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Objetivo: Determinar el rendimiento diagnóstico de la histerosalpingografía por resonancia magnética (HSG-RM), utilizando la laparoscopia como método de referencia. Materiales y métodos: Se incluyeron 22 pacientes. A todas se les realizó una HSG-RM con un resonador 1.5 Tesla y luego una laparoscopia con cromotubación. Dos radiólogos examinaron las RM, determinando la permeabilidad tubaria por consenso. Se realizaron análisis descriptivos y de rendimiento diagnóstico. Resultados: La HSG-RM tuvo una tasa de éxito del 91%. La duración del estudio fue 49ą15 minutos, el volumen inyectado 26 ą 16 cm³ y la escala de dolor 30ą 19 de 100. La sensibilidad y especificidad de la HSG-RM fueron del 100% para la prueba de Cotte global y a la izquierda, y del 25% y 93,3% para la prueba de Cotte a la derecha, respectivamente. Hubo 2 complicaciones menores y ninguna importante. Discusión: Nuestros resultados iniciales demostraron una alta sensibilidad y especificidad. Si bien otros estudios analizaron la capacidad de la HSG-RM para evaluar la permeabilidad tubaria con buenos resultados, el uso de un patrón de referencia defectuoso dejaba margen para una duda razonable, impidiendo una recomendación basada en pruebas sólidas. Sin embargo, al cotejar nuestros resultados con los publicados, observamos un alto grado de concordancia en tanto el derrame positivo se diagnostica correctamente con una especificidad de 100% o con un porcentaje cercano a esta cifra. Conclusión: La HSG-MR es una alternativa factible y segura de la HSG convencional o virtual, la histerosonografía y la cromotubación.
Objective: To determine the diagnostic performance of magnetic resonance hysterosalpingography (MRHSG) using laparoscopic chromotubation as a method of reference. Materials and methods: Twenty-two patients were included. The MRHSG was performed in a 1.5 Tesla MR scanner. Afterwards, patients underwent laparoscopic chromotubation. MR images were examined by two trained radiologists, and tubal patency was determined by consensus. A descriptive analysis was carried out, as well as an analysis of the diagnostic performance. Results: MRHSG had a 91% success rate. Exam duration of the examination was 49ą15min, with an injected volume 26ą 16cc, and pain scale 30ą 19 out of 100. Sensitivity and specificity of MRHSG was 100% for global and left Cotte, and 25% and 93.3% for right Cotte, respectively. Only 2 minor and no major complications were observed. Discussion: The initial results of MRHSG have shown high sensitivity and specificity. Even though other studies have analysed the potential of MRHSG with good results, the use of a flawed reference standard left a margin for a reasonable doubt as regards its true potential, thus preventing a solid evidence based recommendation. Nevertheless, if our results are compared to those published, a high level of agreement is observed in that positive spillage is correctly diagnosed with specificities near or at 100%. Conclusion: MRHSG is a feasible and safe alternative to conventional or virtual HSG, ultrasound-hysterography and chromotubation.
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Humans , Female , Hysterosalpingography/methods , Magnetic Resonance Spectroscopy , Fallopian Tube Patency Tests , LaparoscopyABSTRACT
Objective To study on the factors of countercurrent occured in hysterosalpingography to improve the understanding of countercurrent.Methods 180 patients who underwent hysterosalpingography due to infertility were recruited,and 63 of them who were involved in countercurrent in the process of hysterosalpingography were analyzed statistically.Results The single factor analy-sis demonstrated that such four factors of primary/secondary infertility,menstrual clean days,tubal obstruction or not,and depth of cannula were associated with countercurrent,while Logistic regression analysis indicated that the factors of menstrual clean days, tubal obstruction or not,and depth of cannula during the hysterosalpingography operation were closely related.Conclusion Counter-current are caused by the comprehensive impact of several comprehensive factors like menstrual clean day,tubal obstruction or not, and cannula operation.Therefore adequate preparation should be made before and during the operation,to reduce the occurrences of countercurrent.
