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Soliman AA, Shaalan W, Abdel-Dayem T, Awad EE, Elkassar Y, Lüdders D, Malik E, Sallam HN. Power Doppler flow mapping and four-dimensional ultrasound for evaluating tubal patency compared with laparoscopy. Eur J Obstet Gynecol Reprod Biol 2015; 195:83-87. [PMID: 26479436 DOI: 10.1016/j.ejogrb.2015.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study the accuracy of four-dimensional (4D) ultrasound and power Doppler flow mapping in detecting tubal patency in women with sub-/infertility, and compare it with laparoscopy and chromopertubation. STUDY DESIGN A prospective study. The study was performed in the outpatient clinic and infertility unit of a university hospital. The sonographic team and laparoscopic team were blinded to the results of each other. Women aged younger than 43 years seeking medical advice due to primary or secondary infertility and who planned to have a diagnostic laparoscopy performed, were recruited to the study after signing an informed consent. All of the recruited patients had power Doppler flow mapping and 4D hysterosalpingo-sonography by injecting sterile saline into the fallopian tubes 1 day before surgery. Registering Doppler signals, while using power Doppler, both at the tubal ostia and fimbrial end and the ability to demonstrate the course of the tube especially the isthmus and fimbrial end, while using 4D mode, was considered a patent tube. RESULTS Out of 50 recruited patients, 33 women had bilateral patent tubes and five had unilateral patent tubes as shown by chromopertubation during diagnostic laparoscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for two-dimensional power Doppler hysterosalpingography were 94.4%, 100%, 100%, 89.2%, and 96.2%, respectively and for 4D ultrasound were 70.4%, 100%, 100%, 70.4%, and 82.6%, respectively. CONCLUSIONS Four-dimensional saline hysterosalpingography has acceptable accuracy in detecting tubal patency, but is surpassed by power Doppler saline hysterosalpingography. Power Doppler saline hysterosalpingography could be incorporated into the routine sub-/infertility workup.
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Affiliation(s)
- Amr A Soliman
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt; Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany.
| | - Waleed Shaalan
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Tamer Abdel-Dayem
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Elsayed Elbadawy Awad
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Yasser Elkassar
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
| | - Dörte Lüdders
- Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Eduard Malik
- Carl von Ossietzky University Oldenburg, Department of Obstetrics and Gynecology, Oldenburg University Women's Hospital, Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
| | - Hassan N Sallam
- University of Alexandria, Department of Obstetrics and Gynecology, El Shatby Maternity University Hospital, Port-Said Street, 21526 El-Shatby, Alexandria, Egypt
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[Should a laparoscopy be necessary in case of infertility with normal tubes at hysterosalpingography?]. ACTA ACUST UNITED AC 2011; 39:504-8. [PMID: 21820937 DOI: 10.1016/j.gyobfe.2011.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 06/06/2011] [Indexed: 11/24/2022]
Abstract
The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids).
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