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Geenen RWF, van der Molen AJ, Dekkers IA, Bellin MF, Bertolotto M, Correas JM, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Sebastià C, Stacul F, Romanini L, Clément O, Brismar TB. Contrast media for hysterosalpingography: systematic search and review providing new guidelines by the Contrast Media Safety Committee of the European Society of Urogenital Radiology. Eur Radiol 2024; 34:6435-6443. [PMID: 38573340 PMCID: PMC11399192 DOI: 10.1007/s00330-024-10707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Hysterosalpingography (HSG) is widely used for evaluating the fallopian tubes; however, controversies regarding the use of water- or oil-based iodine-based contrast media (CM) remain. The aim of this work was (1) to discuss reported pregnancy rates related to the CM type used, (2) to validate the used CM in published literature, (3) to discuss possible complications and side effects of CM in HSG, and (4) to develop guidelines on the use of oil-based CM in HSG. METHODS A systematic literature search was conducted for original RCT studies or review/meta-analyses on using water-based and oil-based CM in HSG with fertility outcomes and complications. Nine randomized controlled trials (RCTs) and 10 reviews/meta-analyses were analyzed. Grading of the literature was performed based on the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 classification. RESULTS An approximately 10% higher pregnancy rate is reported for oil-based CM. Side effects are rare, but oil-based CM have potentially more side effects on the maternal thyroid function and the peritoneum. CONCLUSIONS 1. HSG with oil-based CM gives approximately 10% higher pregnancy rates. 2. External validity is limited, as in five of nine RCTs, the CM used is no longer on the market. 3. Oil-based CM have potentially more side effects on the maternal thyroid function and on the peritoneum. 4. Guideline: Maternal thyroid function should be tested before HSG with oil-based CM and monitored for 6 months after. CLINICAL RELEVANCE STATEMENT Oil-based CM is associated with an approximately 10% higher chance of pregnancy compared to water-based CM after HSG. Although side effects are rare, higher iodine concentration and slower clearance of oil-based CM may induce maternal thyroid function disturbance and peritoneal inflammation and granuloma formation. KEY POINTS • It is unknown which type of contrast medium, oil-based or water-based, is the optimal for HSG. • Oil-based contrast media give a 10% higher chance of pregnancy after HSG, compared to water-based contrast media. • From the safety perspective, oil-based CM can cause thyroid dysfunction and an intra-abdominal inflammatory response in the patient.
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Affiliation(s)
- Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-France Bellin
- AP-HP, University Hospital Bicêtre, Department of Radiology, BioMaps, University Paris Saclay, Le Kremlin-Bicêtre, France
| | | | - Jean-Michel Correas
- AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | | | - Olivier Clément
- AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | - Torkel B Brismar
- Unit of Radiology, CLINTEC, Karolinska Institutet, Alfred Nobels alle 8, 141 52, Huddinge, Sweden.
- Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
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Ghonge NP, Ghonge SD. Hystero-Salphingography in current clinical practice-old flames, die hard! Abdom Radiol (NY) 2024:10.1007/s00261-024-04456-9. [PMID: 38913135 DOI: 10.1007/s00261-024-04456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
Hysterosalpingography (HSG) remains a valuable diagnostic tool in current clinical practice, offering crucial insights into endometrial cavity, fallopian tubes and the adjoining part of the pelvic peritoneal cavity. Despite the emergence of alternative imaging and non-imaging options, HSG continues to be widely utilized due to its diagnostic accuracy, cost-effectiveness, and easy accessibility. Due attention to the correct technique and optimal image interpretation will further enhance its diagnostic accuracy and precision in the work-up of patients with fertility problems.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospitals, New Delhi-76, India.
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Chia CY, Lee E. Assessment of contrast intravasation in patients investigated by fluoroscopic hysterosalpingograms: A two-year retrospective audit in Western Australia. J Med Imaging Radiat Oncol 2024. [PMID: 38204210 DOI: 10.1111/1754-9485.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Intravasation on hysterosalpingogram (HSG) is defined by the flow of injected contrast from the uterine cavity into adjacent myometrial vessels. Evidence suggests intravasation can result in consequences such as pulmonary and cerebral embolisms. However, adverse events are poorly reported across published studies. Reported intravasation ranges from 0.0% to 13%, with higher rates attributed to oil-soluble contrast medium (OSCM) use. Recent reviews of OSCM's fertility-enhancing benefits have prompted rapid clinical uptake by fertility specialists worldwide. This instigates increased concern for intravasation and its associated sequelae. We aim to assess the prevalence of intravasation in fluoroscopic HSGs and its reporting in Western Australia (WA). METHODS A two-year retrospective analysis of all fluoroscopic HSGs in one public teaching hospital within WA was conducted. All HSGs were retrieved from the public radiology information system and a blinded method was utilised to verify the presence and grading of intravasation in captured HSG images. Grading of intravasation was attributed by anatomical spread: 1 to myometrium, 2 to parametrium and 3 to para-iliac vessels. Results were subsequently compared with reported intravasation to assess for discrepancies. RESULTS Of 308 successful HSGs, an intravasation rate of 7.1% was identified. Of these cases, 45% were reported and 32% were graded. Majority (73%) of intravasation events were classified as grade 1, with 9.0% and 18% of cases classified as grade 2 and 3, respectively. CONCLUSION Under-reporting of intravasation emphasises a need for increased vigilance of radiologists. Standardised classification can provide interpretational consistency and should be considered to improve safety in future practice.
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Affiliation(s)
- Ci Yue Chia
- Royal Perth Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Western Ultrasound for Women, Perth, Western Australia, Australia
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Yang JJ, Chapman M. What are the risks associated with lipiodol hysterosalpingography? A literature review. Radiography (Lond) 2023; 29:1041-1045. [PMID: 37714068 DOI: 10.1016/j.radi.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Hysterosalpingography is widely used as a first-line investigation for infertility, and may also be therapeutic, increasing pregnancy rates. Aqueous and oil-based contrast agents can be used. Some studies suggest Lipiodol hysterosalpingography has a greater therapeutic effect on fertility than aqueous contrast, though this is contentious. There are additionally safety concerns surrounding Lipiodol hysterosalpingography. This review summarises the adverse effects associated with Lipiodol hysterosalpingography, particularly on thyroid function. KEY FINDINGS 331 articles were identified. Of these, 46 met inclusion criteria. 3 further articles were identified from reference lists. Complications typically cited in the literature include pain, intravasation, life-threatening oil embolism, and lipogranuloma formation. Emerging evidence suggests that Lipiodol hysterosalpingography may also impact maternal and neonatal thyroid function. Women may develop hypo- or hyperthyroidism. Thyroid dysfunction is clinically significant as even subclinical hypothyroidism reduces fertility, increases the risk of pregnancy complications including miscarriage, pre-eclampsia and perinatal mortality, and adversely impacts foetal neurodevelopment. One study suggested a possible link with neonatal congenital hypothyroidism. CONCLUSION There is emerging evidence to suggest that Lipiodol hysterosalpingography can cause hypo- or hyperthyroidism, in addition to known adverse effects of pain, intravasation, oil embolism, and lipogranuloma formation. IMPLICATIONS FOR PRACTICE Given the significance of these risks, and contention surrounding whether Lipiodol truly increases pregnancy rates compared to aqueous mediums, careful consideration is required in the selection of contrast agent. In particular, Lipiodol hysterosalpingography may not be suitable for women with pre-existing thyroid dysfunction.
