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Welie NV, Ludwin A, Martins WP, Mijatovic V, Dreyer K. Tubal Flushing Treatment for Unexplained Infertility. Semin Reprod Med 2020; 38:74-86. [PMID: 33339062 DOI: 10.1055/s-0040-1721720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tubal patency testing was initially introduced as a diagnostic test. However, it has been observed that some tubal patency tests also have a therapeutic effect. This therapeutic effect can be influenced by the contrast medium used during tubal flushing. In this review, we discuss current evidence associated with different methods for tubal flushing and their potential impact on reproductive outcomes in women with unexplained infertility. Furthermore, we discuss their diagnostic accuracy, safety, and cost-effectiveness.
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Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin and Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed, Private Hospital and Clinic, Krakow, Poland
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Reproductive Medicine, SEMEAR fertilidade, Ribeirao Preto/SP, Brazil
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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2
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Tros R, van Kessel M, Oosterhuis J, Kuchenbecker W, Bongers M, Mol BW, Koks C. Transvaginal hydrolaparoscopy and laparoscopy. Reprod Biomed Online 2019; 40:105-112. [PMID: 31899124 DOI: 10.1016/j.rbmo.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION To evaluate the findings of outpatient transvaginal hydrolaparoscopy (THL) in comparison with diagnostic laparoscopy combined with chromopertubation in subfertile women. DESIGN In a retrospective study in four large teaching hospitals, all subfertile women who underwent a THL and a conventional laparoscopy as part of their fertility work-up in the period between 2000 and 2011 were studied. Findings at THL were compared with findings at diagnostic and therapeutic laparoscopies. Tubal occlusion, endometriosis and adhesions were defined as abnormalities. RESULTS Out of 1119 women, 1103 women underwent THL. A complete evaluation or incomplete but diagnostic procedure could be performed in 989 (89.7%) and 28 (2.5%), respectively. An incomplete non-diagnostic procedure was performed in 11 (1.0%) women. Failure of THL occurred in 75 women (6.8%) and 40 of these women (3.6%) subsequently underwent laparoscopy. Laparoscopy was performed in a total of 126 patients with a median time interval of 7 weeks (interquartile range [IQR] 3-13 weeks). Of 64 patients who successfully underwent both THL and laparoscopy, concordant findings were found in 53 women and discordant results in 11 women, 6 of which were caused by tubal spasm. Sensitivity of THL in detecting abnormalities was 100% and specificity was 22.2%, with a likelihood ratio of 1.29. CONCLUSION THL in an outpatient setting can detect anatomical abnormalities comparable to the more invasive reference standard diagnostic laparoscopy. If THL succeeds, there is no need to add a diagnostic laparoscopy in the work-up.
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Affiliation(s)
- Rachel Tros
- Department of Obstetrics and Gynaecology, Amsterdam UMC, VU Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Mianna van Kessel
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede 7500 KA, the Netherlands
| | - Jur Oosterhuis
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht 3543 AZ, the Netherlands
| | - Walter Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala, Zwolle 8000 GK, the Netherlands
| | - Marlies Bongers
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven 5500 MB, the Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton VIC 3168, Australia
| | - Carolien Koks
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven 5500 MB, the Netherlands
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3
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Tardieu A, Sire F, Gauthier T. [Diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530560 DOI: 10.1016/j.gofs.2018.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To provide clinical practice guidelines from the French college of obstetrics and gynecology (CNGOF) with the Haute Autorité de santé (HAS), based on the best evidence available, concerning the diagnosis accuracy of endoscopy (laparoscopy, hysteroscopy, fertiloscopy, cystoscopy, colonoscopy) in case of endometriosis. MATERIAL AND METHODS English and French review of literature about the diagnosis accuracy of endoscopy in case of endometriosis. RESULTS AND CONCLUSION Laparoscopy is useful in case of suspected endometriosis in patients with symptoms or infertility when appropriate preoperative assessment is negative (grade C). Biopsies during diagnosis laparoscopy are recommended in case of typical or atypical lesions to confirm endometriosis (grade B). It is not recommended to perform fertiloscopy in case of suspected endometriosis (grade C). Hysteroscopy could be performed in case of suspected endometriosis and infertility to eliminate endometrial polyp or septate uterus (grade C). Colonoscopy is not recommended in case of suspected deep posterior endometriosis (grade C).
