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Wang L, Chen X, He M, Hu S, Ren Q, Qi X, Tan Y, Luo H. Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study. Quant Imaging Med Surg 2024; 14:3461-3472. [PMID: 38720834 PMCID: PMC11074734 DOI: 10.21037/qims-23-1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Abstract
Background Although the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) has relatively good diagnostic accuracy for assessing the patency of the fallopian tubes, the evaluation process mainly relies on morphological findings of the fallopian tubes and pelvic cavity. The purpose of this study was to explore the relationship of peak injection pressure during 4D-HyCoSy and tubal patency to provide a quantitative indicator for the evaluation of fallopian tube patency. Methods This study included infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation (LC) between 2020 and 2022, with LC serving as the reference test for assessing tubal patency. For the HyCoSy procedure, the ultrasound contrast agent was injected automatically using a liquid injection machine, and real-time pressure values were recorded. Patients were classified based on tubal patency status in LC as bilaterally patent, unilaterally patent, or bilaterally nonpatent. The average peak injection pressure and contrast agent volume of different groups were compared. Receiver operating characteristic (ROC) curve analysis was employed to determine the cutoff value. Results A total of 268 infertile patients were enrolled in the study. With LC as the standard examination, the sensitivity and specificity of 4D-HyCoSy in diagnosing nonpatent fallopian tubes were 91.1% and 95.1%, respectively. In general, peak injection pressure was observed to gradually increase as tubal patency decreased (P<0.001), with average peak injection pressures of 233.5±66.3, 338.8±99.8, and 469.6±63.1 mmHg in the bilaterally patent, unilaterally patent, and bilaterally nonpatent groups, respectively. The volume of contrast agent used in patients in the bilaterally nonpatent group was significantly lower than that in the other two groups (P<0.01), with average volumes of 22.7±6.3, 24.3±9.3, and 18.9±9.2 mL, respectively. When one fallopian tube was patent, the area under the curve (AUC) for distinguishing obstruction from patency of the other fallopian tube was 0.827, with a sensitivity of 79.8% and a specificity of 74.3% (cutoff value: 254.3 mmHg). Similarly, when one fallopian tube was nonpatent, the AUC was 0.866, with a sensitivity of 90.6% and a specificity of 78.3% (cutoff value: 401.3 mmHg). Conclusions Peak injection pressure during 4D-HyCoSy demonstrates promising diagnostic performance in evaluating fallopian tube patency in infertile patients.
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Affiliation(s)
- Ling Wang
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Xin Chen
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Min He
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Sha Hu
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Quanlin Ren
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Xiaoying Qi
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Yifei Tan
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
| | - Hong Luo
- Department of Ultrasound, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
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Romualdi D, Ata B, Bhattacharya S, Bosch E, Costello M, Gersak K, Homburg R, Mincheva M, Norman RJ, Piltonen T, Dos Santos-Ribeiro S, Scicluna D, Somers S, Sunkara SK, Verhoeve HR, Le Clef N. Evidence-based guideline: unexplained infertility†. Hum Reprod 2023; 38:1881-1890. [PMID: 37599566 PMCID: PMC10546081 DOI: 10.1093/humrep/dead150] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 08/22/2023] Open
Abstract
STUDY QUESTION What is the recommended management for couples presenting with unexplained infertility (UI), based on the best available evidence in the literature? SUMMARY ANSWER The evidence-based guideline on UI makes 52 recommendations on the definition, diagnosis, and treatment of UI. WHAT IS KNOWN ALREADY UI is diagnosed in the absence of any abnormalities of the female and male reproductive systems after 'standard' investigations. However, a consensual standardization of the diagnostic work-up is still lacking. The management of UI is traditionally empirical. The efficacy, safety, costs, and risks of treatment options have not been subjected to robust evaluation. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for ESHRE guidelines. Following formulation of key questions by a group of experts, literature searches, and assessments were undertaken. Papers written in English and published up to 24 October 2022 were evaluated. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the available evidence, recommendations were formulated and discussed until consensus was reached within the guideline development group (GDG). Following stakeholder review of an initial draft, the final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help clinicians provide the best care for couples with UI. As UI is a diagnosis of exclusion, the guideline outlined the basic diagnostic procedures that couples should/could undergo during an infertility work-up, and explored the need for additional tests. The first-line treatment for couples with UI was deemed to be IUI in combination with ovarian stimulation. The place of additional and alternative options for treatment of UI was also evaluated. The GDG made 52 recommendations on diagnosis and treatment for couples with UI. The GDG formulated 40 evidence-based recommendations-of which 29 were formulated as strong recommendations and 11 as weak-10 good practice points and two research only recommendations. Of the evidence-based recommendations, none were supported by high-quality evidence, one by moderate-quality evidence, nine by low-quality evidence, and 31 by very low-quality evidence. To support future research in UI, a list of research recommendations was provided. LIMITATIONS, REASONS FOR CAUTION Most additional diagnostic tests and interventions in couples with UI have not been subjected to robust evaluation. For a large proportion of these tests and treatments, evidence was very limited and of very low quality. More evidence is required, and the results of future studies may result in the current recommendations being revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in the care of couples with UI, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. The full guideline and a patient leaflet are available in www.eshre.eu/guideline/UI. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed by ESHRE, who funded the guideline meetings, literature searches, and dissemination of the guideline in collaboration with the Monash University led Australian NHMRC Centre of Research Excellence in Women's Health in Reproductive Life (CREWHIRL). The guideline group members did not receive any financial incentives; all work was provided voluntarily. D.R. reports honoraria from IBSA and Novo Nordisk. B.A. reports speakers' fees from Merck, Gedeon Richter, Organon and Intas Pharma; is part of the advisory board for Organon Turkey and president of the Turkish Society of Reproductive Medicine. S.B. reports speakers' fees from Merck, Organon, Ferring, the Ostetric and Gynaecological Society of Singapore and the Taiwanese Society for Reproductive Medicine; editor and contributing author, Reproductive Medicine for the MRCOG, Cambridge University Press; is part of the METAFOR and CAPE trials data monitoring committee. E.B. reports research grants from Roche diagnostics, Gedeon Richter and IBSA; speaker's fees from Merck, Ferring, MSD, Roche Diagnostics, Gedeon Richter, IBSA; E.B. is also a part of an Advisory Board of Ferring Pharmaceuticals, MSD, Roche Diagnostics, IBSA, Merck, Abbott and Gedeon Richter. M.M. reports consulting fees from Mojo Fertility Ltd. R.J.N. reports research grant from Australian National Health and Medical Research Council (NHMRC); consulting fees from Flinders Fertility Adelaide, VinMec Hospital Hanoi Vietnam; speaker's fees from Merck Australia, Cadilla Pharma India, Ferring Australia; chair clinical advisory committee Westmead Fertility and research institute MyDuc Hospital Vietnam. T.P. is a part of the Research Council of Finland and reports research grants from Roche Diagnostics, Novo Nordics and Sigrid Juselius foundation; consulting fees from Roche Diagnostics and organon; speaker's fees from Gedeon Richter, Roche, Exeltis, Organon, Ferring and Korento patient organization; is a part of NFOG, AE-PCOS society and several Finnish associations. S.S.R. reports research grants from Roche Diagnostics, Organon, Theramex; consulting fees from Ferring Pharmaceuticals, MSD and Organon; speaker's fees from Ferring Pharmaceuticals, MSD/Organon, Besins, Theramex, Gedeon Richter; travel support from Gedeon Richter; S.S.R. is part of the Data Safety Monitoring Board of TTRANSPORT and deputy of the ESHRE Special Interest Group on Safety and Quality in ART; stock or stock options from IVI Lisboa, Clínica de Reprodução assistida Lda; equipment/medical writing/gifts from Roche Diagnostics and Ferring Pharmaceuticals. S.K.S. reports speakers' fees from Merck, Ferring, MSD, Pharmasure. HRV reports consulting and travel fees from Ferring Pharmaceuticals. The other authors have nothing to disclose. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).
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Affiliation(s)
| | - D Romualdi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - B Ata
- Department of Obstetrics and Gynaecology, Koc University, Istanbul, Turkey
- ART Fertility Clinics, Dubai, United Arab Emirates
| | - S Bhattacharya
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - E Bosch
- IVI-RMA Valencia, Valencia, Spain
| | - M Costello
- University of New South Wales, Sydney, Australia
- NHMRC Centre of Research Excellence Women’s Health in Reproductive Life (WHiRL), Monash University, Melbourne, Australia
| | - K Gersak
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - R Homburg
- Liverpool Womens’ Hospital, Hewitt Fertility Centre, Liverpool, UK
| | - M Mincheva
- Centre for Tumour Microenvironment, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R J Norman
- NHMRC Centre of Research Excellence Women’s Health in Reproductive Life (WHiRL), Monash University, Melbourne, Australia
- The Robinson Research Institute The University of Adelaide, Adelaide, Australia
| | - T Piltonen
- Department of Obstetrics and Gynaecology, Reproductive Endocrinology and IVF Unit, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | | | - S Somers
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - H R Verhoeve
- Department of Gynaecology, OLVG, Amsterdam, The Netherlands
| | - N Le Clef
- European Society of Human Reproduction and Embryology, Grimbergen, Belgium
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Jin BB, Ma Y, Zhao XH, Teng YL, Zhu SY. Risk Factors of Contrast Agent Intravasation With Sulfur Hexafluoride Microbubble During Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1587-1594. [PMID: 36637120 DOI: 10.1002/jum.16179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To analyze the risk factors of sulfur hexafluoride microbubble contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy), and to explore a simple prediction model by the obvious clinical history. METHODS This was a retrospective study included 299 infertility women who had undergone HyCoSy examination from July 1, 2018 to June 31, 2019. The factors were recorded, including age, endometrial thickness, balloon length, infertility type, history of intrauterine surgery, history of pelvic surgery, and tubal patency. The method of multivariate logistic regression analysis was adopted to analyze the risk factors affecting the contrast agent intravasation, and the receiver operating characteristic curves were plotted to test their efficacy. RESULTS Secondary infertility, a history of intrauterine surgery, thin endometrial thickness, and tubal obstruction were all risk factors of the occurrence of intravasation (P < .05). And the area under the receiver operating characteristic curves of the multifactor-combined prediction model of the intravasation was significantly larger than that of single-factor. CONCLUSIONS Sonographers and gynecologists should be familiar with the risk factors of intravasation and select the appropriate timing of HyCoSy toward reducing the occurrence of intravasation and other complications after thoroughly explaining and communicating with the patients.
