L(-) (42.9%, 15/35) was significantly higher than that of patients with positive chlamydial antibodies in Group L(+) (22.8%, 44/193, P < 0.05). Conclusions: These finding suggested that even if HSG showed normally patent tubes in a patient with positive Chlamydia trachomatis antibodies, the possibility of tubal occulusion still remains high and further examination by laparoscopy is recommended. (Reprod Med Biol 2007; 6: 39-43).
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Affiliation(s)
- Hisahiko Hiroi
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Toshihiro Fujiwara
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Manabu Nakazawa
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Mikio Momoeda
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Koji Kugu
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Tetsu Yano
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Osamu Tsutsumi
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Yuji Taketani
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW The clinical management of hydrosalpinges in infertile patients remains a contentious issue. This review aims to provide a critical analysis on the available treatments for hydrosalpinges, which have recently created a fierce debate between the promoters of salpingectomy and in-vitro fertilization and those who endorse tubal surgery. RECENT FINDINGS Hydrosalpinges have a detrimental effect on the outcome of in-vitro fertilization yet their mechanism is still unclear. Salpingectomy prior to in-vitro fertilization restores the likelihood of a successful outcome in a well defined group of patients with ultrasound-visible hydrosalpinges. However, not every woman with large hydrosalpinges should undergo salpingectomy as some fallopian tubes may be amenable to surgical repair. Preserved tubal mucosa indicates a good prognosis for tubal surgery, therefore an appropriate mucosal assessment should be routine prior to deciding upon further management. SUMMARY As salpingectomy is a definitive procedure it should be performed when the hydrosalpinges are beyond repair or in cases of in-vitro fertilization failure. Tubal surgery should be preferred to salpingectomy in mild to moderate tubal disease. A comparative study of restorative tubal surgery versus salpingectomy and in-vitro fertilization in selected women with hydrosalpinges is needed and will significantly help this debate. Prophylactic salpingectomy prior to in-vitro fertilization and tubal surgery is not competing but complementary in the treatment of hydrosalpinges-related infertility.
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Affiliation(s)
- Luca Sabatini
- Centre for Reproductive Medicine & Surgery, Department of Obstetrics and Gynecology, St Bartholomew's Hospital, West Smithfield, London, UK.
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Chan CCW, Ng EHY, Tang OS, Chan KKL, Ho PC. Comparison of three-dimensional hysterosalpingo-contrast-sonography and diagnostic laparoscopy with chromopertubation in the assessment of tubal patency for the investigation of subfertility. Acta Obstet Gynecol Scand 2005; 84:909-13. [PMID: 16097985 DOI: 10.1111/j.0001-6349.2005.00797.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Two-dimensional hysterosalpingo-contrast-sonography, as a screening test for tubal patency for subfertile patients, is limited by the difficulty in visualizing the entire Fallopian tube owing to its tortuosity. This major disadvantage can be overcome by means of the three-dimensional hysterosalpingo-contrast-sonography (3D-HyCoSy). The current study compared the efficacy of 3D-HyCoSy with diagnostic laparoscopy and its feasibility as a screening test for tubal patency. METHODS Twenty-one consecutive patients scheduled to have laparoscopy were recruited to undergo the 3D-HyCoSy 2 days before the scheduled laparoscopy. Echovist (Schering AG, Berlin, Germany), the ultrasound contrast medium, was injected into the uterine cavity via a Foley's catheter. The flow of the medium in the Fallopian tube was captured by using three-dimensional power Doppler mode and was stored for later analysis. The person analyzing the images, the surgeon performing the laparoscopy, and the patients were blinded to the patients' identity and the sonography findings. The sonography and the laparoscopy findings were compared. The duration for the ultrasound examination, pain score, and patient acceptability were assessed. RESULTS Thirty-four of 42 (81%) Fallopian tubes were assessed. The sensitivity of 3D-HyCoSy for detecting tubal patency was 100% with a specificity of 67%. The positive and negative predictive values were 89 and 100%, respectively; the concordance rate was 91%. The mean duration (+/- SD) for the 3D-HyCoSy was 13.4 +/- 5.5 min. Fifteen patients (71%) regarded the sonography examination as at least acceptable. CONCLUSIONS This study confirmed the feasibility of using 3D-HyCoSy as an initial investigation for tubal patency.