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Affiliation(s)
- J J Yang
- Discipline of Women's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia.
| | - M Chapman
- Discipline of Women's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; IVF Australia, St George Private Hospital, Sydney, Australia
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Peart JM, Sim RG, Hofman PL. Therapeutic effects of hysterosalpingography contrast media in infertile women: what do we know about the H2O in the H2Oil trial and why does it matter? Hum Reprod 2021; 36:529-535. [PMID: 33326555 DOI: 10.1093/humrep/deaa325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/25/2020] [Indexed: 11/13/2022] Open
Abstract
Recent interest in the use of oil-soluble contrast media (OSCM) for hysterosalpingography (HSG) and other tubal flushing procedures is largely the result of publication of the large, multicentre, randomized controlled H2Oil trial in the New England Journal of Medicine in 2017, addressing the long-held suspicion that pregnancy rates following HSG with OSCM are higher than if a water-soluble contrast media (WSCM) is used. However, the findings of this trial have been compromised by the WSCM selected for comparison with OSCM. The chosen WSCM belongs to a superceded class of ionic media, with an iodine concentration, osmolality and viscosity all lying at the extreme end of the range for water-soluble radiographic contrast. The requirement for safe, cheap, versatile WSCM for intravascular use during computerized tomography, angiography and interventional procedures has resulted in considerable refinement of WSCM, with current widespread use of non-ionic, low osmolality or iso-osmolar WSCM in radiology, including for HSG. However, the use of the earlier ionic, high osmolality agents such as that selected for the H2Oil trial persists for HSG in some centres, despite potential adverse effects on the endometrium and fallopian tubal epithelium compared with more modern, less toxic WSCM. Knowledge of the variety of physical and chemical characteristics of the available WSCM is essential for interpretation of the current literature and establishing the most effective and safe water-soluble agent to use for HSG. Design of future clinical trials to establish the potential superiority of OSCM over WSCM for fertility enhancement must include the use of the readily available, inexpensive modern WSCM. While the fertility rates following OSCM HSG have been shown to be high in women with idiopathic infertility, more robust trials are required before the widespread use of OSCM for HSG or other modalities such as ultrasound and laparoscopy should be adopted.
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Affiliation(s)
| | | | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Roest I, Rosielle K, van Welie N, Dreyer K, Bongers M, Mijatovic V, Mol BW, Koks C. Safety of oil-based contrast medium for hysterosalpingography: a systematic review. Reprod Biomed Online 2021; 42:1119-1129. [PMID: 33931367 DOI: 10.1016/j.rbmo.2021.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
Recent meta-analyses have shown that a hysterosalpingography (HSG) with oil-based contrast increases pregnancy rates in subfertile women. However, the frequency of complications during or after an HSG with oil-based contrast in subfertile women and/or their offspring is still unclear. This systematic review and meta-analysis, without restrictions on language, publication date or study design, was performed to fill this knowledge gap. The results show that the most frequently reported complication was intravasation of contrast, which occurred in 2.7% with the use of oil-based contrast (31 cohort studies and randomized controlled trials [RCT], 95% CI 1.7-3.8, absolute event rate 664/19,339), compared with 2.0% with the use of water-based contrast (8 cohort studies and RCT, 95% CI 1.2-3.0, absolute event rate 18/1006). In the cohort studies and RCT there were 18 women with an oil embolism (18/19,339 HSG), all without serious lasting consequences. Four cases with serious consequences of an oil embolism were described (retinal oil embolism [n = 1] and cerebral complaints [n = 3]); these reports did not describe the use of adequate fluoroscopy guidance during HSG. In conclusion, the most frequently reported complication after an HSG with oil-based contrast is intravasation occurring in 2.7%. In total four cases with serious consequences of oil embolisms in subfertile women were published.
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Affiliation(s)
- Inez Roest
- Department of Obstetrics and Gynecology, Máxima MC, Veldhoven/Eindhoven, the Netherlands; Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Amsterdam, the Netherlands; School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands.
| | - Kimmy Rosielle
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Amsterdam, the Netherlands
| | - Nienke van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Amsterdam, the Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Amsterdam, the Netherlands
| | - Marlies Bongers
- Department of Obstetrics and Gynecology, Máxima MC, Veldhoven/Eindhoven, the Netherlands; School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Amsterdam, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, University of Monash, Melbourne VIC, Australia
| | - Carolien Koks
- Department of Obstetrics and Gynecology, Máxima MC, Veldhoven/Eindhoven, the Netherlands
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Liang G, Zhu Q, He X, Wang X, Jiang L, Zhu C, Xie L, Qian Z, Zhang J. Effects of oil-soluble versus water-soluble contrast media at hysterosalpingography on pregnancy outcomes in women with a low risk of tubal disease: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e039166. [PMID: 33109663 PMCID: PMC7597517 DOI: 10.1136/bmjopen-2020-039166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In recent years, due to various factors, the rate of infertility in China has increased and now affects over 10% of women of reproductive age. Hysterosalpingography (HSG) is a common diagnostic procedure during fertility examinations. However, there is no consensus on the choice of contrast agents and their effects. As the largest multicentre, randomised controlled trial (H2Oil trial from the Netherlands) has shown that oil-soluble contrast at HSG can enhance fertility compared with water-soluble contrast, we propose this study to examine whether the use of oil-soluble contrast media results in increased rates of pregnancy in Chinese women undergoing HSG. METHODS AND ANALYSIS This study is a single-centre, randomised, controlled, parallel-group, superiority trial. Patients with low risk of tubal disease will be randomised to undergo HSG using iodinated oil injection (OSCM group, oil-soluble contrast media) or ioversol injection (WSCM group, water-soluble contrast media). To evaluate the potential superiority of the OSCM group, with 1:1 allocation ratio, 90% statistical power and a two-sided significance level of 5%, we have calculated a sample of 520 women per group to be enrolled, for a total of 1040 including 10% loss to follow-up or protocol variation. The primary outcome is the rate of ongoing pregnancy during 6 months after randomisation. The secondary outcomes will consist of thyroid function of patients and newborns, pain scores during HSG, rate of live birth, clinical pregnancies, miscarriages, ectopic pregnancy, time to ongoing pregnancy, time to live birth, cost calculations of the OSCM group/WSCM group, and assisted reproductive technology treatments between the two groups. ETHICS AND DISSEMINATION This protocol received authorisation from the Medical Research Ethics Committee of International Peace Maternity and Child Health Hospital on 18 January 2020 (approval no GKLW2020-02). The findings will be reported in peer-reviewed publications and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER ChiCTR2000031612.
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Affiliation(s)
- Guiling Liang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Xiaoqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Xiaofeng Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Ling Jiang
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoxia Qian
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
- Department of Radiology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Specialty, Shanghai, China
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Wang R, Watson A, Johnson N, Cheung K, Fitzgerald C, Mol BWJ, Mohiyiddeen L. Tubal flushing for subfertility. Cochrane Database Syst Rev 2020; 10:CD003718. [PMID: 33053612 PMCID: PMC9508794 DOI: 10.1002/14651858.cd003718.pub5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Establishing the subgroup analysis of the fallopian tubes (tubes) is a commonly undertaken diagnostic investigation for women with subfertility. This is usually achieved by flushing contrast medium through the tubes and visualising patency on radiographs, ultrasonography or laparoscopy. Many women were noted to conceive in the first three to six months after tubal flushing, raising the possibility that tubal flushing could also be a treatment for infertility. There has been debate about which contrast medium should be used (water-soluble or oil-soluble media) as this may influence pregnancy rates. An important adverse event during tubal flushing is intravasation (backflow of contrast medium into the blood or lymphatic vessels),which could lead to embolism although it is asymptomatic in most cases. OBJECTIVES To evaluate the effectiveness and safety of tubal flushing with oil-soluble contrast media (OSCM) and water-soluble contrast media (WSCM) on subsequent fertility outcomes in women with subfertility. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, MEDLINE, Embase, CENTRAL, PsycINFO, reference lists of identified articles and trial registries. The most recent search was conducted in April 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing tubal flushing with OSCM, WSCM with each other or with no treatment, in women with subfertility. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trials, assessed risk of bias and extracted data. We contacted study authors for additional information. The overall quality of the evidence was assessed using GRADE methods. MAIN RESULTS Fifteen trials involving 3864 women were included in this systematic review. Overall, the quality of evidence varied from very low to moderate: the main limitations were risk of bias, heterogeneity and imprecision. OSCM versus no treatment Four studies (506 women) were included in this comparison. Tubal flushing with OSCM may increase the odds of live birth (odds ratio (OR) 3.27, 95% confidence interval (CI) 1.57 to 6.85, 3 RCTs, 204 women, I2 = 0, low-quality evidence). This suggests that if the chance of live birth following no treatment is assumed to be 11%, the chance following tubal flushing with OSCM would be between 16% and 46%. Tubal flushing with OSCM may increase in the odds of clinical pregnancy (OR 3.54, 95% CI 2.08 to 6.02, 4 RCTs, 506 women, I2 = 18%, low-quality evidence). This suggests that if the chance of clinical pregnancy following no treatment is assumed to be 9%, the chance following tubal flushing with OSCM would be between 17% and 37%. No study measured intravasation or other adverse events such as infection, haemorrhage and congenital abnormalities. WSCM versus no treatment Only one study (334 women) was included in this comparison. We are uncertain whether tubal flushing with WSCM increase live birth compared to no treatment (OR 1.13, 95% CI 0.67 to 1.91, 1 RCT, 334 women, low-quality evidence). This suggests that if the chance of live birth following no treatment is assumed to be 21%, the chance following tubal flushing with WSCM would be between 15% and 33%. We are uncertain whether tubal flushing with WSCM increases clinical pregnancy compared to no treatment (OR 1.14, 95% CI 0.71 to 1.84, 1 RCT, 334 women, low-quality evidence). This suggests that if the chance of clinical pregnancy following no treatment is assumed to be 27%, the chance following tubal flushing with WSCM would be between 29% and 40%. One case with pelvic infection was reported in the WSCM group and no case with infection in the no treatment group in a one study (334 women). Meta-analysis was not performed due to the rare events. No study measured intravasation or other adverse events such as infection, haemorrhage and congenital abnormalities. OSCM versus WSCM Six studies (2598 women) were included in this comparison. Three studies reported live birth, including two with higher live birth in the OSCM group (OR 1.64, 95% CI 1.27 to 2.11, 1119 women; OR 3.45, 95% CI 1.97 to 6.03, 398 women); and one with insufficient evidence of a difference between groups (OR 0.92, 95% CI 0.60 to 1.40, 533 women). Given the substantial heterogeneity observed (I2 = 86%), meta-analysis was not performed. Tubal flushing with OSCM probably increased in the odds of intravasation (asymptomatic) compared to tubal flushing with WSCM (OR 5.00, 95% CI 2.25 to 11.12, 4 RCTs, 1912 women, I2 = 0, moderate-quality evidence). This suggests that if the chance of intravasation following tubal flushing with WSCM is assumed to be 1%, the chance following tubal flushing with OSCM would be between 2% and 9%. Tubal flushing with OSCM may increase the odds of clinical pregnancy (OR 1.42, 95% CI 1.10 to 1.85, 6 RCTs, 2598 women, I2 = 41%, low-quality evidence). This suggests that if the chance of clinical pregnancy following tubal flushing with WSCM is assumed to be 26%, the chance following tubal flushing with OSCM would be between 28% and 39%. We are uncertain whether tubal flushing with OSCM decreases the odds of infection (OR 0.22, 95% CI 0.04 to 1.22, 2 RCTs, 662 women, I2 = 0, very low-quality evidence) or haemorrhage (OR 0.65, 95% CI 0.40 to 1.06, 2 RCTs, 662 women, I2 = 0, very low-quality evidence). Three neonates with congenital abnormalities were reported in the OSCM group while no congenital abnormality was reported in the WSCM group in one study (1119 women). No meta-analysis was performed due to the rare events. AUTHORS' CONCLUSIONS The evidence suggests that compared to no treatment, tubal flushing with OSCM may increase the chance of live birth and clinical pregnancy, while it is uncertain whether tubal flushing with WSCM improves those outcomes. Compared to tubal flushing with WSCM, OSCM may improve clinical pregnancy while meta-analysis was impossible for live birth due to heterogeneity. Evidence also suggests that OSCM is associated with an increased risk of asymptomatic intravasation. Overall, adverse events, especially long-term adverse events, are poorly reported across studies.
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Affiliation(s)
- Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Andrew Watson
- Department of Obstetrics and Gynaecology, Tameside & Glossop Acute Services NHS Trust, Ashton-Under-Lyne, UK
| | - Neil Johnson
- Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Karen Cheung
- Department of Obstetrics and Gynaecology, Stockport NHS Foundation Trust, Stockport, UK
| | | | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
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Miyazaki Y, Yamamoto T, Hyakudomi R, Taniura T, Hirayama T, Takai K, Hirahara N, Tajima Y. Case of inflammatory granuloma in inguinal hernia sac after hysterosalpingography with oily contrast medium. Int J Surg Case Rep 2020; 72:215-218. [PMID: 32544832 PMCID: PMC7298538 DOI: 10.1016/j.ijscr.2020.05.084] [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: 03/22/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The foreign body reaction caused by oil contrast medium, Lipiodol, is rare. We present a rare case of inflammatory granuloma in the inguinal hernia sac after hysterosalpingography with lipiodol. PRESENTATION OF CASE A 30-year-old woman who had left inguinal growing mass for 7 months after hysterosalpingography with Lipiodol for examination of infertile. About 3 cm soft mass was palpable on the left inguinal region, and plane CT scan showed a multifocal cystic mass with metal concentration. Thus, laparoscopic herniorrhaphy was performed to repair the inguinal hernia and to confirm the contents of cystic lesion. The hernia sac filled with mucinous contents. Pathological examination revealed that inflammatory granuloma due to numerous lipid droplets and phagocytic images of leukocytes in the hernia capsule. DISCUSSION AND CONCLUSION Although oil contrast medium is safety agent, there is rear complication which need the surgical treatment. Complete resection of granuloma, including hernia sac, is important to prevent recurrence.
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Affiliation(s)
- Yoshiko Miyazaki
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan.
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
| | | | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University, Faculty of Medicine, Japan
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Peart J, Sim R. Safety of Lipiodol use for assessment of tubal patency and therapeutic tubal flushing – Fluoroscopy versus ultrasound? J Med Imaging Radiat Oncol 2020; 64:522-524. [DOI: 10.1111/1754-9485.13025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jane Peart
- Auckland Radiology Group Auckland New Zealand
| | - Robert Sim
- Auckland Radiology Group Auckland New Zealand
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11
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Peart J. Letter: Higher reported rates of intravasation of oil-soluble contrast media—there may be a silver lining. Hum Reprod Open 2020; 2020:hoaa030. [PMID: 32665979 PMCID: PMC7331473 DOI: 10.1093/hropen/hoaa030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jane Peart
- Auckland Radiology Group, Auckland 1023, New Zealand
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12
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Guvenc G, Bektas Pardes B, Kinci MF, Karasahin KE. Effect of education and counselling on reducing pain and anxiety in women undergoing hysterosalpingography: A randomised controlled trial. J Clin Nurs 2020; 29:1653-1661. [PMID: 31889350 DOI: 10.1111/jocn.15166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/31/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the effects of education and counselling on anxiety and pain in women undergoing hysterosalpingography (HSG) as part of infertility treatment. BACKGROUND The hysterosalpingography has an important diagnostic role in finding the cause of infertility and making a decision on management of treatment. In addition, it is considered a feared procedure in the infertility process and the one about which very little is known. Women often experience anxiety and pain during the HSG procedure. DESIGN A randomised controlled trial. METHODS The CONSORT guidelines have been used to describe the methods. Women who were diagnosed with infertility between February-October 2016 were included in the study. The participants were randomised and divided into intervention (52) and control (53) groups. The sociodemographic and obstetric data collection form, the State-Trait Anxiety Inventory and a visual analogue scale were used before the procedure. After the questionnaires were applied to the intervention group, individual learning and counselling sessions were given about the hysterosalpingography process. Brochures were also distributed to the patients for their reference after the learning session. The control group received standard care. RESULTS When the intervention and control groups were compared, it was found that the education and counselling given before the HSG procedure significantly decreased the level of pain and anxiety felt by women. In addition, a significant positive correlation was found between pain and anxiety after the training in the intervention group. CONCLUSIONS This study indicates that the education and counselling given to women before the HSG procedure are effective interventions for reducing pain and anxiety in women undergoing HSG. RELEVANCE TO CLINICAL PRACTICE With the application of HSG education and counselling, and the distribution of brochures to each patient, pain and anxiety can be reduced during the HSG procedure.
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Affiliation(s)
- Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Burcin Bektas Pardes
- Department of Nursing, University of Health Sciences, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Mehmet Ferdi Kinci
- Obstetrics and Gynecology Ankara, University of Health Sciences, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Kazım Emre Karasahin
- Obstetrics and Gynecology Ankara, University of Health Sciences, Gulhane Education and Research Hospital, Ankara, Turkey
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13
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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.