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Affiliation(s)
- Bin-Bin Jin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Ma
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiu-Hua Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Ling Teng
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shang-Yong Zhu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Qu E, Zhang M, Ju J, Chen Y, Lin X, Zhang X. Is Hysterosalpingo-Contrast Sonography (HyCoSy) Using Sulfur Hexafluoride Microbubbles (SonoVue) Sufficient for the Assessment of Fallopian Tube Patency? A Systematic Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:7-15. [PMID: 35441714 DOI: 10.1002/jum.15988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/27/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to evaluate the diagnostic value of HyCoSy using sulfur hexafluoride microbubbles for fallopian tubal patency assessment in infertile females. Twenty-four studies, including 1358 females with 2661 detected fallopian tubes published from January 2003 to May 2019, were identified. The pooled sensitivity was 93% (95% CI: 90-95%), while the specificity was 90% (95% CI: 87-92%). The area under the receiver-operating characteristic curve was 0.96 (95% CI: 94-98%). The specificity of the four-dimensional HyCoSy subgroup was higher than the 2D/3D subgroup; an increased dose of contrast agent did not affect the specificity, with only a slightly reduced sensitivity.
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Affiliation(s)
- Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinxiu Ju
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Chen
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Lin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Muacevic A, Adler JR. A Review of Tubal Factors Affecting Fertility and its Management. Cureus 2022; 14:e30990. [PMID: 36475176 PMCID: PMC9717713 DOI: 10.7759/cureus.30990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023] Open
Abstract
Infertility is a problem that affects both developed and developing countries today. Many couples choose to have financial stability before conception, irrespective of age. Tubal blockage accounts for 30%-40% of a woman's fertility. Congenital abnormalities, acute and persistent inflammatory diseases, endometriosis, and different pathologies are associated with infertility and cause partial or complete obstruction of the fallopian tubes. Approximately 30% of women experience infertility due to fallopian tube illness, with 10%-25% of these women experiencing proximal fallopian tube obstruction. The fallopian tube is an integral part of the union of sperm, and its normal function is a prerequisite for natural conception. Tubal obstruction is a common cause of infertility. These patients are keen to unblock their blocked fallopian tubes and restore reproductive function. Accurate diagnosis and optimal treatment options are essential for treating infertility.
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Jin BB, Ma Y, Zhao XH, Teng YL, Zhu SY. Operator's Influence on Contrast Agent Intravasation During Hysterosalpingo-Contrast Sonography: Explanation Based on a Physics Model. Int J Gen Med 2022; 15:7709-7718. [PMID: 36238541 PMCID: PMC9552795 DOI: 10.2147/ijgm.s380917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the risk factors of the operators on contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy). Methods We retrospectively collected 399 infertile women who underwent HyCoSy by the same sonographer. These patients were divided into two groups according to the way how the assistants connected the syringe to the uterus radiography catheter to inject the contrast agent. We analyzed whether the use of different contrast bolus injection methods had any influence on the incidence of intravasation during HyCoSy. Results There was no significant difference between the two groups with different cross-sectional areas of the syringe outflow tract in the risk variables for intravasation, but the intravasation rates of the two groups were different, 26.4% in group A and 17.1% in group B, P <0.05. The primary manifestation was that when both fallopian tubes were unobstructed, the intravasation rate of group B with smaller cross-sectional area of the outflow tract of the syringe was lower, and the difference was statistically significant. The inferences drawn from our physics model were also in line with the clinical results. Conclusion The influence of different operators on the contrast agent intravasation rate of HyCoSy cannot be ignored. The assistants of HyCoSy examination should inject the contrast agent slowly and steady, and a needle can be used as a flow restrictor to control the flow into the uterine cavity per unit time, slow down the rising speed of intrauterine pressure, and avoid the accumulation of contrast agent in the uterine cavity, so as to reduce the intravasation caused by operator factors.