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Affiliation(s)
- A Tardieu
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - F Sire
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France
| | - T Gauthier
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France.
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Coenders-Tros R, van Kessel M, Vernooij M, Oosterhuis G, Kuchenbecker W, Mol B, Koks C. Performance of outpatient transvaginal hydrolaparoscopy. Hum Reprod 2016; 31:2285-91. [DOI: 10.1093/humrep/dew161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/20/2016] [Indexed: 01/10/2023] Open
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Braidy C, Nazac A, Legendre G, Capmas P, Fernandez H. [Comparison of fertiloscopy versus laparoscopy in the exploration of the infertility: analysis of the literature]. ACTA ACUST UNITED AC 2014; 43:488-95. [PMID: 24767305 DOI: 10.1016/j.jgyn.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fertiloscopy is a recent technique designed to explore the tubo-ovarian axis in unexplained infertility. It is a simple outpatient technique, allowing to perform operative procedures, but its position relative to laparoscopy is yet to be defined. MATERIAL AND METHODS A thorough and extensive bibliographical search was undertaken to fully embrace the question, challenging Medline at the National Library of Medicine, Cochrane Library, National Guideline Clearinghouse, Health Technology Assessment Database. All the retrieved articles were classified as either descriptive or comparative studies and evaluated on a set of criteria. RESULTS Most of the papers described case series coming from a few teams, focusing mainly on the technical aspect of the procedure, like the access rate to the posterior cul-de-sac, the success rate in visualizing the pelvis, the complications rate (mainly rectal perforation), and its operative performance in drilling ovaries for resistant polycystic ovarian syndrome. Comparative studies numbered six trials. They all followed the same design, fertiloscopy preceding conventional laparoscopy in patients taken as their own control. The concordance rate between the two modalities reaches 80% in terms of tubal pathology, adherences and endometriosis, with an estimated reduction of laparoscopies varying from 40% to 93%. CONCLUSION The current literature shows a concordance between fertiloscopy and conventional laparoscopic findings for certain parameters in cases of tubal pathology, adherences and endometriosis. The relative positions of these two modalities in unexplained infertility still remain elusive.
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Affiliation(s)
- C Braidy
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A Nazac
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Legendre
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P Capmas
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Fernandez
- Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm U1018, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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De Wilde RL, Brosens I. Rationale of first-line endoscopy-based fertility exploration using transvaginal hydrolaparoscopy and minihysteroscopy. Hum Reprod 2012; 27:2247-53. [DOI: 10.1093/humrep/des192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Escobar PF, Starks D, Fader AN, Catenacci M, Falcone T. Laparoendoscopic single-site and natural orifice surgery in gynecology. Fertil Steril 2010; 94:2497-502. [DOI: 10.1016/j.fertnstert.2010.08.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 07/02/2010] [Accepted: 08/10/2010] [Indexed: 02/03/2023]
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Daraï E, Rouzier R, Ballester M. Transvaginal Hydrolaparoscopy: Practices in French Teaching Hospitals. J Minim Invasive Gynecol 2008; 15:273-6. [DOI: 10.1016/j.jmig.2008.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Revised: 12/22/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Transvaginal access: a safe technique for tubo-ovarian exploration in infertility? Review of the literature. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0374-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shibahara H, Shimada K, Kikuchi K, Hirano Y, Suzuki T, Takamizawa S, Fujiwara H, Suzuki M. Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy. J Obstet Gynaecol Res 2007; 33:705-9. [PMID: 17845334 DOI: 10.1111/j.1447-0756.2007.00636.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review. METHODS The authors carried out diagnostic or operative THL in 177 infertile women, aged 22-43 years. Major complications during THL and a review of the literature were analyzed. RESULTS Two cases of bowel injury were diagnosed during diagnostic THL. No complication occurred during operative THL. In total, the incidence of bowel injury was 1.1%. The injuries were diagnosed during THL and treated expectantly under strict conditions in both cases. Ten studies in the literature reported a total of 4232 procedures, including 26 bowel injuries (0.61%) and one perforation of a retroflexed uterus (0.02%). CONCLUSIONS The usefulness of THL for diagnostic and operative purposes is in no doubt. However, informed consent should be obtained and vigilance before and during THL should be maintained, although it can be done on an outpatient clinic basis.