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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
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Wang R, van Welie N, van Rijswijk J, Johnson NP, Norman RJ, Dreyer K, Mijatovic V, Mol BW. Effectiveness on fertility outcome of tubal flushing with different contrast media: systematic review and network meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:172-181. [PMID: 30740799 DOI: 10.1002/uog.20238] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To compare, in women with infertility, the effectiveness and safety of tubal flushing using oil-based contrast medium, water-based contrast medium or their combination, and no tubal flushing, and to evaluate the effectiveness of tubal flushing on fertility outcome over time. METHODS We performed a systematic review and network meta-analysis, searching the electronic databases MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, and trial registries, up to 25 September 2018. We included randomized controlled trials (RCTs) comparing the following interventions with each other or with no intervention in women with infertility: tubal flushing using water-based contrast medium, tubal flushing using oil-based contrast medium or additional tubal flushing with oil-based medium following diagnostic tubal flushing with water-based medium. The outcomes included clinical pregnancy, live birth, ongoing pregnancy, miscarriage, ectopic pregnancy and adverse events. RESULTS Of the 283 studies identified through the search, 14 RCTs reporting on 3852 women with infertility were included. Network meta-analysis showed that tubal flushing using oil-based contrast medium was associated with higher odds of clinical pregnancy within 6 months after randomization and more subsequent live births compared with tubal flushing using water-based medium (odds ratio (OR), 1.67 (95% CI, 1.38-2.03), moderate certainty of evidence; and OR, 2.18 (95% CI, 1.30-3.65), low certainty of evidence, respectively) and compared with no intervention (OR, 2.28 (95% CI, 1.50-3.47), moderate certainty of evidence; and OR, 2.85 (95% CI, 1.41-5.74), low certainty of evidence, respectively). These results agreed with those of the pairwise meta-analysis. For clinical pregnancy within 6 months, there was insufficient evidence of a difference between tubal flushing with water-based contrast medium and no intervention (OR, 1.36 (95% CI, 0.91-2.04), low certainty of evidence). For fertility outcomes after 6 months, there was insufficient evidence of a difference in any comparison (low to very low certainty of evidence). Compared with tubal flushing using water-based contrast medium, the use of oil-based contrast medium was associated with higher odds of asymptomatic intravasation (OR, 5.06 (95% CI, 2.29-11.18), moderate certainty of evidence). CONCLUSIONS In women with infertility undergoing fertility workup, tubal flushing using oil-based contrast medium probably increases clinical pregnancy rates within 6 months after randomization and may increase subsequent live-birth rates, compared with tubal flushing using water-based contrast medium and compared with no intervention. Evidence on fertility outcomes beyond 6 months is inadequate to draw firm conclusions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Wang
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
| | - N van Welie
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J van Rijswijk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N P Johnson
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - R J Norman
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Fertility SA, Adelaide, Australia
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B W Mol
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, North Adelaide, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University and Monash Health, Clayton, Australia
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15
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Tan Y, Zheng S, Lei W, Wang F, Jiang S, Zeng T, Zhou B, Hong F. Ethiodized poppyseed oil versus ioversol for image quality and adverse events in hysterosalpingography: a prospective cohort study. BMC Med Imaging 2019; 19:50. [PMID: 31234782 PMCID: PMC6591817 DOI: 10.1186/s12880-019-0346-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to investigate the image quality and adverse events (AEs) of ethiodized poppyseed oil (EPO) compared with ioversol as contrast agents in hysterosalpingography (HSG). Methods Two hundred twenty-eight patients underwent HSG were consecutively recruited in this prospective cohort study, and were accordingly divided into EPO group (N = 165) and ioversol group (N = 63). The quality of image was assessed according to the European Guidelines on quality criteria for diagnostic radiographic images. AEs during, within 2 h and at 1-month post-HSG were recorded. Results EPO displayed elevated image quality compared with ioversol including the total image quality score (P < 0.001), the cervical canal display score (P < 0.001), shape and outline of uterus score (P < 0.01), cervical mucosa or folds score (P < 0.001), oviduct isthmus score (P < 0.001), ampulla and fimbriae of oviduct score (P < 0.001) and celiac diffuse image score (P < 0.001). Multivariate linear regression displayed that EPO (P < 0.001) was an independent predictive factor for increased total image quality score. AEs were similar between EPO group and ioversol group during and within 2 h post-HSG (all P > 0.05). However, at 1-month post-HSG, the number of patients had unchanged and faded menstrual blood color decreased but the proportion of patients with deepened menstrual color increased in EPO group compared with ioversol group (P = 0.007). In addition, the number of patients had iodine residue in uterine cavity was elevated in EPO group compared with ioversol group (P < 0.001). Conclusion EPO is more efficient in image quality and equally tolerant compared to ioversol as contrast agents in HSG. Electronic supplementary material The online version of this article (10.1186/s12880-019-0346-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yiqing Tan
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China.
| | - Shilin Zheng
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Wenfeng Lei
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Fuhua Wang
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Shengpan Jiang
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Ting Zeng
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Bei Zhou
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
| | - Fan Hong
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei, China
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Li HM, Sung FC, Li SC, Huang YK, Chang Y, Chang CC, Huang SJ, Lin CL, Kao CH. The effect of antibiotic prophylaxis for acute pelvic inflammatory disease after hysterosalpingography: a retrospective cohort study. Curr Med Res Opin 2018; 34:1271-1276. [PMID: 29239678 DOI: 10.1080/03007995.2017.1417243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Concerns about acute pelvic inflammatory disease (PID) after hysterosalpingography (HSG) have been raised since 1980. However, the effectiveness of prophylactic antibiotics remains unclear. This study investigated the effect of antibiotic prophylaxis in women undergoing HSG. METHODS Women undergoing HSG between 2000 and 2012 were screened from the Taiwan National Health Insurance Research Database for eligibility. The prophylactic cohort included patients using any antibiotics of 1st-generation cephalosporins, doxycycline, clindamycin, and metronidazole, within 7 days before HSG (n = 3257). Patients not using any antibiotics were registered as the non-prophylactic cohort (n = 4662). An unconditional logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of acute PID after HSG associated with prophylactic antibiotics. RESULTS The cumulative incidences of acute PID after HSG were 0.46% and 1.42% in the prophylactic and non-prophylactic cohorts, respectively. Prophylactic patients had a significantly reduced estimated relative risk of acute PID compared with non-prophylactic patients (adjusted OR = 0.33, 95% CI = 0.19-0.58; p = .001). Doxycycline users had the lowest adjusted OR of 0.20 (95% CI = 0.04-0.81; p = .02), followed by users of 1st-generation cephalosporins (adjusted OR = 0.35, 95% CI = 0.18-0.68; p = .002). Multivariate sub-group analysis verified this protective effect for almost all sub-groups of prophylactic patients. CONCLUSIONS Antibiotic prophylaxis is associated with a decreased estimated relative risk of acute PID in HSG patients. Doxycycline and 1st-generation cephalosporins may be effective prophylactic regimens for HSG.
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Affiliation(s)
- Hao-Ming Li
- a Department of Radiology , E-Da Hospital , Kaohsiung , Taiwan
| | - Fung-Chang Sung
- b Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
| | - Shang-Chieh Li
- a Department of Radiology , E-Da Hospital , Kaohsiung , Taiwan
| | - Ying-Kai Huang
- c Department of Radiology , Kaohsiung Municipal Min-Sheng Hospital , Kaohsiung , Taiwan
| | - Yu Chang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
| | - Chi-Chang Chang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
- e School of Medicine , I-Shou University , Kaohsiung , Taiwan
| | - S Joseph Huang
- d Department of Obstetrics and Gynecology , E-Da Hospital , Kaohsiung , Taiwan
- e School of Medicine , I-Shou University , Kaohsiung , Taiwan
- f Department of Obstetrics and Gynecology, College of Medicine , University of South Florida , Tampa , FL , USA
| | - Cheng-Li Lin
- b Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- g College of Medicine , China Medical University , Taichung , Taiwan
| | - Chia-Hung Kao
- h Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine , China Medical University , Taichung , Taiwan
- i Department of Nuclear Medicine and PET Center , China Medical University Hospital , Taichung , Taiwan
- j Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan
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Abstract
RATIONALE Hysterosalpingography (HSG), a standard procedure for the evaluation of women with infertility and repetitive pregnancy loss, is associated with complications such as uterine perforation, infection, allergic reactions, syncope, hemorrhage and shock, and pulmonary or retinal embolus. However, hyperthyroidism has not been reported as one of its complications. PATIENT CONCERNS AND DIAGNOSES We report the case of a 33-year-old euthyroid woman who presented to our hospital with palpitation, hand tremor, fatigue, and excessive sweating after HSG. Thyroid function tests revealed a thyroid stimulating hormone (TSH) level of 0.012 μIU/mL (range 0.38-4.34 μIU/mL), free T4 of 2.886 ng/dL (range 0.81-1.89 ng/dL), and free T3 levels of 9.4 pg/mL (range 1.80-4.10 pg/mL), and antithyroglobulin antibody of 31.78 IU/mL (range <115 IU/mL). The triiodothyronine uptake was 3.057 ng/mL (range 0.66-1.92 ng/mL). Serum iodine (SI) and urinary iodine (UI) levels: SI of 4717.748 μg/L (range 45-90 μg/L) and UI of 18069.336 μg/L (range 26-705 μg/L). INTERVENTIONS AND OUTCOMES The patient was diagnosed with iodine-induced hyperthyroidism (IIH), but was not treated with antithyroid drugs. She has spontaneously recovered and is pregnant currently. LESSONS This is the first reported case of overt IIH caused by HSG in a euthyroid patient without risk factors. It suggests that HSG also leads to excessive iodine absorption, which induces secondary hyperthyroidism.