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Affiliation(s)
- Bin-Bin Jin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yan Ma
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Xiu-Hua Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yi-Ling Teng
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shang-Yong Zhu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China,Correspondence: Shang-Yong Zhu, Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Email
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Jin Y, Huang W, Qv Q, Liu S. Development of a Nomogram for Predicting Intravasation Before Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography. Int J Womens Health 2022; 14:583-591. [PMID: 35479293 PMCID: PMC9037719 DOI: 10.2147/ijwh.s359467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy) may lead to false-negative results in tubal patency evaluation. Although the influencing factors associated with intravasation have been investigated, some factors are only identified during 4D-HyCoSy, thus currently no studies on preventing intravasation. However, several preprocedural features can be collected in advance, which may be valuable in predicting intravasation. Objective The purpose of this study is to establish a nomogram incorporating the preprocedural features to predict the risk of intravasation before TVS 4D-HyCoSy. Methods The data of 276 infertile women with patent fallopian tubes were analyzed retrospectively. They were assigned to the study group (n = 62) and the control group (n = 214) according to the development of intravasation. The preprocedural characteristics were collected to investigate the predictors independently associated with intravasation, which were then served as the construction of a nomogram. The performance of the nomogram was verified internally. Results History of uterine curettage (OR = 2.341, P = 0.009), endometrial thickness (OR = 0.587, P < 0.001), and examination schedule (OR = 0.790, P = 0.024) were found to be the independent influencing factors associated with intravasation. The established nomogram incorporating these preprocedural features was useful for predicting the risk of intravasation prior to 4D-HyCoSy. It yielded net benefits when the predicted probability was less than 50%. Conclusion The nomogram incorporating the preprocedural characteristics achieved a net benefit for clinical decision-making when the estimated risk was less than 50%. It is recommended to change the examination schedule for patients with an estimated risk greater than 50% and perform 4D-HyCoSy when the risk is less than 50%.
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Affiliation(s)
- Yi Jin
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Wendi Huang
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Qinhong Qv
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
| | - Shuling Liu
- Department of Ultrasound Imaging, the First People's Hospital of Wenling, Wenling City, Zhejiang Province, People's Republic of China
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van Welie N, van Rijswijk J, Dreyer K, van Hooff MHA, de Bruin JP, Verhoeve HR, Mol F, van Baal WM, Traas MAF, van Peperstraten AM, Manger AP, Gianotten J, de Koning CH, Koning AMH, Bayram N, van der Ham DP, Vrouenraets FPJM, Kalafusova M, van de Laar BIG, Kaijser J, Lambeek AF, Meijer WJ, Broekmans FJM, Valkenburg O, van der Voet LF, van Disseldorp J, Lambers MJ, Tros R, Lambalk CB, Stoker J, van Wely M, Bossuyt PMM, Mol BWJ, Mijatovic V. OUP accepted manuscript. Hum Reprod 2022; 37:969-979. [PMID: 35220432 PMCID: PMC9071226 DOI: 10.1093/humrep/deac034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
STUDY QUESTION Does hysterosalpingo-foam sonography (HyFoSy) lead to similar pregnancy outcomes, compared with hysterosalpingography (HSG), as first-choice tubal patency test in infertile couples? SUMMARY ANSWER HyFoSy and HSG produce similar findings in a majority of patients and clinical management based on the results of either HyFoSy or HSG, leads to comparable pregnancy outcomes. HyFoSy is experienced as significantly less painful. WHAT IS KNOWN ALREADY Traditionally, tubal patency testing during fertility work-up is performed by HSG. HyFoSy is an alternative imaging technique lacking ionizing radiation and iodinated contrast medium exposure which is less expensive than HSG. Globally, there is a shift towards the use of office-based diagnostic methods, such as HyFoSy. STUDY DESIGN, SIZE, DURATION This multicentre, prospective, comparative study with a randomized design was conducted in 26 hospitals in The Netherlands. Participating women underwent both HyFoSy and HSG in randomized order. In case of discordant results, women were randomly allocated to either a management strategy based on HyFoSy or one based on HSG. PARTICIPANTS/MATERIALS, SETTING, METHODS We included infertile women between 18 and 41 years old who were scheduled for tubal patency testing during their fertility work-up. Women with anovulatory cycles not responding to ovulation induction, endometriosis, severe male infertility or a known iodine contrast allergy were excluded. The primary outcome for the comparison of the HyFoSy- and HSG-based strategies was ongoing pregnancy leading to live birth within 12 months after inclusion in an intention-to-treat analysis. MAIN RESULTS AND THE ROLE OF CHANCE Between May 2015 and January 2019, 1026 women underwent HyFoSy and HSG. HyFoSy was inconclusive in 97 of them (9.5%), HSG was inconclusive in 30 (2.9%) and both were inconclusive in 9 (0.9%). In 747 women (73%) conclusive tests results were concordant. Of the 143/1026 (14%) with discordant results, 105 were randomized to clinical management based on the results of either HyFoSy or HSG. In this group, 22 of the 54 women (41%) allocated to management based on HyFoSy and 25 of 51 women (49%) allocated to management based on HSG had an ongoing pregnancy leading to live birth (Difference −8%; 95% CI: −27% to 10%). In total, clinical management based on the results of HyFoSy was estimated to lead to a live birth in 474 of 1026 women (46%) versus 486 of 1026 (47%) for management based