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Objective To investigate the relationship between women's reproductive tract mycoplasma infec-tion and tubal obstruction effusion .Methods A retrospective analysis of 60 cases infertility infertility clinic patients and healthy control were detected in our hospital from Junuary 2013 to December 2014.The cervical secretion sam-ples were used for detection of Mycoplasma ( leucorrhea , Ureaplasma urealyticum ( Uu ) and Mycoplasma hominis ( Mh) lipiodol angiography and fallopian tube , and two groups of patients with mycoplasma infection and tubal cir-cumstance tube obstruction were compared .Results The two groups infertile patients with Cervical Mycoplasma ex-amination with Uu positive were 41 cases, accounting for 68.3%of the patients in the control group .Uu was positive in 16 cases, accounting for 26.6%; Infertile patients with Uu +Mh positive were 15 cases, accounting for 25%, while the control group were no cases were positive for Uu +Mh;Infertility group patients detected negative for Myco-plasma in 4 cases, accounting for 6.7%, while the control group were negative for the detection of Mycoplasma in 44 cases, accounting for 73.3%.The results showed that infertility group and Uu in patients with Mh infection was high-er than that of the control group, and the difference is statistically significant (p<0.05).The infertile patients with fallopian tube patency were 12 cases, accounting for 20%; The control group of tubal patency were 33 cases, ac-counting for 55%, and it was accounted for 19.3% of 21 cases of tubal infertility group , obstruction.The control group of 13 cases of tubal obstruction patients , accounting for 21.7%;27 cases had complete obstruction of fallopian tube infertility patients group , accounting for 45.0%, and the control group had complete tubal obstruction in 14 ca-ses, accounting for 23.3%.The results showed that infertile patients with fallopian tube obstruction was significantly higher than that in the control group , and the difference was statistically significant (p<0.05).Conclusion Infer-tility women with genital tract mycoplasma infection occurrence are closely related .We should make a comprehensive inspection to discover occult infection of Mycoplasma timely and treat actively in women with infertility treatment .
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A suscetibilidade à infecção por C. trachomatis, curso, complicações e resolução da doença depende do tipo da bactéria, de fatores ambientais eda genética do paciente. Entre as mulheres uma forma frequente da infecção é a endocervicite, que pode se complicar com salpingite com consequente lesãotubária. Acredita-se que as complicações a longo prazo desta infecção ocorrem via heat shock protein HSP 60 e toll-like receptors (TLR)...
The susceptibility, course, complications and outcome of Chlamydia trachomatis infection depends on the type of bacteria, environmentalfactors and host genetic factors. Among women, the most common infection is cervicitis that can be complicated by salpingitis leading to tubal damage.It is believed that long-term complications occur via HSP 60 and toll-like receptors...
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Humans , Female , Fallopian Tube Diseases , Fallopian Tube Patency Tests , Sexually Transmitted DiseasesABSTRACT
OBJECTIVE: To investigate the value of stimulated intrauterine insemination (IUI) in women with unilateral tubal occlusion. METHODS: Superovulation and IUI was performed during 2003-2010 and the medical records were reviewed retrospectively. Thirty-seven infertile women (52 cycles) with unilateral tubal occlusion diagnosed by hysterosalpingography and without other causes of infertility were selected. One-hundred fourteen patients with unexplained infertility served as a control group (182 cycles). The main outcome was the clinical pregnancy rate per cycle. RESULTS: The pregnancy rate per cycle was similar, 17.3% for the unilateral tubal occlusion group and 16.5% for the unexplained infertility group. The rate of miscarriage (11.1% vs. 23.3%) and ectopic pregnancy (11.1% vs. 6.7%) was similar between the two groups. The pregnancy rate was higher in patients with proximal occlusion (25.0%) compared with distal occlusion (13.9%) or unexplained infertility, but not statistically significant. CONCLUSION: Stimulated IUI can be suggested as the initial treatment option in women with unilateral proximal or distal tubal occlusion.
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Female , Humans , Pregnancy , Abortion, Spontaneous , Fallopian Tube Diseases , Hysterosalpingography , Infertility , Insemination , Medical Records , Pregnancy Rate , Pregnancy, Ectopic , Retrospective Studies , Sterilization, Tubal , SuperovulationABSTRACT
Objective To investigate the diagnosis and treatment value of laparoscopic surgery in tubal obstruction infertility patients with endometriosis.Methods Retrospective analysis was done in 381 cases underwent laparoscopic treatment for tubal obstruction from May 2005 to May 2010,,of which 119 cases were combined with endometriosis.The treatment results were analyzed,including the decomposition of the umbrella side tubal obstruction adhesions,lesions of endometriosis electrocoagulation,endometriosis cystectomy and pregnancy and so on.Results Hysterosalpingography(HSG)showed tubal occlusion in both side or one side in the distal end in 381 cases,and these patients were treated with laparoscopic surgery.There were 262 cases showed distal tubal occlusion not companied with endometriosis,of which 82 cases clinically pregnanced,accounting for 31.3％.Surgical treatment of endometriosis found in 119 cases,accounting for 31.2％ ; and 29 cases pregnaced,which accounted 24.4％.We found 42 cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,16 cases of clinical pregnancy,accounting for 38.1％ ;Twenty-six cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,7 cases of clinical pregnancy,accounting for 26.9％ ;Twenty-eitht cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅰ-Ⅱ,4 cases of clinical pregnancy,accounting for 14.3％ ;Twenty-three cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅲ-Ⅳ,2 cases of clinical pregnancy,accounting for 8.7％.The clinical pregnancy rate in the first group was significantly higher than the other groups,chnical pregnancy rate of the last group was the lowest.Conclusion Laparoscopic surgery is an effective treatment of tubal obstruction infertility combined with endometriosis.After laparoscopic surgery,the clinical pregnancy rate is significantly higher in Tubal obstruction without endometriosis than patients with endometriosis.After surgery,the clinical pregnancy rate in patients with the light stage tubal adhesions and endometriosis is better than those severely.