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Affiliation(s)
- Guotao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Rui Mao
- Department of Plastic Surgery, Plastic Surgery Hospital (Institute), Chinese Academy of Medical Science & Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Haixin Zhai
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Beijing, China
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Karaman E, Çim N, Alkış İ, Yıldırım A, Yıldızhan R. Rectal indomethacin use in pain relief during hysterosalpingography: A randomized placebo controlled trial. J Obstet Gynaecol Res 2015; 42:195-201. [PMID: 26711715 DOI: 10.1111/jog.12863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/31/2015] [Accepted: 08/23/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a rectal nonsteroidal anti-inflammatory drug (indomethacin) for pain relief during a hysterosalpingography (HSG). MATERIALS AND METHODS This prospective, randomized study included 82 women divided randomly into two groups. The study group received self-administered rectal indomethacin, while the control group received a placebo before the procedure. Degrees of pain were evaluated using the visual analog scale (VAS) at four different steps during the procedure and 30 min afterwards. The anxiety-depression status of the patients was evaluated using a validated Turkish version of the Beck anxiety-depression form before the procedure. RESULTS There were no statistically significant differences in the demographic characteristics of patients. The mean pain scores during tenaculum application (step 2), cervical traction (step 3), contrast injection (step 4) and 30 min after the procedure, were significantly lower in the study than the control group (P < 0.05). Step 4 was the most painful in both groups (VAS scores 3.2 ± 0.6 study vs. 5.3 ± 1.1 control). The mean pain score in step 4 for patients with abnormal HSG results was significantly higher than in patients with normal HSG results (P < 0.05). The mean anxiety and depression scores immediately before the procedure were not statistically different between the groups (P = 0.610 and P = 0.129, respectively). CONCLUSION Our study demonstrated a significant reduction in pain in patients who received a single rectal dose of indomethacin; therefore, we recommend the use of rectal indomethacin for reducing pain during a HSG procedure.
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Affiliation(s)
- Erbil Karaman
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - Numan Çim
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - İsmet Alkış
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | - Abdullah Yıldırım
- School of Medicine, Department of Psychiatry, Yuzuncu Yıl University, Van, Turkey
| | - Recep Yıldızhan
- School of Medicine, Department of Obstetric and Gynecology, Yuzuncu Yıl University, Van, Turkey
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Mohiyiddeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BWJ, Johnson N, Watson A. Tubal flushing for subfertility. Cochrane Database Syst Rev 2015; 2015:CD003718. [PMID: 25929235 PMCID: PMC7133784 DOI: 10.1002/14651858.cd003718.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Establishing the patency of the fallopian tubes is a commonly undertaken diagnostic investigation for women with subfertility. This is usually achieved by flushing contrast medium through the tubes and taking radiographs. However, it has been noted that many women conceive in the first three to six months after the tubal flushing, which has raised the possibility that tubal flushing could also be a treatment for infertility. There has been debate about which contrast medium should be used (water-soluble or oil-soluble media) as this may influence pregnancy rates. OBJECTIVES To evaluate the effect of flushing fallopian tubes with oil- or water-soluble contrast media on live birth and pregnancy rates in women with subfertility. SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register of trials, MEDLINE, EMBASE, Biological Abstracts, trial registers and reference lists of identified articles. The most recent search was conducted in June 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing tubal flushing with oil-soluble or water-soluble contrast media, or with no treatment, in women with subfertility. DATA COLLECTION AND ANALYSIS Two authors independently selected the trials, assessed risk of bias and extracted data. We contacted study authors for additional information. The overall quality of the evidence was assessed using GRADE methods. MAIN RESULTS Thirteen trials involving 2914 women were included, of whom 2494 were included in the analysis. Oil-soluble contrast media (OSCM) versus no interventionThe OSCM group had a higher rate of live birth (odds ratio (OR) 3.09, 95% CI 1.39 to 6.91, 1 RCT, 158 women, low quality evidence) and ongoing pregnancy (OR 3.59, 95% CI 2.06 to 6.26, 3 RCTs, 382 women, I(2) = 0%, low quality evidence) than women who had no intervention. Our findings suggest that among subfertile women with a 17% chance of an ongoing pregnancy if they have no intervention, the rate will increase to between 29% and 55% if they have tubal flushing with OSCM. Water-soluble contrast media (WSCM) versus no interventionThere was no evidence of a difference between the groups in rates of live birth (OR 1.13, 95% CI 0.67 to 1.91, 1 RCT, 334 women, very low quality evidence) or ongoing pregnancy (OR 1.14, 95% CI 0.71 to 1.84, 1 RCT, 334 women, very low quality evidence). OSCM versus WSCMTwo RCTs reported live birth: one found a higher live birth rate in the oil-soluble group and the other found no evidence of a difference between the groups. These studies were not pooled due to very high heterogeneity (I(2) = 93%). There was no evidence of a difference between the groups in rates of ongoing pregnancy, however there was high heterogeneity (OR 1.44, 95% CI 0.84 to 2.47, 5 RCTs, 1454 women, I(2) = 76%, random-effects model, very low quality evidence). OSCM plus WSCM versus WSCM aloneThere was no evidence of a difference between the groups in rates of live birth (OR 1.06, 95% CI 0.64 to 1.77, 1 RCT, 393 women, very low quality evidence) or ongoing pregnancy (OR 1.23, 95% CI 0.87 to 1.72, 4 RCTs, 633 women, I(2) = 0%, low quality evidence).There was no evidence of a difference between any of the interventions in rates of adverse events, but such events were poorly reported in most studies. AUTHORS' CONCLUSIONS The evidence suggests that tubal flushing with oil-soluble contrast media may increase the chance of pregnancy and live birth compared to no intervention. Findings for other comparisons were inconclusive due to inconsistency and lack of statistical power. There was insufficient evidence on adverse events to reach firm conclusions. Further robust randomised controlled trials are needed.
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Affiliation(s)
| | - Anne Hardiman
- Royal Bolton HospitalDepartment of O & GBoltonUKBL4 0JR
| | | | - Edward Hughes
- McMaster University, REI Consultant, ONE FertilityDepartment of Obstetrics and Gynaecology1200 Main Street WestRoom 4D14HamiltonONCanadaL8N 3Z5
| | - Ben Willem J Mol
- The University of AdelaideThe Robinson Institute, School of Paediatrics and Reproductive HealthLevel 3, Medical School South BuildingFrome RoadAdelaideSouth AustraliaAustraliaSA 5005
| | - Neil Johnson
- University of AdelaideRobinson Research InstituteNorwich Centre Ground Floor, 55 King William RoadNorth AdelaideAdelaideSouth AustraliaAustralia5006
| | - Andrew Watson
- Tameside General HospitalTameside & Glossop Acute Services NHS TrustFountain StreetAshton‐Under‐LyneLancashireUKOL6 9RW
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Kalantari M, Zadeh Modares S, Ahmadi F, Hazari V, Haghighi H, Chehrazi M, Razaghi M. Randomized double-blind clinical trial of eutectic mixture of local anesthetic creams in reducing pain during hysterosalpingography. IRANIAN JOURNAL OF RADIOLOGY 2015; 11:e10513. [PMID: 25780541 PMCID: PMC4347756 DOI: 10.5812/iranjradiol.10513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/16/2013] [Accepted: 08/07/2013] [Indexed: 01/04/2023]
Abstract
Background: Hysterosalpingography (HSG) is considered as a primary test in infertility work up worldwide due to its reliability in evaluating abnormalities related to the uterus and fallopian tubes. Objectives: To assess the efficacy of applying eutectic mixture of local anesthetics (lidocaine-prilocaine cream) (EMLA) on the uterine cervix in reducing pain during HSG. Patients and Methods: Eighty patients undergoing HSG as part of infertility evaluation were randomly allocated to groups receiving either EMLA (N = 40) or placebo cream (N = 40) in a double-blinded prospective study. Fifteen minutes before HSG, 5 grams of 5% cream was applied to the uterine cervix using a cervical applicator. The degree of pain experienced by the patient was evaluated during and after HSG at five predefined steps on a visual analogue scale (VAS). Results: There was no significant difference in the efficacy between EMLA and placebo creams in pain perception during the entire procedure. There was no significant difference in long term pain perception half an hour after the HSG performance. Conclusions: This study does not support the use of EMLA for HSG.