on HSG (Difference −1.2%; 95% CI: −3.4% to 1.5%). Given the pre-defined margin of −2%, statistically significant non-inferiority of HyFoSy relative to HSG could not be demonstrated (P = 0.27). The mean pain score for HyFoSy on the 1–10 Visual Analogue Scale (VAS) was 3.1 (SD 2.2) and the mean VAS pain score for HSG was 5.4 (SD 2.5; P for difference < 0.001). LIMITATIONS, REASONS FOR CAUTION Since all women underwent both tubal patency tests, no conclusions on a direct therapeutic effect of tubal flushing could be drawn. WIDER IMPLICATIONS OF THE FINDINGS HyFoSy or HSG produce similar tubal pathology findings in a majority of infertile couples and, where they differ, a difference in findings does not lead to substantial difference in pregnancy outcome, while HyFoSy is associated with significantly less pain. STUDY FUNDING/COMPETING INTEREST(S) The FOAM study was an investigator-initiated study funded by ZonMw, The Netherlands organization for Health Research and Development (project number 837001504). ZonMw funded the whole project. IQ Medical Ventures provided the ExEm-foam® kits free of charge. The funders had no role in study design, collection, analysis and interpretation of the data. K.D. reports travel and speaker fees from Guerbet. F.J.M.B. reports personal fees as a member of the external advisory board for Merck Serono, The Netherlands, and a research support grant from Merck Serono, outside the submitted work. C.B.L. reports speakers’ fee from Ferring in the past, and his department receives research grants from Ferring, Merck and Guerbet. J.S. reports a research agreement with Takeda on MR of motility outside the submitted work. M.V.W. reports leading The Netherlands Satellite of the Cochrane Gynaecology and Fertility Group. B.W.J.M. is supported by an NHMRC Investigator grant (GNT1176437). B.W.J.M. reports consultancy for Guerbet and research funding from Merck and Guerbet. V.M. reports non-financial support from IQ medicals ventures, during the conduct of the study; grants and personal fees from Guerbet, outside the submitted work. The other authors do not report conflicts of interest. TRIAL REGISTRATION NUMBER NTR4746/NL4587 (https://www.trialregister.nl) TRIAL REGISTRATION DATE 19 August 2014 DATE OF FIRST PATIENT’S ENROLMENT 7 May 2015
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Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Correspondence address. Department of Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands. E-mail:
| | - Joukje van Rijswijk
- Department of Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Machiel H A van Hooff
- Department of Obstetrics and Gynaecology, Franciscus Hospital, Rotterdam, The Netherlands
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Harold R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, The Netherlands
| | - Femke Mol
- Centre for Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Maaike A F Traas
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Location Apeldoorn, Apeldoorn, The Netherlands
| | - Arno M van Peperstraten
- Department of Obstetrics and Gynaecology, Rivierenland Hospital, Tiel, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arentje P Manger
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Judith Gianotten
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Cornelia H de Koning
- Department of Obstetrics and Gynaecology, Tergooi Hospital, Blaricum, The Netherlands
| | - Aafke M H Koning
- Department of Obstetrics and Gynaecology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Neriman Bayram
- Department of Obstetrics and Gynaecology, Zaans Medical Centre, Zaandam, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynaecology, Martini Hospital Groningen, Groningen, The Netherlands
| | | | - Michaela Kalafusova
- Department of Obstetrics and Gynaecology, Refaja Hospital, Stadskanaal, The Netherlands
| | - Bob I G van de Laar
- Department of Obstetrics and Gynaecology, OLVG West, Amsterdam, The Netherlands
| | - Jeroen Kaijser
- Department of Obstetrics and Gynaecology, Ikazia Medical Center, Rotterdam, The Netherlands
| | - Arjon F Lambeek
- Department of Obstetrics and Gynaecology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Wouter J Meijer
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Location Zutphen, Zutphen, The Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Olivier Valkenburg
- Department of Reproductive Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lucy F van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - Jeroen van Disseldorp
- Department of Obstetrics and Gynaecology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Marieke J Lambers
- Department of Obstetrics and Gynaecology, Dijklander Hospital, Hoorn, The Netherlands
| | - Rachel Tros
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon van Wely
- Centre for Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Aberdeen Centre for Women’s Health Research, King’s College, University of Aberdeen, Aberdeen, UK
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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9
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Contrast-enhanced genitosonography and colosonography: emerging alternatives to fluoroscopy. Pediatr Radiol 2021; 51:2387-2395. [PMID: 33978789 DOI: 10.1007/s00247-020-04770-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/18/2020] [Accepted: 07/01/2020] [Indexed: 10/21/2022]
Abstract
Imaging plays a crucial role in evaluating newborns and infants with cloacal and urogenital malformations. Contrast-enhanced genitosonography (ceGS) and contrast-enhanced colosonography (ceCS) are sensitive and radiation-free alternatives to fluoroscopic genitography and colography for diagnosis and surgical planning. These imaging techniques are performed by instilling a US contrast agent into specific body cavities to define the genitourinary and colorectal anatomy. This review article presents the experience with ceGS and ceCS applications in children, focusing on the background, examination technique, and interpretation of imaging findings, as well as strengths and weaknesses compared to conventional techniques.
