Hysterosalpingographic evaluation of primary and secondary infertility

Prevalence of Congenital Uterine Anomalies and Tubal Blockage in Infertile Omani Women: A Retrospective Study

Objectives

Congenital uterine anomalies (CUAs) occur because of malformation of the female genital tract at any stage of the Müllerian duct development process. This retrospective study investigated the prevalence of CUAs and tubal blockage in infertile Omani women who underwent a hysterosalpingogram procedure as part of the evaluation of infertility.

Methods

The radiographic reports of patients aged 19-48 years who underwent hysterosalpingogram as part of infertility evaluation during the 2013-2018 period, were collected and analyzed for the presence and the type of CUAs.

Results

The records of N = 912 patients were evaluated, 44.3% of whom had been investigated for primary infertility and 55.7% for secondary infertility. Patients with primary infertility were significantly younger than those with secondary infertility. Of the 27 (3.0%) patients who were found to have CUAs, 19 had arcuate uterus. No correlation was found between the type of infertility and the CUAs.

Conclusions

CUAs were prevalent in 3.0% of the cohort, most of whom were diagnosed with arcuate uterus.

Causes of Infertility: Diagnosis and Management With Microfluidic Sperm Sorter

This case study refers to a three-and-a-half-year married couple who visited an infertility clinic and are facing infertility for two-and-a-half years. They started in vitro fertilization/assisted reproduction technology (IVF/ART) procedures from December 2021. In 2019, the couple underwent infertility therapy in Wardha, India, including three intra‐uterine insemination (IUI) treatments which failed. The couple was then recommended the intracytoplasmic sperm injection (ICSI) procedure in which the semen sample was separated using a microfluidic sperm sorter for separating good quality sperms. There was no past medical history of both of the partners. Since she was infertile, the desire to have a child was extremely strong. Sadness, helplessness, bewilderment, and frustration are all common feelings associated with infertility. The left fallopian tube delays spillage in females and oligoasthenozoospermia in males; women were detected with secondary infertility and male sperm samples were sorted using a microfluidic sperm sorter and fertilized frozen oocytes for ICSI. As the male partner, in this case, had oligoasthenozoospermia, he was prescribed multivitamins and other medications. After ICSI, the blastocyst formation was good with the use of a microfluidic sperm sorter.

Hysterosalpingographic Findings of Infertile Patients Presenting to Our Reproductive Endocrinology Department: Analysis of 1,996 Cases

BACKGROUND

To evaluate the hysterosalpingography (HSG) findings of women with infertility in a tertiary center located in central Turkey.

METHODS

A total of 1,996 patients undergoing the HSG procedure for the investigation of infertility from April 2012 to 2017 were retrospectively evaluated using the archives of the reproductive endocrinology and radiology departments. Demographic and clinical characteristics of patients with normal HSG findings (n = 1,549) and patients with abnormal HSG findings (n = 447) were compared, and the distribution of pathologies on the HSG examinations was evaluated as well.

RESULTS

There were statistically significant differences between patients with normal and abnormal HSG findings in terms of age (25.68 ± 4.54 vs. 35.87 ± 2.65, p < 0.001), type (for secondary) and duration of infertility [43.1% vs. 50.6% (p = 0.006); 7 (1-22) vs. 2 (1-12) (p < 0.001), respectively], and baseline follicle stimulating hormone and estradiol levels [7.22 ± 1.38 vs. 7.55 ± 1.42 (p < 0.001); 45.54 ± 9.92 vs. 44.40 ± 9.99 (p < 0.001), respectively]. Among a total of 1,996 HSG examinations, 447 (22.39%) showed abnormalities, of which 237 (11.87%) were associated with tubal pathologies, 163 (8.17%) with uterine pathologies, and 47 (2.35%) with a combination of both. While the most common tubal pathology was one-sided distal tubal occlusion (2.91%), the most common uterine pathology was filling defects (4.16%).

CONCLUSION

HSG is the most commonly used, well-tolerated, low-cost, and safe radiological procedure to use for the investigation of the causes of female infertility.

Evaluation of hysterosalpingographic findings among patients presenting with infertility

Background

Infertility is a global health issue and hysterosalpingography (HSG) is a valuable radiological tool in infertility workup and remains a main modality for investigating female infertility. However, the HSG findings of infertility are not the same worldwide.

This study aimed at evaluating the incidence of HSG findings in patients investigated for primary and secondary infertility, correlating these findings with their clinical data that reflect the infertility causes and comparing the findings with previous international studies.