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Affiliation(s)
- Mojgan Kalantari
- Department of Radiology, Mahdieh Hospital, Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrzad Zadeh Modares
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Firoozeh Ahmadi
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Corresponding author: Firoozeh Ahmadi, Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Tel: +98-9121503522, E-mail:
| | - Vajihe Hazari
- Mahdieh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadieh Haghighi
- Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Chehrazi
- Department of Epidemiology and Reproductive Health at Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Melika Razaghi
- Department of Endodontics, Shahed Dental University, Tehran, Iran
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Dusak A, Soydinc HE, Onder H, Ekinci F, Görük NY, Hamidi C, Bilici A. Venous intravasation as a complication and potential pitfall during hysterosalpingography: re-emerging study with a novel classification. J Clin Imaging Sci 2013; 3:67. [PMID: 24605262 PMCID: PMC3935269 DOI: 10.4103/2156-7514.124105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/16/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation. MATERIALS AND METHODS This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software. RESULTS Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation. CONCLUSIONS Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.
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Affiliation(s)
| | - Hatice E Soydinc
- Department of Obstetrics and Gynecology, Dicle University, Diyarbakir, Turkey
| | - Hakan Onder
- Department of Radiology, Dicle University, Diyarbakir, Turkey
| | - Faysal Ekinci
- Department of Radiology, Dicle University, Diyarbakir, Turkey
| | - Neval Y Görük
- Department of Obstetrics and Gynecology, Dicle University, Diyarbakir, Turkey
| | - Cihat Hamidi
- Department of Radiology, Dicle University, Diyarbakir, Turkey
| | - Aslan Bilici
- Department of Radiology, Dicle University, Diyarbakir, Turkey
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Siam EM. Pregnancy outcome after hystero-salpingo-contrast-sonography (HyCoSy) versus hysterosalpingography (HSG) using different contrast media. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.05.001] [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] Open
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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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Lim CP, Hasafa Z, Bhattacharya S, Maheshwari A. Should a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup? Hum Reprod 2011; 26:967-71. [PMID: 21357604 DOI: 10.1093/humrep/der046] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tubal assessment is an integral part of female fertility evaluation. While diagnostic laparoscopy is gold standard, it is not suitable to be used as a screening test. Hysterosalpingogram (HSG) has been advocated as first-line investigation historically. With advances in diagnostics, more tests are available, such as hysterosalpingo contrast sonography (HyCoSy) and Chlamydia antibody titre (CAT) are available. The CAT test is much cheaper, less invasive and can be performed at any time during the cycle. The CAT test can also be used as a means of identifying which patients need further evaluation. HyCoSy has same diagnostic accuracy as HSG, without exposing women to radiation. We argue that HSG is out of date and has no place in a modern infertility evaluation. We also suggest a pathway (based on history, clinical and ultrasound evaluation) for investigations to screen for and diagnose tubal pathology.
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Affiliation(s)
- Chou Phay Lim
- Obstetrics and Gynaecology, Aberdeen Maternity Hospital, NHS Grampian, Aberdeen AB25 2ZL, UK
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Diagnostic image quality of hysterosalpingography: ionic versus non ionic water soluble iodinated contrast media. Biomed Imaging Interv J 2009; 5:e29. [PMID: 21611058 PMCID: PMC3097785 DOI: 10.2349/biij.5.3.e29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 07/18/2009] [Accepted: 09/17/2009] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the diagnostic image quality between three different water soluble iodinated contrast media in hysterosalpingography (HSG). Material and method In a prospective randomised study of 204 patients, the diagnostic quality of images obtained after hysterosalpingography were evaluated using Iopramide (106 patients) and Ioxaglate (98 patients). 114 patients who had undergone HSG examination using Iodamide were analysed retrospectively. Image quality was assessed by three radiologists independently based on an objective set of criteria. The obtained results were statistically analysed using Kruskal-Wallis and Mann-Whitney U test. Results Visualisation of fimbrial rugae was significantly better with Iopramide and Ioxaglate than Iodamide. All contrast media provided acceptable diagnostic image quality with regard to uterine, fallopian tubes outline and peritoneal spill. Uterine opacification was noted to be too dense in all three contrast media and not optimal for the assessment of intrauterine pathology. Higher incidence of contrast intravasation was noted in the Iodamide group. Similarly, the numbers of patients diagnosed with bilateral blocked fallopian tubes were also higher in the Iodamide group. Conclusion HSG using low osmolar contrast media (Iopramide and Ioxaglate) demonstrated diagnostic image qualities similar to HSG using conventional high osmolar contrast media (Iodamide). However, all three contrast media were found to be too dense for the detection of intrauterine pathology. Better visualisation of the fimbrial outline using Ioxaglate and Iopramide were attributed to their low contrast viscosity. The increased incidence of contrast media intravasation and bilateral tubal blockage using Iodamide are probably related to the high viscosity.
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Lindborg L, Thorburn J, Bergh C, Strandell A. Influence of HyCoSy on spontaneous pregnancy: a randomized controlled trial. Hum Reprod 2009; 24:1075-9. [DOI: 10.1093/humrep/den485] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. OBJECTIVES To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 31 January 2007), MEDLINE, EMBASE, Biological Abstract and reference lists of articles. SELECTION CRITERIA All randomised trials comparing tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media or with no treatment in women with subfertility. DATA COLLECTION AND ANALYSIS Four authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS Twelve trials involving 2079 participants were included. Tubal flushing with oil-soluble media versus no intervention was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95% CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95% CI 2.00 to 5.43). For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media, the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95% CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.21, 95% CI 0.95 to 1.54). The addition of oil-soluble media to flushing with water-soluble media showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.28, 95% CI 0.92 to 1.79) or live birth (Peto OR 1.06, 95% CI 0.64 to 1.77). There were no serious adverse event reported. AUTHORS' CONCLUSIONS There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. Future robust randomised trials, comparing oil-soluble versus water-soluble media, water-soluble media versus no intervention and tubal flushing versus established treatments for infertility would be a useful further guide to clinical practice.
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Affiliation(s)
- F Luttjeboer
- Maxima Medical Centre, Department of Obstetrics and Gynaecology, Wilhelminapark 3, Valkenswaard, Noord-Brabant, Netherlands, 5554JD.
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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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Brent K, Hadden WE, Weston-Webb M, Johnson NP. After the FLUSH trial: A prospective observational study of lipiodol flushing as an innovative treatment for unexplained and endometriosis-related infertility. Aust N Z J Obstet Gynaecol 2006; 46:293-7. [PMID: 16866789 DOI: 10.1111/j.1479-828x.2006.00595.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. DESIGN Prospective observational study. SETTING Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. POPULATION The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. METHODS Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. MAIN OUTCOME MEASURES Clinical pregnancy at 6 months post-treatment; and live birth or ongoing pregnancy. RESULTS The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. CONCLUSION This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.
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Affiliation(s)
- Kira Brent
- University of Auckland, Auckland, New Zealand
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Perquin DAM, Dörr PJ, de Craen AJM, Helmerhorst FM. Routine use of hysterosalpingography prior to laparoscopy in the fertility workup: a multicentre randomized controlled trial. Hum Reprod 2006; 21:1227-31. [PMID: 16476679 DOI: 10.1093/humrep/dei478] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A multicentre randomized controlled trial with or without hysterosalpingography (HSG) was conducted to assess the usefulness of HSG as a routine investigation in the fertility workup prior to laparoscopy and dye. METHODS From 1 April 1997 to 1 April 2002, subfertile women were allocated by a computer-based 1 : 1 ratio randomization procedure, either for an HSG followed by laparoscopy and dye (the intervention group) of for laparoscopy and dye only (the control group) as a part of their fertility workup. Cumulative pregnancy rate (CPR) within 18 months after randomization was the primary outcome of interest. RESULTS 344 women were randomized to the intervention group (n = 169) and the control group (n = 175). There was no significant difference in CPR at 18 months in the intervention group (49.1%) [95% confidence interval (CI) 41.6 to 56.6] and the control group (50.3%) (95% CI 42.8 to 57.8), a difference of -1.2% (95% CI -11.8% to 9.5%). CONCLUSION The routine use of HSG at an early stage in the fertility workup prior to laparoscopy and dye does not influence CPR, compared with the routine use of laparoscopy and dye without HSG.