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10
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Lee S, Hitt WC. Clinical Applications of Telemedicine in Gynecology and Women's Health. Obstet Gynecol Clin North Am 2021; 47:259-270. [PMID: 32451017 DOI: 10.1016/j.ogc.2020.02.002] [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] [Indexed: 11/25/2022]
Abstract
Telemedicine and telehealth (TM/TH) are the 2 terms used interchangeably focusing on the delivery of health care services at a long distance using telecommunication technology. TM/TH has several gynecologic applications, including the well-woman visits, preventive care, preconception counseling, family planning including contraception and medical abortion, infertility workup, teleradiology, cervical cancer screening and colposcopy, mental health, and telesurgery. The goals of TM/TH are not only improving quality of health care in patients and building a virtual community of physicians but also increasing convenience, efficacy, and decreasing medical cost. In gynecology, TM/TH plays an important role, especially in well-woman care.
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Affiliation(s)
- Siwon Lee
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA
| | - Wilbur C Hitt
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 4302 Alton Road, Suite 920, Miami Beach, FL 33140, USA.
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11
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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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12
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Alcázar JL, Martinez A, Duarte M, Welly A, Marín A, Calle A, Garrido R, Pascual MA, Guerriero S. Two-dimensional hysterosalpingo-contrast-sonography compared to three/four-dimensional hysterosalpingo-contrast-sonography for the assessment of tubal occlusion in women with infertility/subfertility: a systematic review with meta-analysis. HUM FERTIL 2020; 25:43-55. [PMID: 32484066 DOI: 10.1080/14647273.2020.1769204] [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] [Indexed: 10/24/2022]
Abstract
In this meta-analysis, we aimed to compare the diagnostic accuracy of 2D- and 3D/4D-HyCoSy for the assessment of tubal occlusion in women with infertility, using a laparoscopic tubal chromoperturbation dye test as the reference standard. Studies assessing 2D- and 3D/4D-HyCoSy for the assessment of tubal occlusion in women with infertility were searched from January 1990 to April 2019 using Medline and Web of Science databases by three of the authors, using the terms: 'hysterosalpingo-contrast-sonography', 'sonohysterosalpingography', 'HyCoSy', 'HyFoSy', 'three-dimensional', 'four-dimensional', 'ultrasound', 'tubal patency' and 'tubal occlusion'. Data quality was determined using the QUADAS-2 tool. Thirty articles were included; twenty-one studies used 2D-HyCoSy to assess tubal occlusion, six used 3D/4D-HyCoSy, one study used both techniques but in a different set of patients and two used both techniques in the same patients. The risk of bias for most studies was low as determined by QUADAS-2, except for the patient selection domain. Overall, pooled estimated sensitivity and specificity of 2D-HyCoSy were 86% (95% CI = 80%-91%) and 94% (95% CI = 90%-96%), respectively. The corresponding figures for 3D/4D HyCoSy were 95% (95% CI = 89%-98%) and 89% (95% CI = 82%-94%). High heterogeneity was found for both sensitivity and specificity. No statistically significant differences were found between the methods (p = 0.13). We concluded that 2D-HyCoSy has a similar diagnostic performance to 3D/4D-HyCoSy.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andrea Martinez
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Manuel Duarte
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico, Valencia, Spain
| | - Andry Welly
- Department of Obstetrics and Gynecology, Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Antonio Marín
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Raquel Garrido
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico, Valencia, Spain
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
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13
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Chen LS, Zhu ZQ, Li J, Wang ZT, Qiang Y, Hu XY, Zhang MM, Wang ZQ. Hysterosalpingo-contrast-sonography vs. magnetic resonance-hysterosalpingography for diagnosing fallopian tubal patency: A systematic review and meta-analysis. Eur J Radiol 2020; 125:108891. [PMID: 32088657 DOI: 10.1016/j.ejrad.2020.108891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare hysterosalpingo-contrast-sonography (HyCoSy) and magnetic resonance-hysterosalpingography (MR-HSG) in the diagnosis of fallopian tubal patency. MATERIALS AND METHODS The databases of PubMed, Embase, and the Cochrane Library were searched for records up to November 30, 2019. Studies involved in the diagnostic detection of HyCoSy or MR-HSG for fallopian tubal patency using conventional HSG or laparoscopy as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (sROC) plots of both HyCoSy and MR-HSG. Quality was assessed using the QUADAS-2 tool. RESULTS The analysis included 24 articles involving 1340 patients. HyCoSy was studied in 17 studies, and MR-HSG was studied in seven studies. For HyCoSy in diagnosis of fallopian tubal patency, pooled sensitivity was 89 % (95 % confidence interval [CI], 87 %-91 %), and specificity was 93 % (95 % CI, 91 %-94 %). For MR-HSG in diagnosis of fallopian tubal patency, pooled sensitivity was 100 % (95 % CI, 98 %-100 %), and specificity was 82 % (95 % CI, 74 %-89 %). The sROC showed similar diagnostic accuracy for MR-HSG and HyCoSy. 3D/4D HyCoSy with ultrasound microbubbles had equal sensitivity (95 % vs. 100 %, P = 0.186) and significantly higher specificity (94 % vs. 82 %, P = 0.005) compared with MR-HSG. CONCLUSIONS HyCoSy and MR-HSG showed similar overall diagnostic performance for diagnosing fallopian tubal patency. 3D/4D HyCoSy with ultrasound microbubbles could significantly improve the diagnostic specificity of HyCoSy.
