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Kazmerski TM, West NE, Jain R, Uluer A, Georgiopoulos AM, Aitken ML, Taylor-Cousar JL. Family-building and parenting considerations for people with cystic fibrosis. Pediatr Pulmonol 2022; 57 Suppl 1:S75-S88. [PMID: 34407321 PMCID: PMC9292426 DOI: 10.1002/ppul.25620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 01/24/2023]
Abstract
As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Women's Health Research and Innovation (CWHRI), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Natalie E West
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ahmet Uluer
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moira L Aitken
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Lörincz J, Vitale SG, Barna SK, Dinkó F, Riemma G, Tünde H, Nagyházi O, Lampé R, De Franciscis P, Török P. Hystero-salpingo scintigraphy for fallopian tubal patency assessment: results from a prospective study. MINIM INVASIV THER 2021; 31:797-802. [PMID: 34636280 DOI: 10.1080/13645706.2021.1986845] [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: 10/20/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (HSSG), for tubal patency assessment of infertile women. MATERIAL AND METHODS Prospective cohort study involving women in the infertility workup at the University of Debrecen, Hungary. Seventy infertile patients were scheduled to either basic dynamic HSSG, post-purge dynamic HSSG, or post-purge dynamic HSSG followed by SPECT/CT for reducing tracer contamination. The primary endpoint was the evaluation of the diagnostic accuracy of HSSG for the three methods. RESULTS During the basic dynamic group, the examination yielded a sensitivity of 87.5%, with a specificity of 71.7%, while positive and negative predictive values were 31.8%, and 97.4% respectively. Using post purge dynamic HSSG, it resulted in a sensitivity of 87.5%, a specificity of 88.7%, a positive predictive value of 53.8%, and a negative predictive value of 97.9%. Adding SPECT/CT to post-purge dynamic HSSG increased diagnostic accuracy with 100% sensitivity and 88.7% specificity, while positive and negative predictive values were 57.1% and 100%, respectively. CONCLUSION HSSG is a non-invasive and well-tolerated technique for tubal patency. It could be used initially to predict tubal patency in case of infertility. Its diagnostic accuracy is higher when it is carried out by adding SPECT/CT to the post-purge dynamic method.
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Affiliation(s)
- Judit Lörincz
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Sándor Kristóf Barna
- Faculty of Medicine, Medical Imaging Clinic - Nuclear Medicine, University of Debrecen, Debrecen, Hungary
| | - Fanni Dinkó
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Herman Tünde
- Center of Assisted Reproduction, University of Debrecen, Debrecen, Hungary
| | - Orsolya Nagyházi
- Department of Obstetrics and Gynecology, Saint Margaret Hospital, Budapest, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Péter Török
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
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Gündüz R, Ağaçayak E, Okutucu G, Kömürcü Karuserci Ö, Peker N, Güli Çetinçakmak M, Gül T. Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients? Afr Health Sci 2021; 21:373-378. [PMID: 34394319 PMCID: PMC8356590 DOI: 10.4314/ahs.v21i1.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. OBJECTIVES To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. METHODS The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gynecology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. RESULTS The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. CONCLUSION Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in consideration of the invasive nature and the higher complication rate of laparoscopy.
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Lörincz J, Molnár S, Herman T, Vitale SG, Jashanjeet S, Lampé R, Kardos L, Török P. Predictive value of bubble sign for tubal patency during office hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2020; 253:58-60. [PMID: 32777542 DOI: 10.1016/j.ejogrb.2020.07.048] [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: 01/06/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. METHODS In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. RESULTS Mean age of patients was 33.45 ± 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). CONCLUSIONS A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.
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Affiliation(s)
- Judit Lörincz
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Hungary.
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Singh Jashanjeet
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - László Kardos
- University of Debrecen, Kenézy Gyula Teaching Hospital, Department of Clinical Pharmacology, Infectology and Allergology, Hungary.
| | - Péter Török
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
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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.