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Affiliation(s)
- D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Centre Haaglanden, The Hague, The Netherlands.
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Al-Fadhli R, Sylvestre C, Buckett W, Tulandi T. A randomized study of laparoscopic chromopertubation with lipiodol versus saline in infertile women. Fertil Steril 2006; 85:505-7. [PMID: 16595242 DOI: 10.1016/j.fertnstert.2005.07.1309] [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: 05/10/2005] [Revised: 07/14/2005] [Accepted: 07/14/2005] [Indexed: 11/16/2022]
Abstract
Eighty-eight infertile patients undergoing laparoscopy were randomized to undergo chromopertubation with lipiodol or with normal saline. The cumulative probability of conception at 1, 3, and 6 months following laparoscopy was not statistically different between the lipiodol group (21%, 31% , and 43%, respectively) and the saline group (18%, 21%, and 33%, respectively).
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Affiliation(s)
- Raedah Al-Fadhli
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Abstract
BACKGROUND A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay. OBJECTIVES To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 2 March 2004), MEDLINE (1966 to Mar 2004), EMBASE (1980 to Mar 2004), Biological Abstract (1980 to Mar 2004) and reference lists of articles. SELECTION CRITERIA All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS Eleven randomised controlled trials were identified and included in this review. All trials were assessed for quality criteria. The studied primary outcome was live birth (and ongoing pregnancy), with secondary outcomes pregnancy, miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality. MAIN RESULTS Tubal flushing with oil-soluble media versus no intervention (three trials including 381 participants) was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95%CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95%CI 2.00 to 5.43). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media (six trials including 1,483 participants), the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95%CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.24, 95%CI 0.97 to 1.57). The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone; three trials including 555 participants) showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.18, 95%CI 0.82 to 1.70) or live birth (Peto OR 1.06, 95%CI 0.64 to 1.77). Adverse event data were only available for the comparison OSCM versus WSCM: OSCM carried a significantly higher chance of intravasation (Peto OR 5.41, 95%CI 2.57 to 11.37) but a significantly lower chance of immediate pain (Peto OR 0.53, 95%CI 0.34 to 0.84), prolonged pain (Peto OR 0.26, 95%CI 0.15 to 0.45) and post-procedure bleeding (Peto OR 0.22, 95%CI 0.15 to 0.31), and no serious adverse events were reported. AUTHORS' CONCLUSIONS There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing water-soluble media versus no intervention, would be a useful further guide to clinical practice. Further research is merited to ascertain the mechanism of the fertility enhancing effect of oil-soluble media, as to whether this is a 'tubal flushing' phenomenon, an effect on the intraperitoneal environment, or an implantation enhancing effect on the endometrium.
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Affiliation(s)
- N Johnson
- Department of Obstetrics & Gynaecology, University of Auckland, PO Box 92019, Auckland, New Zealand, 1003.
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Venous-Lymphatic Intravasation During Hysterosalpingography Using Hydrosoluble Contrast Medium. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/01.jwi.0000159508.18689.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
There has been speculation for decades regarding the role of flushing women's fallopian tubes in improving the chance of pregnancy. More recent evidence has highlighted a possible specific role for lipiodol (ethiodized oil), an oil-soluble contrast medium, in the enhancement of fertility by these means. This systematic review was designed to assess the effectiveness of tubal flushing with various contrast media in improving the chance of pregnancy. The review was performed using Cochrane guidelines, including only data from randomized controlled trials. Results confirm the effectiveness of flushing with lipiodol in improving the chance of pregnancy and live birth. Although there was limited evidence to suggest a possible benefit of oil- over water-soluble contrast media, the answer to this question remains unclear. The specific groups who appear to benefit most from lipiodol flushing are couples with unexplained infertility, but particularly couples where the woman has endometriosis in the context of normal patent fallopian tubes. As a simple, low-cost, minimally invasive intervention that carries a low risk of complications and no increased risk of multiple pregnancy, lipiodol flushing may prove an appealing alternative to established fertility treatments for many couples.
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Affiliation(s)
- Neil P Johnson
- University of Auckland and Fertility Plus, National Women's Hospital, Auckland Gynaecology Group, Auckland, New Zealand.
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Papaioannou S, Bourdrez P, Varma R, Afnan M, Mol BWJ, Coomarasamy A. Tubal evaluation in the investigation of subfertility: A structured comparison of tests. BJOG 2004; 111:1313-21. [PMID: 15663113 DOI: 10.1111/j.1471-0528.2004.00403.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pinto ABM, Hovsepian DM, Wattanakumtornkul S, Pilgram TK. Pregnancy outcomes after fallopian tube recanalization: oil-based versus water-soluble contrast agents. J Vasc Interv Radiol 2003; 14:69-74. [PMID: 12525588 DOI: 10.1097/01.rvi.0000052293.26939.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the pregnancy outcomes in patients undergoing fallopian tube recanalization (FTR) with use of oil-based versus water-soluble contrast agents. MATERIALS AND METHODS Ninety-three patients with unilateral or bilateral proximal tubal occlusion confirmed by hysterosalpingography or laparoscopy underwent FTR with use of water-soluble contrast material alone (n = 50) or also had an oil-based agent injected into each tube after recanalization (n = 43). Pregnancy rates and outcomes of the two groups were studied retrospectively. RESULTS With respect to differences between groups, only the body mass index proved to be a significant predictor (oil, 28.4; water, 24.7; P =.008). Mean age, duration of infertility, type of infertility, and initial diagnosis were comparable. There was a weak trend toward a higher pregnancy rate in the oil-based contrast material group, but it was not significant (P =.64). The average time to pregnancy was 4.4 months with use of oil-based contrast material, compared to 7.7 months with use of only water-soluble contrast material (P =.03). CONCLUSION The use of an oil-based agent had little effect on the rate of conception, but time to conception was reduced by more than 3 months.
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Affiliation(s)
- Anil B M Pinto
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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Oil-Soluble Contrast During Hysterosalpingography in Women With Proven Tubal Patency. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boudghène FP, Bazot M, Robert Y, Perrot N, Rocourt N, Antoine JM, Morris H, Leroy JL, Uzan S, Bigot JM. Assessment of Fallopian tube patency by HyCoSy: comparison of a positive contrast agent with saline solution. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:525-530. [PMID: 11844177 DOI: 10.1046/j.0960-7692.2001.00513.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To compare the efficiency of air-filled albumin microspheres (Infoson) with saline solution in determining Fallopian tube patency during hysterosalpingo contrast sonography (HyCoSy). METHODS This was a prospective randomized multicenter study with a sequential design. Over a 10-month period, 23 patients (mean age, 33 years) referred for infertility were examined by HyCoSy (saline or Infoson) before conventional hysterosalpingography (Iopamiron 370), performed during the same session. Contrast agents were administered through a 5-F Ackrad balloon catheter inserted transcervically into the uterine cavity. HyCoSy was performed with a 7-MHz transvaginal probe using both B-mode and color Doppler, and tubal patency was demonstrated by the appearance of contrast agent in the peritoneal cavity near the ovaries. Data were registered for each patient during the examination and the results were monitored by sequential analysis. RESULTS Mean volumes of contrast injections were 35.3 mL of saline, 14.4 mL of Infoson, and 13.8 mL of Iopamiron 370. Infoson-enhanced HyCoSy provided a significantly larger (P = 0.006) number of correct diagnoses (20/22 Fallopian tubes) than did saline HyCoSy (12/24 Fallopian tubes), and the same number as that achieved by hysterosalpingography. CONCLUSION A positive ultrasound contrast agent appears to be more efficient than saline solution at determining Fallopian tube patency in infertile women by means of HyCoSy, and as efficient as an iodinated contrast agent in the same population explored by HSG. HyCoSy could be used to screen infertile women, thereby avoiding the use of iodinated contrast medium and exposure to ionizing radiation during conventional HSG in patients with patent Fallopian tubes.
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Affiliation(s)
- F P Boudghène
- Department of Radiology, Hôpital Tenon, Université Paris 6, France.