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Affiliation(s)
- Ling-Shan Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zheng-Qiu Zhu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Jing Li
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zhi-Tao Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Ye Qiang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Xu-Yu Hu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Mei-Mei Zhang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zhong-Qiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China.
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Exalto N, Emanuel MH. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4827376. [PMID: 31360713 PMCID: PMC6644241 DOI: 10.1155/2019/4827376] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. OBJECTIVES AND RATIONALE The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. SEARCH METHODS A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. OUTCOMES Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. WIDER IMPLICATIONS HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.
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Affiliation(s)
- Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Mark Hans Emanuel
- Division of Woman and Baby, Department of Gynaecology and Reproductive Medicine, University Medical Centre, Utrecht, Netherlands
- Department of (Uro)gynaecology, University Hospital, Ghent, Belgium
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15
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Wang W, Zhou Q, Zhou X, Chen Z, Zhang H. Influence Factors on Contrast Agent Venous Intravasation During Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2379-2385. [PMID: 29637586 DOI: 10.1002/jum.14594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). METHODS The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. RESULTS In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. CONCLUSIONS Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.
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Affiliation(s)
- Weiqun Wang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiulan Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xingxing Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hui Zhang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Mardanian F, Rouholamin S, Nazemi M. Evaluation of Efficacy of Transvaginal Sonography with Hysteroscopy for Assessment of Tubal Patency in Infertile Women Regarding Diagnostic Laparoscopy. Adv Biomed Res 2018; 7:101. [PMID: 30050889 PMCID: PMC6036783 DOI: 10.4103/abr.abr_71_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Infertility, as one of the most common gynecological disorders, affects many people worldwide. To choose the clinical treatment, correct assessment of tubal patency can provide an important clue; therefore, it is considered as one of the major steps in workup examinations of infertile women. In this study, we aimed to compare the results of transvaginal ultrasonography (TVS) after hysteroscopy (HSC) with laparoscopy, as a gold standard, for assessing the fallopian tubal patency in infertile women. Materials and Methods This is a cross-sectional study which included 49 infertile women referred to Shahid Beheshti Hospital affiliated with Isfahan University of Medical Sciences during the years 2015 and 2016. At first, patients who met the inclusion criteria were examined through HSC in by a specialist in gynecology and obstetrics in operating room because laparoscopy was performed after TVS with HSC, but HSC was performed without anesthesia. TVS was performed before and after of HSC to observe fluid in the pouch of Douglas. The findings of TVS with HSC and laparoscopy were compared. Results There was a strong agreement between TVS after HSC and laparoscopy (kappa coefficient = 0.935, 95% confidence interval [CI]: 0.81, 1.00). The sensitivity of TVS after HSC was 100% (95% CI: 66.37, 100) and specificity was 97.50% (95% CI: 86.84, 99.94) with a positive predictive value of 90% (95% CI: 55.50, 99.75) and negative predictive value of 100% (95% CI: 90.97, 100). Conclusion TVS after HSC is an accurate diagnostic tool for examination of fallopian tubal patency in infertile women.
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Affiliation(s)
- Farahnaz Mardanian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nazemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Castro PT, Matos APP, Aranda OL, Marchiori E, Alves HDL, Machado AS, Lopes RT, Werner H, Araujo Júnior E. Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies. J Matern Fetal Neonatal Med 2018; 32:3082-3087. [PMID: 29558232 DOI: 10.1080/14767058.2018.1455181] [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: 10/17/2022]
Abstract
Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.
