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Background: Tubal factor is responsible for infertility and is found in one of three infertile women. The current research was undertaken to compare the efficacy of hysterosalpingo contrast sonography (HyCoSy) with laparoscopy and chromopertubation in infertile women.Methods: A cross-sectional study was conducted from August 2016 to March 2017 among the patients attending outpatient department with complaints of primary or secondary infertility after obtaining written and informed consent. Detailed history of the patient was taken; clinical examination and necessary investigations were done. Data analysis was carried out using SPSS version 22.Results: All the HyCoSy findings showed excellent specificity (84-100%) and the sensitivity ranged from 40-87%.Conclusions: Study conclude that HyCoSy is a good screening method for evaluating uterine cavity lesions and tubal block in infertile women being safe, sensitive, cost effective, non-invasive procedure giving additional information regarding ovarian, adnexal and peritoneal pathology.
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ObjectiveTo explore the influencing factors of moderate-to-severe pain in transvaginal real-time threedimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy). MethodsTotally 235 suspected infertility patients who underwent RT-3D-HyCoSy in the First Affiliated Hospital of Anhui University of Chinese Medicine between Jan. 2017 and Dec. 2018 were chosen for this study. The degree of pain was assessed by numeric rating scale (NRS). The patients were divided into non-moderate-to-severe pain group (NRS score was 0-3) and moderate-to-severe pain group (NRS score was 4-10). Patients' age, infertile time, infertile type, fallopian tube patency, balloon size (≥2 mL), contrast agent reflux, uterine space-occupying lesion, uterine malformation, intrauterine adhesion, uterine position, ectopic pregnancy history, gynecological inflammation, pelvic surgery history and emotion were collected for comparison between the two groups. Multivariate logistic regression model was used to analyze the risk factors of moderate-to-severe pain during RT-3D-HyCoSy examination, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor. ResultsThe univariate analysis showed that the balloon size (≥2 mL), contrast agent reflux, abnormal fallopian tube patency, intrauterine adhesion, and emotional tension were the influencing factors for moderate-to-severe pain (P<0.01, P< 0.05). The multivariate logistic regression model showed that balloon size (≥2 mL), abnormal fallopian tube patency, and emotional tension were the risk factors for moderate-to-severe pain (odds ratio [OR]?2.223, 95% CI: 1.088-4.542, P<0.05; OR?13.824, 95% CI: 5.582-34.239, P<0.01: OR?2.606, 95% CI: 1.255-5.414, P<0.05). ROC curve confirmed that multi-factor (balloon size ≥2 mL, abnormal fallopian tube patency, and emotional tension) combined had the highest prediction accuracy for moderate-to-severe pain (area under curve [AUC]?0.841, 95% CI: 0.785-0.898). ConclusionBalloon size (≥2 mL), abnormal fallopian tubal patency and emotional tension are risk factors for moderate-to-severe pain in RT-3D-HyCoSy examination. During RT-3D-HyCoSy examination, we should pay attention to the causes of moderate-tosevere pain and avoid them, so as to improve the comfort level of patients and the success rate of the examination.
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Objective: To explore the application value of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) with transvaginal ultrasound in evaluation of fallopian tube patency in infertile patients. Methods Clinical data of 112 infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation using methylene blue (LC) were retrospectively analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and AUC of 4D-HyCoSy in diagnosis of tubal obstruction were calculated. Then the consistency between 4D-HyCoSy and LC in diagnosis of fallopian tube patency was evaluated. Results: A total of 218 fallopian tubes were examined in 112 infertile patients. Taken LC results as gold standards, the coincidence rates of 4D-HyCoSy in diagnosis of tubal patency, partially obstructed and completely obstructed were 88.64% (39/44), 72.09% (62/86) and 89.77% (79/88), respectively, and the overall coincidence rate was 82.57% (180/218). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 4D-HyCoSy in diagnosis of tubal obstruction were 80.61% (79/98), 92.50% (111/120), 89.77% (79/88), 85.38% (111/130), 10.75 and 0.19, respectively, AUC was 0.87 (P<0.01). 4D-HyCoSy had higher consistency with LC in diagnosis of tubal patency (Kappa=0.74). Conclusion: 4D-HyCoSy is consistent with LC in diagnosis of fallopian tube patency, which has high specificity in diagnosing tubal obstruction.