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OBJECTIVE: To observe the therapeutic effect of fallopian incubation recanalization (FIR) and Sargentodoxa cuneata decoction coloclysis in the treatment of tubal obstruction infertility. METHODS: 180 patients with tubal obstruction infertility were randomly divided into therapy group and control group (n=90). Therapy group were given S. cuneata decoction after FTR via self-made semi-Y-shaped catheter; control group were given FTR only. RESULTS: Two years after operation, the total effective rate of therapy group was 83.3%. In control group,the total effective rate was 60.0%. There was a significant difference between two groups (P
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Objective To explore the main reason of secondary barrenness resulted from drug miscarriage before childbearing. Methods Gynecologic examination was performed in 156 patients with secondary barrenness after drug miscarriage. Uterus neck and vaginal smear examination, mycoplasma and chlamydozoon detection, and hysterosalpingograghy were performed in the same time. Results 101 patients (101/156,64.74%) had genital duct inflammation,61 patients (61/156,39.1%) had various degrees of tubal obstruction. Conclusion The main reason of secondary barrenness after drug miscarriage was the tubal obstruction resulted from inflammation, especially chlamydozoon and mycoplasma infection. Drug miscarriage was not so safe before childbearing.
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Objective To investigate the diagnostic value and therapeutic effect of laparoscopy combined with hysteroscopy in patients with tubal infertility.Methods A total of 133 patients with tubal infertility were treated by laparoscopy combined with hysteroscopy in our hospital from September 2004 to December 2007.All the cases were diagnosed by hysterosalpingography(HSG) and hysteroscopy.Results Totally 225 fallopian tubes were examined in the 133 patients,among which 180 tubes were completely occluded,57 were partially occluded,and 18 were patent.After the surgeries,211 tubes wee patent,24 were partially blocked,while 20 were still occluded.The success rate of the operations was 81.4%(193/237).Follow-up was achieved in 92 patients for 4 to 18 months,in the cases,30 were pregnant during the period(pregnancy rate: 32.6%).Of the 30 cases,2 women had tubal pregnancy;22 women were pregnant in 6 months after the treatments,and the other 8 were pregnant in 6-12 months after the operations.In this group of patients,the pregnancy rate in the women with both patent fallopian tubes was 26.1%(24/92),and in those with single patent fallopian tube was 6.5%(6/92).The pregnancy rate in patients with simple tubal infertility was 22.8%(21/92),while that of those who were complicated with tubal diseases was 9.8%(9/92).Conclusion Laparoscopy combined with hysteroscopy can accurately diagnose tubal infertility,and improve the therapeutic effect.
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Objective To assess the diagnostic and curative efficacy of laparoscopy combined with hysteroscopy for tubal infertility. Methods A combined use of laparoscopy and hysteroscopy was performed in 62 cases of tubal obstructive infertility (124 oviducts), which had been tentatively diagnosed by lipiodol hysterosalpingography (HSG). Results Out of the 62 cases, 11 cases (22 oviducts) were found bilaterally unobstructed (17.7%, 22/124), 8 cases (8 oviducts) were found unilaterally unobstructed (6.5%, 8/124). Tubal interstitial or isthmus obstruction was observed in 40 oviducts (32.3%, 40/124) and hydrosalpinx in 54 oviducts (43.5%, 54/124). The consistency ratio between lipiodol HSG and endoscopy in the diagnosis of tubal obstruction was 75.8% (94/124). Tubal catheterization under hysteroscope and laparoscope was adopted in the 40 ducts of interstitial or isthmus obstruction, and 30 were cured, 5 perforated and 5 failed. Laparoscopic salpingostomy and salpingolysis was employed successfully in 54 tubes. Conclusions Combined use of hysteroscopy and laparoscopy is useful in the diagnosis and treatment of tubal obstruction and infertility tentatively diagnosed by HSG.