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Affiliation(s)
- Carina C W Chan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
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Popescu LM, Ciontea SM, Cretoiu D, Hinescu ME, Radu E, Ionescu N, Ceausu M, Gherghiceanu M, Braga RI, Vasilescu F, Zagrean L, Ardeleanu C. Novel type of interstitial cell (Cajal-like) in human fallopian tube. J Cell Mol Med 2005; 9:479-523. [PMID: 15963270 PMCID: PMC6740321 DOI: 10.1111/j.1582-4934.2005.tb00376.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We describe here--presumably for the first time--a Cajal-like type of tubal interstitial cells (t-ICC), resembling the archetypal enteric ICC. t-ICC were demonstrated in situ and in vitro on fresh preparations (tissue cryosections and primary cell cultures) using methylene-blue, crystal-violet, Janus-Green B or MitoTracker-Green FM Probe vital stainings. Also, t-ICC were identified in fixed specimens by light microscopy (methylene-blue, Giemsa, trichrome stainings, Gomori silver-impregnation) or transmission electron microscopy (TEM). The positive diagnosis of t-ICC was strengthened by immunohistochemistry (IHC; CD117/c-kit+ and other 14 antigens) and immunofluorescence (IF; CD117/c-kit+ and other 7 antigens). The spatial density of t-ICC (ampullar-segment cryosections) was 100-150 cells/mm2. Non-conventional light microscopy (NCLM) of Epon semithin-sections revealed a network-like distribution of t-ICC in lamina propria and smooth muscle meshwork. t-ICC appeared located beneath of epithelium, in a 10-15 microm thick 'belt', where 18+/-2% of cells were t-ICC. In the whole lamina propria, t-ICC were about 9%, and in muscularis approximately 7%. In toto, t-ICC represent ~8% of subepithelial cells, as counted by NCLM. In vitro, t-ICC were 9.9+/-0.9% of total cell population. TEM showed that the diagnostic 'gold standard' (Huizinga et al., 1997) is fulfilled by 'our' t-ICC. However, we suggest a 'platinum standard', adding a new defining criterion- characteristic cytoplasmic processes (number: 1-5; length: tens of microm; thickness: < or =0.5 microm; aspect: moniliform; branching: dichotomous; organization: network, labyrinthic-system). Quantitatively, the ultrastructural architecture of t-ICC is: nucleus, 23.6+/-3.2% of cell volume, with heterochromatin 49.1+/-3.8%; mitochondria, 4.8+/-1.7%; rough and smooth endoplasmic-reticulum (1.1+/-0.6%, 1.0+/-0.2%, respectively); caveolae, 3.4+/-0.5%. We found more caveolae on the surface of cell processes versus cell body, as confirmed by IF for caveolins. Occasionally, the so-called 'Ca2+-release units' (subplasmalemmal close associations of caveolae+endoplasmic reticulum+mitochondria) were detected in the dilations of cell processes. Electrophysiological single unit recordings of t-ICC in primary cultures indicated sustained spontaneous electrical activity (amplitude of membrane potentials: 57.26+/-6.56 mV). Besides the CD117/c-kit marker, t-ICC expressed variously CD34, caveolins 1&2, alpha-SMA, S-100, vimentin, nestin, desmin, NK-1. t-ICC were negative for: CD68, CD1a, CD62P, NSE, GFAP, chromogranin-A, PGP9.5, but IHC showed the possible existence of (neuro)endocrine cells in tubal interstitium. We call them 'JF cells'. In conclusion, the identification of t-ICC might open the door for understanding some tubal functions, e.g. pace-making/peristaltism, secretion (auto-, juxta- and/or paracrine), regulation of neurotransmission (nitrergic/purinergic) and intercellular signaling, via the very long processes. Furthermore, t-ICC might even be uncommitted bipotential progenitor cells.
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Affiliation(s)
- L M Popescu
- Department of Cellular and Molecular Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 050474, Romania.
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Affiliation(s)
- Gavin Sacks
- Department of Reproductive Medicine, Hammersmith Hospital, London, UK
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