Tubal patency following surgical and clinical treatment of ectopic pregnancy

The Potential Relationship Between Different Human Female Reproductive Disorders and Sperm Quality in Female Genital Tract

Spermatozoa should travel throughout the female reproductive tract to reach its ultimate goal, fertilization of the oocyte. At the ejaculation moment, millions of sperm within a few milliliters of the ejaculate are deposited at the cranial segment of vagina and make their journey to the fertilization site. This is done by means of various factors, such as sperm motility, the uterine and fallopian tubes contractility, and the ciliary movement of the lining cells. During this migration, spermatozoa interact with the female microenvironment both physically and molecularly. In this regard, the quality of the environmental conditions may affect this interaction. Therefore, some alterations in women's genital tract microenvironment, such as conditions that occur in female reproductive disorders, may have detrimental effects on sperm reproductive function. In this review, human sperm migration through the female tract is described, and the potential effects of different reproductive disorders at reproductive organs, such as vagina, uterine cervix, uterus, fallopian tubes, and ovary on sperm survival and quality, are also argued. The understanding of those conditions that may impair sperm fertility in the female genital tract can provide a more accurate diagnosis of the causes of infertility in couples. This can ultimately lead to the discovery of effective treatment approaches.

Ethiodized poppyseed oil versus ioversol for image quality and adverse events in hysterosalpingography: a prospective cohort study

Background

This study aimed to investigate the image quality and adverse events (AEs) of ethiodized poppyseed oil (EPO) compared with ioversol as contrast agents in hysterosalpingography (HSG).

Methods

Two hundred twenty-eight patients underwent HSG were consecutively recruited in this prospective cohort study, and were accordingly divided into EPO group (N = 165) and ioversol group (N = 63). The quality of image was assessed according to the European Guidelines on quality criteria for diagnostic radiographic images. AEs during, within 2 h and at 1-month post-HSG were recorded.

Results

EPO displayed elevated image quality compared with ioversol including the total image quality score (P < 0.001), the cervical canal display score (P < 0.001), shape and outline of uterus score (P < 0.01), cervical mucosa or folds score (P < 0.001), oviduct isthmus score (P < 0.001), ampulla and fimbriae of oviduct score (P < 0.001) and celiac diffuse image score (P < 0.001). Multivariate linear regression displayed that EPO (P < 0.001) was an independent predictive factor for increased total image quality score. AEs were similar between EPO group and ioversol group during and within 2 h post-HSG (all P > 0.05). However, at 1-month post-HSG, the number of patients had unchanged and faded menstrual blood color decreased but the proportion of patients with deepened menstrual color increased in EPO group compared with ioversol group (P = 0.007). In addition, the number of patients had iodine residue in uterine cavity was elevated in EPO group compared with ioversol group (P < 0.001).

Conclusion

EPO is more efficient in image quality and equally tolerant compared to ioversol as contrast agents in HSG.

Electronic supplementary material

The online version of this article (10.1186/s12880-019-0346-0) contains supplementary material, which is available to authorized users.

Frequency and related factors of tubal patency after methotrexate treatment in women with ectopic pregnancy

AIM

Ectopic pregnancy is a medical emergency. The classic treatment for this condition is surgery but early diagnosis allows for non-surgical treatment. In recent years, intramuscular methotrexate has been considered, due to easy administration, its less invasive nature and low complications, but there are arguments about its effects. The aim of this study was to evaluate tubal patency after treatment of ectopic pregnancy with methotrexate and related factors.

METHODS

This cross-sectional study was conducted on 80 women with ectopic pregnancy who were admitted to Sanandaj Be'sat Hospital in 2014. Patients who had successful treatment for ectopic pregnancy with single or multiple doses of methotrexate 50 mL/m(2) were enrolled. Three to 6 months after treatment, the patients were evaluated for tubal patency by hysterosalpingography. Data were analyzed using spss, t-tests, χ(2) -test and logistic regression.

RESULTS

The tubal patency rate after treatment of ectopic pregnancy with methotrexate was 75% in hysterosalpingography. The average size of the ectopic pregnancy mass of women with open fallopian tubes was 22.5 ± 7.0 mm and for women with closed fallopian tubes it was 34.7 ± 10.0 mm (P = 0.0001). β-human chorionic gonadotropin levels were 642.1 ± 850.5 in women with open fallopian tubes and 3816.3 ± 4487.3 for women with closed fallopian tubes (P = 0.0001). There was no significant correlation statistically between tubal patency with a history of stillbirth and number of pregnancies (P > 0.5). There was a statistically significant relation between tubal patency and the number of births and also methotrexate dose (P < 0.05).

CONCLUSION

Treatment of ectopic pregnancy with methotrexate is effective for saving tubal patency. Levels of human chorionic gonadotrophin-β < 1745, the treatment regimen of methotrexate (single or multiple doses) and ectopic pregnancy mass size smaller than 33.5 mm are significant predictors of tubal patency.

The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

Fertility outcomes following expectant management of tubal ectopic pregnancy

OBJECTIVES

To evaluate fertility outcome after the expectant management of tubal ectopic pregnancy.

METHODS

Our dedicated early pregnancy database was searched for all women diagnosed with a tubal ectopic pregnancy between January 1999 and June 2003 who were either managed expectantly or underwent a salpingectomy. They were contacted to enquire about their ability to conceive following the ectopic pregnancy and about the outcomes of any subsequent pregnancies.

RESULTS

Four hundred and forty-four women had a diagnosis of tubal ectopic pregnancy, and 173 (39%) were successfully contacted. A total of 146/173 (84.4%; 95% CI, 79-89.8%) tried for another pregnancy: 49/59 (83.1%; 95% CI, 73.4-92.6%) in the expectant management and 97/114 (85.1%; 95% CI, 78.4-91.6%) in the salpingectomy group (P > 0.05). Spontaneous intrauterine pregnancy occurred in 41/49 (83.7%; 95% CI, 73.3-94.2%) women managed expectantly and in 62/97 (63.9%; 95% CI, 54.4-73.5%) women managed surgically (odds ratio 2.89; 95% CI, 1.22-6.86%). The risk of recurrent ectopic pregnancy was not significantly different between the two management groups.

CONCLUSIONS

Fertility outcomes following the expectant management of tubal ectopic pregnancy are comparable to those following salpingectomy.