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The prognostic capacity of transvaginal hydrolaparoscopy to predict non-IVF conception. Reprod Biomed Online 2018; 36:552-559. [DOI: 10.1016/j.rbmo.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/21/2022]
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Török P, Lőrincz J, Dobrai M, Póka R. Tubal flushing effect of hysteroscopic patency test. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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He Y, Ma X, Xu J, Li S, Wu H, Liu Q, Kong L, Luo J, Liu H. Comparison of Assessment Methods for Fallopian Tubal Patency and Peritubal Adhesion Between Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography and Laparoscopic Chromopertubation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:547-556. [PMID: 28151551 DOI: 10.7863/ultra.15.11056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to compare transvaginal 4-dimensional hysterosalpingo-contrast sonography with laparoscopic chromopertubation and evaluate the former's clinical value in assessing fallopian tubal patency and peritubal adhesion. METHODS Fifty-six patients visiting infertility clinics were included in the study and underwent surgery by their own choice in 1 month. In total, 112 fallopian tubes were assessed. Twenty-five were primarily infertile, and the rest were secondarily infertile. Laparoscopic chromopertubation was taken as the reference standard. RESULTS In a comparison of fallopian tubal patency between transvaginal hysterosalpingo-contrast sonography and laparoscopic chromopertubation, the sensitivity, specify, positive predictive value, and negative predictive value of hysterosalpingo-contrast sonography for diagnosing blocked fallopian tubes were 88.4%, 85.2%, 90.5%, and 82.1% respectively. In a comparison of spray at the fimbrial end between the no-peritubal adhesion and peritubal adhesion groups, the spray score at the fimbrial end in the no-peritubal adhesion group was significantly lower than that in the peritubal adhesion group. In a comparison of periovarian diffusion between the no-peritubal adhesion and peritubal adhesion groups, the periovarian diffusion score in the no-peritubal adhesion group was significantly lower than that in the peritubal adhesion group. In a comparison of periovarian diffusion between the patent-tube and blocked groups confirmed by chromopertubation, the periovarian diffusion score in the patent group was significantly lower than that in the blocked group. CONCLUSIONS Transvaginal hysterosalpingo-contrast sonography is a method with high sensitivity and specificity for screening fallopian tubal patency and peritubal adhesion.
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Affiliation(s)
- Yanni He
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Xiaohui Ma
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Jingjiao Xu
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Sushu Li
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Haorong Wu
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Qiuxiang Liu
- Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Linghong Kong
- Obstetrics and Gynecology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Juan Luo
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Hongmei Liu
- Departments of Ultrasonography, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangdong Province, Guangzhou, China
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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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Rezk M, Shawky M. The safety and acceptability of saline infusion sonography versus hysterosalpingography for evaluation of tubal patency in infertile women. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Incidence of infertility increased in the past years and it affects 15% of couples. Female and male factors are responsible in 40% and 40% of the cases, respectively, while factors present in both females and males can be found in 20% of cases. Female factors can be further divided into organic and functional ones. Function of the female organs can be evaluated in an outpatient setting by well-developed laboratory techniques but evaluation of the uterine cavity and inspection of the tubal patency have been traditionally carried out in one-day surgery. However, the latter can be performed under ambulatory setting with the use of office hysteroscopy, so that the use of operating theatre and staff costs can be saved. Using selective pertubation for the evaluation of tubal patency via office hysteroscopy can reduce cost further. The new methods in infertility workup which can be performed in ambulatory setting have several advantages for the patients. Orv. Hetil., 2013, 154, 1287–1290.