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Affiliation(s)
- Hiroaki Shibahara
- Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University and Center for Reproductive Medicine, Jichi Medical University Hospital, Yakushiji, Shimotsuke, Tochigi, Japan.
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12
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Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Belgium.
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Fujiwara H, Shibahara H, Hirano Y, Suzuki T, Takamizawa S, Sato I. Usefulness and prognostic value of transvaginal hydrolaparoscopy in infertile women. Fertil Steril 2003; 79:186-9. [PMID: 12524086 DOI: 10.1016/s0015-0282(02)04549-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the usefulness and prognostic value of transvaginal hydrolaparoscopy (THL) in infertile women. DESIGN Retrospective study. SETTING Jichi Medical School Hospital, Tochigi, Japan. PATIENT(S) Thirty-six patients who were followed up for 6 months or longer after THL was performed. INTERVENTION(S) Transvaginal hydrolaparoscopy findings in comparison with hysterosalpingography (HSG). MAIN OUTCOME MEASURES Transvaginal hydrolaparoscopy findings, HSG findings, treatment strategy, and prognosis. RESULT(S) Twenty of 36 patients (55.5%) became pregnant, including 7 by coitus, 7 by artificial insemination with the husband's semen, and 6 by assisted reproductive technology (ART). In 11 of these pregnant patients, information obtained during THL differed from findings on HSG. CONCLUSION(S) Transvaginal hydrolaparoscopy is useful in selecting a future treatment strategy.
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Affiliation(s)
- Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Abstract
PURPOSE OF REVIEW The investigation of the infertile couple is currently a highly debated issue. The purpose is to review whether transvaginal hydrolaparoscopy in combination with mini-hysteroscopy and chromopertubation can be offered as a one-stop infertility investigation. RECENT FINDINGS The technique is based on the direct visualization of the reproductive organs and the presence of tubal patency, and has been clinically validated during the past year for its accuracy, safety and patient tolerance. SUMMARY Further prospective randomized studies are required to prove the superiority of transvaginal hydrolaparoscopy in comparison with hysterosalpingography as a first-line investigation in predicting the fertility outcome.
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Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
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Gordts S, Campo R, Puttemans P, Verhoeven H, Gianaroli L, Brosens J, Brosens I. Investigation of the infertile couple: a one-stop outpatient endoscopy-based approach. Hum Reprod 2002; 17:1684-7. [PMID: 12093824 DOI: 10.1093/humrep/17.7.1684] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity that takes advantage of micro-endoscopic technology and uses aquaflotation for inspection of the tubo-ovarian structures. In infertility patients, THL is systematically combined with mini-hysteroscopy, chromopertubation, fimbrioscopy and, when indicated, salpingoscopy. Mini-hysteroscopy in combination with the chromopertubation test allows accurate assessment of the uterine cavity and tubal patency. The transvaginal access combined with the aquaflotation during THL facilitates detailed inspection of the tubo-ovarian structures and detection of subtle pelvic disease. This combined transvaginal endoscopic approach allows complete evaluation of the reproductive tract. THL is better tolerated than hysterosalpingography, less invasive than standard laparoscopy, and can be used safely as a first line investigation of the female partner in a one-stop infertility clinic.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium
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Nisolle M. Ovarian endometriosis and peritoneal endometriosis: are they different entities from a fertility perspective? Curr Opin Obstet Gynecol 2002; 14:283-8. [PMID: 12032383 DOI: 10.1097/00001703-200206000-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review summarizes the recent literature concerning new data on the pathogenesis of peritoneal endometriosis and its natural evolution. Indeed, the main concern in endometriosis is the choice of treatment in cases of infertility problems: medical or surgical. This concern could hypothetically be avoided if endometriosis were considered as a spontaneously regressive phenomenon. The present paper also discusses the risk of recurrence and the results of in-vitro fertilization and embryo transfer in cases of ovarian endometriosis. Whatever type of surgery is performed, the results of in-vitro fertilization and embryo transfer are not impaired, especially if damage to the ovarian cortex is avoided. Further studies are required to determine if oocytes from endometriosis patients are altered and could be responsible for the development of lower quality embryos.
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