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Valentini AL, Muzii L, Marana R, Catalano GF, Felici F, Destito C, Marano P. Fallopian tube disease: the cobblestone pattern as a radiographic sign. Radiology 2000; 217:521-5. [PMID: 11058655 DOI: 10.1148/radiology.217.2.r00nv04521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study. MATERIALS AND METHODS Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was categorized by means of inspection into five classes of fold pattern: classes I and II, normal; classes III-V, abnormal. Hysterosalpingographic and salpingoscopic results were compared by means of a two-by-two table and kappa statistics. RESULTS Seventy-four tubes were evaluated. At hysterosalpingography, 31 tubes were distally nonpatent. Of these, 26 showed a distal obstruction at salpingoscopy. None of the patent tubes at hysterosalpingography showed obstruction at salpingoscopy. The agreement between hysterosalpingography and salpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 0.73; P: <.001). The cobblestone pattern always corresponded to intraluminal adhesions at salpingoscopy. The absence of radiolucent bands corresponded to abnormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal patent tubes at hysterosalpingography showed intraluminal adhesions at salpingoscopy. CONCLUSION Results indicate that the cobblestone pattern is an effective radiographic sign of intraluminal adhesions in hydrosalpinges and suggest that intraluminal disease in patent tubes might not always be excluded on normal hysterosalpingograms.
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Affiliation(s)
- A L Valentini
- Department of Radiology , , Universita' Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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Vandekerckhove P, Watson A, Lilford R, Harada T, Hughes E. Oil-soluble versus water-soluble media for assessing tubal patency with hysterosalpingography or laparoscopy in subfertile women. Cochrane Database Syst Rev 2000; 1996:CD000092. [PMID: 10796691 PMCID: PMC10866108 DOI: 10.1002/14651858.cd000092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There has been debate in the literature for more than 40 years as to whether flushing of the Fallopian tubes enhances fertility and whether this presumed therapeutic effect is greater with oil-soluble media than with water-soluble media. A meta-analysis of the therapeutic role of oil-soluble contrast media at hysterosalpingography was published in March 1994 (Watson 1994). This Cochrane Review is an expansion and update of that overview. OBJECTIVES To evaluate the effect of flushing the Fallopian tubes with oil- or water-soluble contrast media on subsequent pregnancy rates in infertility patients. SEARCH STRATEGY 1. For randomised controlled trials (RCTs): we searched the Cochrane Subfertility Review Group specialised register of controlled trials. 2. For non-randomised controlled studies: Medline and manual search of eight relevant journals. SELECTION CRITERIA Six RCTs and six non-randomised controlled studies. In two studies tubal flushing was compared with no treatment-controls. Eleven studies, comprising a total of 2635 subjects, compared oil- with water-soluble media. DATA COLLECTION AND ANALYSIS Independently by first 2 authors for: 1. Methodological trial characteristics 2. Characteristics of participants 3. OUTCOMES the main studied outcome was pregnancy rate per patient MAIN RESULTS In comparison with no treatment, a significant benefit on pregnancy rates was seen by flushing the tubes with oil-soluble media (OR 1.80, 95% CI 1.29-2.50) but not with water-soluble media (OR 0.87, 95% CI 0.50-1.52). In the direct comparison of oil- and water-soluble media the former lead to significantly higher pregnancy rates (OR 1.92, 95% CI 1.60-2.29). The treatment effect appeared similar in RCTs and non-RCTs. Subgroup analysis suggested the therapeutic benefit was greatest for patients suffering from unexplained infertility and least for those with tubal factor infertility. REVIEWER'S CONCLUSIONS Flushing of the tubes with oil-soluble media increases subsequent pregnancy rates in infertility patients. The hypothesis that tubal "plugs" are a cause of proximal tubal occlusion and that oil-soluble media may flush them out, is supported by new techniques such as falloposcopy. Clinicians should consider flushing the tubes with OSCM before contemplating more invasive therapies.
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Affiliation(s)
- P Vandekerckhove
- Institute of Epidemiology, University of Leeds, 34 Hyde Terrace, Leeds, Yorkshire, UK, LS2 9LN.
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Infertility. Clin Nucl Med 1998. [DOI: 10.1007/978-1-4899-3356-0_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eimers JM, Omtzigt AM, Vogelzang ET, van Ommen R, Habbema JD, te Velde ER. Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation. J Psychosom Obstet Gynaecol 1997; 18:31-5. [PMID: 9138204 DOI: 10.3109/01674829709085566] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to map out the extent of the physical complaints and emotional stress due to diagnostic routines of the infertility work-up. To this end a questionnaire was sent to 96 consecutive couples visiting an infertility clinic of a university hospital. The results indicate that women often have physical complaints as a result of the hysterosalpingography (59%) and the diagnostic laparoscopy (47%) and mostly experience these diagnostic procedures as very stressful. Both the postcoital test and the semen analysis caused a moderate amount of stress. The other diagnostic procedures, including physical examination of both sexes, recording of the basal temperature and taking blood for hormonal determinations, were accompanied by fewer complaints and much less stress. It is concluded that the role of the hysterosalpingography and the diagnostic laparoscopy in the routine infertility work-up needs to be reconsidered in view of the burden they pose to the women involved.
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Affiliation(s)
- J M Eimers
- Department of Obstetrics and Gynecology, University Hospital Utrecht, The Netherlands
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Lee FT, Grist TM, Nelson KG, Chosy SG, Rappe AH, Shapiro SS, Kelcz F. MR hysterosalpingography in a rabbit model. J Magn Reson Imaging 1996; 6:300-4. [PMID: 9132095 DOI: 10.1002/jmri.1880060208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Our objective was to evaluate the efficacy of MR imaging as compared with conventional hysterosalpingography (HSG) for the detection of fallopian tube patency after uterine injection of contrast material. Rabbit uterine horns (n= 18) were catheterized transvaginally. Five fallopian tubes were ligated and 11 were left unaltered. T1-weighted gradient-echo MR images were obtained before, during, and after injection of 1.0-3.0 mL of a dilute gadolinium-containing contrast agent. Corresponding conventional studies were performed with an equivalent volume of iohexol. Images were evaluated by two blinded readers. Observers agreed in all cases on the presence (n = 11) or absence (n = 5) of peritoneal spill with conventional HSG. Interpretation of MR HSG concurred with conventional HSG in 14 of 16 cases for each observer (P > .05). Reasons for misdiagnosis included small amounts of spill (n = 2), artifact (n = 1), and subtle spill between bowel loops (n = 1). Sensitivity and specificity for MR HSG were 95.5% and 70%, respectively, for the diagnosis of tubal patency/occlusions. No statistical difference was found between MR HSG and conventional HSG for the diagnosis of fallopian tube patency/obstruction. Potential advantages of MR HSG include no ionizing radiation, potentially diminished local contrast toxicity, superior visualization of uterine fibroids and endometriosis, and visualization of ovaries. We conclude that this technique warrants further study, including the use of a primate model to better simulate human anatomy.
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Affiliation(s)
- F T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, WI 53792, USA
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Watson A, Vandekerckhove P, Lilford R, Vail A, Brosens I, Hughes E. A meta-analysis of the therapeutic role of oil soluble contrast media at hysterosalpingography: a surprising result? Fertil Steril 1994; 61:470-7. [PMID: 8137969 DOI: 10.1016/s0015-0282(16)56578-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effect of oil-soluble contrast media compared with water-soluble contrast media after hysterosalpingography (HSG) in infertile couples. DESIGN Meta-analysis of four randomized clinical trials (RCTs) and six nonrandomized controlled studies evaluating pregnancy rates after the use of oil- or water-soluble contrast media during HSG. SETTING Institute of Epidemiology and Health Services Research, Leeds, United Kingdom. PATIENTS Four identified RCTs studied 800 patients and six nonrandomized studies comprised an additional 1,806 patients, all experiencing primary or secondary infertility. INTERVENTION Hysterosalpingography as part of infertility investigation. MAIN OUTCOME MEASURE Pregnancy rates after HSG. RESULTS Pregnancy rates were significantly higher in the oil-soluble contrast media group compared with the water-soluble contrast media group in the RCTs. Inclusion of the six nonrandomized studies did not alter this conclusion. This apparent benefit was greatest for patients with unexplained infertility. CONCLUSIONS Oil-soluble contrast media have a therapeutic effect compared with water-soluble media and this effect is greatest for patients who have been diagnosed as having unexplained infertility. New techniques for the evaluation of tubal patency support the hypothesis that tubal "plugs" may be involved in proximal tubal blockage.
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Affiliation(s)
- A Watson
- Institute of Epidemiology and Health Services Research, University of Leeds, United Kingdom
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Radiological contrast media and radiopharmaceuticals. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/s0378-6080(05)80528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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