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Affiliation(s)
- Péter Török
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032
| | - Tamás Major
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Szülészeti és Nőgyógyászati Klinika Debrecen Nagyerdei krt. 98. 4032
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He Y, Geng Q, Liu H, Han X. First experience using 4-dimensional hysterosalpingo-contrast sonography with SonoVue for assessing fallopian tube patency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1233-1243. [PMID: 23804346 DOI: 10.7863/ultra.32.7.1233] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study was conducted to describe our first experience using transvaginal 4-dimensional (4D) hysterosalpingo-contrast sonography with SonoVue (Bracco International BV, Amsterdam, the Netherlands) for diagnosis of fallopian tube patency. The study was prospective and conducted in a university hospital setting. The sonographic procedures included 2-dimensional transvaginal sonography for evaluating uterine and ovarian mobility, observing intubation, and determining the initial plane and 4D hysterosalpingo-contrast sonography for observing periovarian and pelvic diffusion. Ninety-six outpatients visiting infertility clinics underwent 4D hysterosalpingo-contrast sonography. All patients finished the examination successfully. A total of 192 fallopian tubes were assessed, of which 95 (49.5%) were classified as type A (the tube was patent, and the contrast agent flowed smoothly through it), 72 (37.5%) as type B (the tube was patent, but the contrast agent did not flow smoothly inside it), and 25 (13.0%) as type C (blocked). Sixteen patients underwent laparoscopy or laparoscopy combined with hysteroscopy; 28 tubes (87.5%) were concordant with laparoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for 4D hysterosalpingo-contrast sonography versus laparoscopy were 81.8%, 90.5%, 81.8%, 90.5%, and 0.72 respectively. In total, 92.7% of patients did not require a hospital stay after 4D hysterosalpingo-contrast sonography, and none need resuscitation. The others stayed in the hospital for clinical observation because of a severe vasovagal reaction or severe pain but received only bed rest without any medical treatment. Forty patients (41.7%) felt slight pain; 39 (40.6%) felt moderate pain; and 15 (15.6%) had a vasovagal reaction. No procedure or postprocedure complications occurred in any patient. In conclusion, 4D hysterosalpingo-contrast sonography with SonoVue is an available screening method for assessment of tubal patency and is tolerable for most patients.
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Affiliation(s)
- Yanni He
- Department of Ultrasonography, Third Affiliated Hospital of Southern Medical University, 183 W Zhongshan Ave, 510630 Guangzhou, Guangdong, China
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Török P, Major T. Accuracy of Assessment of Tubal Patency With Selective Pertubation at Office Hysteroscopy Compared With Laparoscopy in Infertile Women. J Minim Invasive Gynecol 2012; 19:627-30. [DOI: 10.1016/j.jmig.2012.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/08/2012] [Accepted: 03/21/2012] [Indexed: 12/14/2022]
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Cobellis L, Argano F, Castaldi MA, Acone G, Mele D, Signoriello G, Colacurci N. Selective salpingography: preliminary experience of an office operative option for proximal tubal recanalization. Eur J Obstet Gynecol Reprod Biol 2012; 163:62-6. [DOI: 10.1016/j.ejogrb.2012.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 03/08/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
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Tur-Kaspa I. Fear no pain: uterine cavity and tubal patency assessment tests should be pain free. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:247-251. [PMID: 22535627 DOI: 10.1002/uog.11128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- I Tur-Kaspa
- Institute for Human Reproduction, Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60657, USA.
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Emanuel MH, van Vliet M, Weber M, Exalto N. First experiences with hysterosalpingo-foam sonography (HyFoSy) for office tubal patency testing. Hum Reprod 2011; 27:114-7. [PMID: 22064649 DOI: 10.1093/humrep/der367] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study was conducted to describe the first experiences with hysterosalpingo-foam sonography (HyFoSy) as a first step routine office procedure for tubal patency testing. METHODS A prospective observational cohort study was started in a university affiliated teaching hospital. In 2010, 73 patients with subfertility and a low risk of tubal pathology were examined. A non-toxic foam containing hydroxymethylcellulose and glycerol was applicated through a cervical applicator for contrast sonography (HyFoSy). Tubal patency was determined by transvaginal ultrasonographic demonstration of echogenic dispersion of foam in the Fallopian tube and/or the peritoneal cavity. Only in case patency could not be demonstrated, a hysterosalpingography (HSG) was performed as a control. RESULTS In 67 out of 73 (92%) patients, a successful procedure was performed. In 57 out of 73 (78%) cases, there was no further need for a HSG. In five patients (5/73; 7%) tubal occlusion was confirmed by HSG and in five patients (5/73; 7%) there was discordance between HyFoSy and HSG. Of 73 patients, 14 (19%) conceived within a median of 3 months after the procedure. CONCLUSIONS HyFoSy is a successful procedure to demonstrate tubal patency as a first step office procedure.
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Affiliation(s)
- Mark Hans Emanuel
- Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Heemstede/Hoofddorp, PO Box 770, 2130 AT Hoofddorp, The Netherlands.