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This review introduces the tubal liquidinstillations,hysterosalpingography(HSG),two-di-mensional/three-dimensional and dynamic three-di-mensional(four-dimensional)hysterosalpingo-contrastsonography,MRI-HSG,tubal patency test by hyster-oscopy and hysteroscopy-laparoscopy.We comparesthe advantages and disadvantages of various kinds oftests,mainly the different characteristics of oil-basedor water-based contrast medium,and the high falsepositive rate of HSG diagnosis of proximal obstruction,etc,in order to enable the readers to choose suitabletubal evaluation methods according to the conditions oftheir unit.
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Objective To evaluate the feasibility of quantitative evaluation of fallopian tubes patency by the rising slope of pressure curve produced by bolus injection using a liquid diagnostic apparatus in the four-dimen-sional hysterosalpingo-contrast sonography. Methods A total of 205 patients with infertility were collected for four-dimensional hysterosalpingo-contrast sonography. In the examination,the contrast medium concentration,the liquid volume of the liquid diagnostic apparatus and the speed of the liquid were stationary calculated. The rising slope of the curve was calculated according to the real-time pressure curve produced by the contrast agent injection process. According to the hysterosalpingo-contrast sonography examination's results ,patients were divided into one side patency group,one side partial obstruction group and one side obstruction group. The correlation between the slope and the patency of the fallopian tube was analyzed by binary logistic regression. Results Binary logistic regression showed that the slope and fallopian tube patency had good correlation(all P < 0.05)between one side patency group and one side obstruction group,and also between one side partial obstruction group and one side obstruction group;but had no correlation between one side patency group and one side partial obstruction group(regression coefficient P>0.05,regression constant P=0.000). Conclusion The slope of pressure curve produced by four-dimensional hysterosalpingo-contrast sonography can be used to assess the patency of fallopian tubes quantitatively. It is a new auxiliary index for evaluating the patency of fallopian tubes.
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assessment of uterine cavity and tubal patency compare with hysterosalpingography ( HSG ). Thirty four of infertile women undergoing investigation for infertility were enrolled from July 1997 until November 1998 for the current study. HyCoSy using Echovistฎ and HSG were successful carried out during the first half of each patient’s menstrual cycle. The flow of contrast medium through the uterine cavity and each fallopian tube was visualised in real time by transvaginal ultrasonography for HyCoSy. Meanwhile, HSG was performed and reported by consultant radiologists. Regarding the uterine cavity evaluation, 32 of 34 cases ( 94.1 % ) was reported to be normal by both procedures. Only 2 cases were noted with different results. From the 68 fallopian tubes studied, though 47 of 68 tubes were showed patent by the two procedures, HyCoSy could detect occlusion in only 5 of 10 left fallopian tubes and in 5 of 9 right fallopian tubes which were reported to be occluded by HSG. Mean length of time for HyCoSy was 8.7 minutes (range 2-30 minutes, Std. Dev. 5.4) and mild pelvic pain was the only complication incurred. In conclusion, HyCoSy using Echovistฎ is a reliable and safe procedure for outpatient uterine cavity evaluation. However, it does not substitute to HSG for tubal patency assessment in basic infertility investigation.
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Twenty nine fallopian tubes from 15 patients were examined for tubal patency using HyCoSy followed by chromolaparoscopy. The mean volume of contrast medium used was 14.3 ml and the duration of HyCoSy was 8.5 minutes. Concordance, sensitivity, specificity, positive predictive value and negative predictive value were 75.9, 44.4, 90.0, 66.7 and 78.3% respectively. The only adverse effect was mild pelvic pain and this was found in 60%. These results suggest that HyCoSy may become an established method for assessing fallopian tubal patency in the future.