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Affiliation(s)
- Pedro Teixeira Castro
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Ana Paula Pinho Matos
- b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Osvaldo Luiz Aranda
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil.,c Department of Obstetrics and Gynecology , Vassouras University , Vassouras , Brazil
| | - Edson Marchiori
- a Department of Radiology , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Haimon Diniz Lopes Alves
- d Department of Applied Physics and Thermodynamics , Physics Institute, State University of Rio de Janeiro (UERJ) , Rio de Janeiro , Brazil.,e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Alessandra Silveira Machado
- e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Ricardo Tadeu Lopes
- e Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Heron Werner
- b Department of Radiology , Clínica Diagnóstico por Imagem (CDPI) , Rio de Janeiro , Brazil
| | - Edward Araujo Júnior
- f Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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Promberger R, Simek IM, Nouri K, Obermaier K, Kurz C, Ott J. Accuracy of Tubal Patency Assessment in Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study. J Minim Invasive Gynecol 2017; 25:794-799. [PMID: 29221993 DOI: 10.1016/j.jmig.2017.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopic routine evaluation is predictive of tube patency. DESIGN A retrospective cohort study (Canadian Task Force Classification II-2). SETTING Data from all patients who underwent surgery because of infertility at the study center between 2008 and 2016 were analyzed retrospectively. The main outcome parameter was fallopian tube patency as assessed by laparoscopic chromopertubation. The predictive parameters tested were the presence of hysteroscopic tube "flow," general patient characteristics, and intraoperative findings. PATIENTS Five hundred eleven infertile women who underwent combined hysteroscopy and laparoscopy were included. INTERVENTIONS All women underwent combined hysteroscopy and laparoscopy. Some had other interventions when necessary, but no additional interventions were taken because of this study. RESULTS In an analysis of 998 fallopian tubes, the hysteroscopic assessment of fallopian tube "flow" was highly accurate in predicting fallopian tube patency (p < .001), with a sensitivity of 86.4% (95% confidence interval [CI], 83.7-88.8) and a specificity of 77.6% (95% CI, 72.1-82.5). Risk factors for a false-negative hysteroscopy result were the presence of uterine myomas (odds ratio [OR] = 2.11; 95% CI, 1.10-4.05; p = .025), the presence of a hydrosalpinx on the analyzed side (OR = 2.50, 95% CI, 1.17-5.34; p = .019), and the presence of peritubal adhesions surrounding the analyzed tube (OR = 2.87; 95% CI, 1.21-6.76; p = .016). CONCLUSION A visualizable tube "flow" in hysteroscopy was accurate in the prediction of tubal patency, with a positive predictive value of about 91%. Knowledge about hysteroscopic fallopian tube "flow" can help to plan the future approach in an individual patient.
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Affiliation(s)
- Regina Promberger
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Burgenland, Austria
| | - Inga-Malin Simek
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Kazem Nouri
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Karin Obermaier
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Neurology, Krankenhaus Mistelbach, Lower Austria, Austria
| | - Christine Kurz
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.
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Wang W, Zhou Q, Gong Y, Li Y, Huang Y, Chen Z. Assessment of Fallopian Tube Fimbria Patency With 4-Dimensional Hysterosalpingo-Contrast Sonography in Infertile Women. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2061-2069. [PMID: 28543598 DOI: 10.1002/jum.14244] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the performance of 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy) for assessing fallopian tube fimbria patency in infertile women. METHODS Seventy-seven infertile female patients with obstruction at the tubal fimbria or partial obstruction with pelvic adhesions were included. All of the patients underwent 4D HyCoSy enhanced by dynamic observation after a flush of normal saline and were followed with laparoscopic chromopertubation using methylene blue within 6 months. RESULTS The overall accordance between 4D HyCoSy and laparoscopic chromopertubation was 92.9%. The sensitivity and specificity of 4D HyCoSy with laparoscopic chromopertubation as a reference standard were 93.8% and 92.2%, respectively. CONCLUSIONS Four-dimensional HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesions surrounding the ovaries, with its advantages of accuracy, noninvasiveness, and a good safety profile.
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Affiliation(s)
- Weiqun Wang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiulan Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yafei Gong
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ying Li
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yinying Huang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
We present an overview of the common types of tubal patency tests, with a focus on hysterosalpingo-foam sonography (HyFoSy). Current evidence suggests that HyFoSy is an accurate alternative to X-ray hysterosalpingography (HSG) for outpatient tubal evaluation in women who are at low risk for tubal disease. It may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. A hyperechogenic medium may enhance contrast visualization and enable clearer delineation of tubal anatomy. This may enhance confidence in the diagnosis of tubal patency, reduce false occlusion results, and improve the diagnostic yield of the test. It would be reasonable to deduce that HyFoSy would have similar performance characteristics as HyCoSy with other positive contrast agents. The available evidence supports the accuracy of HyFoSy compared to other forms of tubal investigation. We suggest a decision-making pathway based on the most current professional recommendations and available evidence. However, in this article, we do not provide a definitive exposition of the methods used for investigating tubal patency. Rather, we explore the contexts in which the various investigations are most and least suitable, and identify their strengths and limitations. Finally, we also discuss challenges encountered when performing tubal contrast sonography in clinical practice, including the problem of false occlusion results.
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Affiliation(s)
- Hemashree Rajesh
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Serene Liqing Lim
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
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