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Spurbeck RR, Arvidson CG. Lactobacilli at the front line of defense against vaginally acquired infections. Future Microbiol 2011; 6:567-82. [PMID: 21585263 DOI: 10.2217/fmb.11.36] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Probiotics are microorganisms that provide a health benefit to the host and are promoted as alternatives for the treatment and prevention of infectious diseases and other conditions. One of the most rapidly developing areas of probiotic research is in the management of vaginally acquired infections. Several Lactobacillus species produce compounds that kill or inhibit the growth of vaginally acquired pathogens. Other lactobacilli reduce the adherence of pathogens to urogenital epithelial cells in culture. This article discusses the mechanisms by which vaginal lactobacilli prevent pathogen colonization of the urogenital tract, and potential mechanisms that warrant investigation. Animal models and clinical studies, while limited, are discussed with the idea that these are the next critical steps to advance the study of probiotics for the treatment and prevention of vaginally acquired infections.
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Affiliation(s)
- Rachel R Spurbeck
- Genetics Program, Michigan State University, Michigan State University, East Lansing, 48824-1101, USA
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Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril 2011; 95:2171-9. [DOI: 10.1016/j.fertnstert.2011.02.054] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 01/05/2011] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
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Torre A, Pouly JL, Wainer B. [Anatomic evaluation of the female of the infertile couple]. ACTA ACUST UNITED AC 2011; 39:S34-44. [PMID: 21185484 DOI: 10.1016/s0368-2315(10)70029-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
One third of infertility cases are due to anatomical abnormalities of the female reproductive tract: endometrial polyps (33%), bilateral tubal blockage (12%), hydrosalpinx (7%), sub-mucosal fibroids (3%) and pelvic endometriosis. These may need surgical correction which could restore fertility. This review aim to determine which examinations should be performed first. Hysterosalpingography shows sensitivity of only 65% but it increases the achievement of spontaneous pregnancy by three times. Office hysteroscopy has an excellent sensitivity (>95%) for diagnosing intra-uterine lesions. Pelvic ultrasound, whose good sensitivity is improved by adding 3D imaging and hysterosonography, seems as efficient as office hysteroscopy in diagnosing uterine cavity abnormalities. Moreover, it also efficiently diagnoses pelvic diseases such as hydrosalpinx or endometrioma without laparoscopy. A first line laparoscopy is indicated in for woman suspected of endometriosis or tubal pathology (history of complicated appendicitis, previous pelvic surgery, pelvic inflammatory disease). For the others straight forward cases, the majority of patients, hysterosalpingography and pelvic ultrasound seem to be sufficient as primary diagnostic tool.
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Affiliation(s)
- A Torre
- Faculté de médecine Paris-Ouest, Université de Versailles Saint-Quentin en Yvelines, 9 boulevard d'Alembert, 78280 Guyancourt, France.
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Lanzani C, Savasi V, Leone FP, Ratti M, Ferrazzi E. Two-dimensional HyCoSy with contrast tuned imaging technology and a second-generation contrast media for the assessment of tubal patency in an infertility program. Fertil Steril 2009; 92:1158-1161. [DOI: 10.1016/j.fertnstert.2008.07.1746] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 06/21/2008] [Accepted: 07/16/2008] [Indexed: 11/27/2022]
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Coppus SF, Chandra M, Coomarasamy A, Johnson N, Van der Veen F, Bossuyt PMM, Mol BWJ. Chlamydia antibody titer testing versus hysterosalpingography for detection of tubal pathology in subfertile women. Hippokratia 2008. [DOI: 10.1002/14651858.cd007433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sjors F Coppus
- Máxima Medical Centre; Obstetrics and Gynaecology; De Run 4600 Veldhoven Netherlands 5500 MB
| | - M Chandra
- Máxima Medical Centre; Obstetrics and Gynaecology; De Run 4600 Veldhoven Netherlands 5500 MB
| | - A Coomarasamy
- Máxima Medical Centre; Obstetrics and Gynaecology; De Run 4600 Veldhoven Netherlands 5500 MB
| | - Neil Johnson
- University of Auckland; Department of Obstetrics & Gynaecology; PO Box 92019 Auckland New Zealand 1003
| | - Fulco Van der Veen
- Academic Medical Center; Center for Reproductive Medicine - H4-205, Department of Obstetrics & Gynaecology; University of Amsterdam Meibergdreef 9 Amsterdam Netherlands 1105 AZ
| | - Patrick MM Bossuyt