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Objective To develop a more effective method to treat proximal tubal obstruction. Methods In a total of 89 cases, there were 113 oviduct lesions diagnosed by hysterosalpingogram (HSG) and then by laparoscopy as proximal tubal obstructions. Intubations and recanalizations were performed by means of laparoscopy combined with hysteroscopy. Results Out of the 113 oviduct lesions in 89 cases, 73 (64.6%) were recanalized. In follow-up of 20 days～58 months, there were 20 cases of successful pregnancies and labours, 2 inevitable abortions and 1 ectopic pregnancy, with the rate of pregnancy 25.8% (23 of 89). Conclusions It is an effective approach to treat proximal tubal obstruction by using laparoscopy combined with hysteroscopy. It can also be used to identify the true proximal tubal obstruction from the false one.
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Objective To study efficacy and its affected factors of laparoscopic treatment for infertility caused by distal tubal obstruction. Methods 113 infertile patients with occlusive distal tubal disease received leparoscopic surgery from January to December 1999.The postoperative pregnancy rate was observed. Results Occlusive tubal disease was presented in 64 cases (56.6%),Among them 46 cases had been followed up and 10 cases (21.7%) obtained interuterine pregnancy.The pregnancy rate of normal fimbria and unobstructed tube after lysis of periadnexal adhesion was 47.4%,26 cases of laparoscopic salpingostomy had no pregnancy. Conclusions laparoscopic surgery may be effective in the treatment of periadnexal adhesions in tubal infertility,and had no effect in salpingostomy.
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Recent studies have suggested that the presence of hydrosalpinx has a negative effecton in-vitro fertilization(IVF) outocme, with markedly diminished implantation and pregnancyrates, and creased early pregnancy loss. The pregnancy rate for patients with persistenthydrosalpinx was only half of that of patients with other tubal damage without hydrosalpinx.We evaluated the impact of hydrosalpix on IVF outcome in a large population withtubal factor infertility. A retrospective study was designed to examine whether the presenceof a hydrosalpinx influenced pregnancy outcome following IVF/ET treatment in stimulatedcycles.Patients with both tubal obstructions having at least one side hydrosalpinx were comparedwith patients having both tubal obstructions(BTOs) due to other tubal lesions withouthydrosalpinx. And pregnancy rates were analysed.Infertile patients with BTOs were classified into two groups: group 1 - The 38 women(44 cycles) with at least one side hydrosalpinx, group 2- the 44 women(52 cycles) withBTOs caused by other tubal factors without hydrosalpinx. They were analyzed by retrospectivestudy. Hydrosalpinx was diagnosed by transvaginal ultrasonography, hysterosalpingography,and diagnostic laparoscopy.The mean ages were 35.5+/-9.3 years in the patients group 1 and 32.6+/-4.8 years in thepatient group 2. Although the duration of infertility and serum peak estradiol level weredifferent, there were no significant statistical differences in age of patients, serum basalFSH/LH level, the numbrs of oocytes retrieved and embryo transfered in two groups. Therewere no significant statistical differences in baseline sperm analyses. Pregnancy wasdefined as serum beta-HCG level above 10 mIU/ml. The pregnancy rates were 15.8% in thepatient group 1, and 28.8% in the patient group 2. The abortion rates were 57.1% in thepatient group 1 and 26.7% in the patient group 2. The pregnancy rates were significantlyhigher in the patient group 2 compared with group 1. The abortion rates were significantlyhigher in the patient group 1 compared with group 2. There were no ectopic pregnanciesin two groups.These findings strongly indicate that a premanant hydrosalpinx has a negative influenceon implantation, as well as on pregnancy, and suggest that a more active approachagainst large hydrosalpinges should be undertaken before IVF/ET treatment, in order toimprove the implantation rates and the pregnancy rates. And prospective multicenter studiesevaluating the effect of hydrosalpinx and its treatment on IVF outcome are needed.
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Female , Humans , Pregnancy , Abortion, Induced , Embryonic Structures , Estradiol , Fallopian Tube Diseases , Infertility , Oocytes , Pregnancy Outcome , Pregnancy Rate , Retrospective Studies , Spermatozoa , UltrasonographyABSTRACT
The effect of tubal obstruction on sexual behavior and physical strength has been observed in mice. The appearance of vaginal plug was used as an index of coitus and the interval that the mice could swim in the water tank till death as an index of physical strength. There was no significant differences between the operation group and the control group. Besides, the oestrous cycle still appeared regularly in the operation group. It shows that the tubal obstruction may not affect the normal sexual behavior, physical strength and the ovarian function