Methods

A prospective descriptive study of 75 female patients referred, as cases of infertility, for HSG examination in Elrebat Hospital and Khartoum Advanced Diagnostic Center. HSG was performed in the first half of the cycle. The procedure and its complications, were explained to the patients and informed consents were obtained. Patients with active pelvic infection and active uterine or vaginal bleeding were excluded from the study. Using aseptic technique and with proper patient’s positioning, iodinated contrast was introduced into the cervix under fluoroscopic monitoring, to demonstrate the uterine cavity, fallopian tubes and free spillage into the peritoneal cavity. Personal data, clinical data and HSG findings were analyzed using SPSS version 23.

Results

The commonest age group seen was 26–36 years. Close incidences of primary and secondary infertility were detected. 52.7% had abnormal findings in HSG. Tubal pathology (42.7%) being the most common abnormality, followed by uterine and combined abnormalities. There was strong association between past medical history suggesting pelvic inflammatory disease (PID) or past history suggesting tubal blockage secondary to abdominopelvic surgery and tubal abnormalities.

Conclusion

HSG examinations revealed that the most common abnormality was tubal blockage possibly complicating PID and abdominopelvic surgeries. This reflects the HSG diagnostic and therapeutic role in the assessment of female infertility and the further needs for more preventive measures targeting the reduction of tubal pathologies in developing countries.

The relationship between hysterosalpingography findings and female infertility in a Nigerian population

Purpose

This study aims to explore the relationships between abnormal hysterosalpingography (HSG) findings and all types of infertility.

Material and methods

This retrospective study was carried out at a private radiodiagnostic centre in Lagos, Nigeria. The radiologist reports of all consecutive patients who had HSG evaluation from 2016 to 2018 were analysed. Biodemographic information and indications for HSG evaluation were also documented. Logistic regression was used to test correlations between the explanatory and outcome variables. P ≤ 0.05 represented a statistically significant result.

Results

A total of 450 patients were involved in this study, with ages ranging from 21 to 51 years and a mean age of 34.6 ± 5.56 years. The age group 31-35 years had the highest frequency of infertility. There were 299 patients referred for infertility. Secondary infertility was seen in 211 patients (46.9%), primary infertility was seen in 79 patients (17.6%), and subfertility was seen in nine patients (2%). There were 49 patients (10.9%) with cornual tubal blockage, while 57 patients (12.7%) had perifimbrial adhesion and/or blockage. There were 56 patients (12.4%) with hydrosalpinx and nine patients (2.0%) with tubal occlusion. Multivariate logistic regression analysis showed women with hydrosalpinx were 2.11 times more likely to be infertile than those without hydrosalpinx (95% CI: 1.02-4.36, p = 0.042).

Conclusions

The presence of hydrosalpinx was a significant risk factor in developing all types of infertility. Understanding the HSG patterns and their correlations with infertility will help physicians across the world when evaluating infertility in patients of similar background to our patient population.

Long-term indwelling copper intrauterine device (IUD) found during primary infertility work up

Infertility is a public health concern worldwide. Hysterosalpingogram is a useful diagnostic tool to both evaluate the contours of the uterine cavity and to assess tubal patency. Intrauterine devices (IUDs) are the world's most prevalent form of long-acting reversible contraception. In this case, a 30-year-old P0 female, an immigrant from Jamaica, was referred for hysterosalpingogram for primary infertility workup. Under fluoroscopic imaging, an unexpected T-shaped IUD was visualized in the expected location of the uterus. The IUD lacked portions of the radiopaque copper lining. The patient initially denied IUD insertion. However, after further investigation, the patient's mother admitted IUD insertion at the age of 14 in Jamaica. This case raises a concern for the possibility of unexpected IUD discovery during infertility work up and emphasizes the importance of clinician awareness of the changes that may be seen on imaging when these devices are in place long-term.

The effect of a pre-procedure information video on anxiety levels in patients undergoing hysterosalpingography: A prospective case-control study

Objective:

To evaluate the effect of a pre-procedural information video on anxiety levels in patients undergoing hysterosalpingography (HSG).

Material and Methods:

Among a total of 131 primary or secondary infertile patients, 66 were shown an information video and 67 control patients received standard care between August 2014 and January 2016. The video included information on the procedure, personnel, and the room for the procedure; the video was shown on the morning of the procedure. Patients were randomized using the complete randomization technique through which patients were included in the study and control groups week by week, randomly. The Beck Anxiety Inventory scale was conducted to the patients one hour before the procedure

Results:

There were no differences in demographic data. The history of previous gynecologic operations was higher in the control group. The Beck Anxiety score was significantly lower in the study group compared with the control group (6 vs 10).

Conclusion:

Our findings suggest that as an easy intervention to implement, a pre-procedural video education may be a beneficial tool for the management of HSG-related anxiety.