- Academic Medical Center, University of Amsterdam; Department of Clinical Epidemiology and Biostatistics; Room J2-209, PO Box 22700 Amsterdam Netherlands 1105 DD
| | - Ben Willem J Mol
- Máxima Medical Center; Obstetrics and Gynaecology; Postbox 7777 Veldhoven Netherlands 5500 MB
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Ricci G, Guastalla P, Ammar L, Cervi G, Guarnieri S, Sartore A. Balloon catheter vs. cervical vacuum cup for hysterosalpingography: a prospective, randomized, single-blinded study. Fertil Steril 2007; 87:1458-67. [DOI: 10.1016/j.fertnstert.2006.11.096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2006] [Revised: 10/09/2006] [Accepted: 11/15/2006] [Indexed: 11/25/2022]
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De Geyter C, Steimann S, Fröhlich JM, Wiesner W, Wight E, Steinbrich W, Pegios W. Selective visualization of the Fallopian tube with magnetic resonance imaging. Reprod Biomed Online 2007; 14:593-7. [PMID: 17509199 DOI: 10.1016/s1472-6483(10)61051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
At present, X-ray hysterosalpingography is used commonly as a screening method for testing Fallopian tube patency, but the results are often unreliable due to mucous plugs or muscular contractions. Selective catheterization of the tubes under X-ray control is feasible, but is rarely used due to exposure of young individuals aiming for pregnancy to a high ionizing dose. Here, a case is described of a patient whose Fallopian tubes were selectively catheterized and visualized three-dimensionally under contrast-enhanced magnetic resonance imaging (MRI) guidance using a high-viscous gadoteric acid solution (Dotarem). In this patient, bilateral peritubal adhesions caused a blockage of the fimbrial part of the tube leading to transuterine spilling of tubal fluid. Laparoscopy followed by bilateral salpingectomy was then performed, which confirmed the three-dimensional MRI images, and the excised specimens were examined histologically. The advantages of this novel technique include the avoidance of ionizing damage to the gonads and the potential for development of more elaborate interventional methods, such as ballooning and stenting. It is intended to develop contrast MRI further, both for improved non-invasive visualization and for manipulative technology of the Fallopian tubes.
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Affiliation(s)
- Christian De Geyter
- University Women's Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
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Guven ESG, Dilbaz S, Dilbaz B, Ozdemir DS, Akdag D, Haberal A. Comparison of the effect of single-dose and multiple-dose methotrexate therapy on tubal patency. Fertil Steril 2007; 88:1288-92. [PMID: 17418839 DOI: 10.1016/j.fertnstert.2006.12.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 12/27/2006] [Accepted: 12/27/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) regimen. DESIGN A case series with a retrospective statistical analysis. SETTING Maternity and teaching hospital in Turkey. PATIENT(S) Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy. INTERVENTION(S) Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency. MAIN OUTCOME MEASURE(S) Ipsilateral and contralateral tubal obstruction rates. RESULT(S) Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction. CONCLUSION(S) In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy.
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Affiliation(s)
- Emine Seda Guvendag Guven
- Department of Obstetrics and Gynecology, Etlik Womens' Health and Teaching Hospital, Ankara, Turkey.
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Schemoul G, Silvera S, Augui J, Legman P, Vignaux O. [Radiologically-guided hysterosalpingography and tubal catheterization]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2007; 35:55-9. [PMID: 17188546 DOI: 10.1016/j.gyobfe.2006.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 10/18/2006] [Indexed: 05/13/2023]
Abstract
Radiological exploration of hypofertility by means of hysterosalpingography is a method still valid but no longer sufficient. Tubal catheterization has thus become a necessary complementary exam in order to eliminate the pseudo-obturations of hysterosalpingography and, in case of proximal tubal obstructions, to obtain pregnancies. The conditions for the realization of hysteroalpingography and tubal catheterization are hereby described, with emphasis on the rigorous technique that is required together with careful listening to the patients.
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Affiliation(s)
- G Schemoul
- Hôpital privé Armand-Brillard, 94130 Nogent-sur-Marne, France.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000169110.00376.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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