PubMed · 6505207
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G de Rossi, M Salvatori, A Giordano, C Romanini, S Dell'Acque, D Arduini, G Rizzo. 1984. Hysterosalpingoscintigraphy.. https://pubmed.ncbi.nlm.nih.gov/6505207/
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OBJECTIVE: To determine how a standard infertility investigation is conducted and to determine the use of fertility tests used in such investigations in relation to WHO guidelines. DESIGN: Questionnaire survey. SETTING: Dutch medical schools. METHOD: A questionnaire survey among the heads of all 8 university and 20 non-university teaching departments of obstetrics and gynaecology or their fertility units was conducted. One non-university department failed to respond. RESULTS: The examinations recommended by the WHO (general physical examination, andrological and gynaecological examination, semen analysis, ovulation detection, tubal patency testing) in general were carried out, but general physical examination of the male as a rule was only carried out if indicated. Popular routine examinations not recommended by the WHO were the postcoital test and hysterosalpingography. Regarding the postcoital test, there was variation in the time interval after coitus and the standards for spermatozoal motility. CONCLUSION: Standard fertility investigations are usually based on empiricism and tradition, including the testing recommended by the WHO.
UNLABELLED: This study is a follow-up analysis of 103 patients who desired to preserve their fertile ability after treatment of tubal pregnancy. Among the 103 cases, 58 were treated by unilateral salpingectomy, 15 by salpingostomy and 30 by drug conservative therapy. RESULTS: 67 cases had intrauterine pregnancy and 9 cases repeated ectopic pregnancy. The intrauterine pregnancy rate of the surgical group (71.2%) was higher than that of the nonsurgical group (50.0%). And the pregnancy rate of salpingostomy group (86.7%) was higher than that of salpingectomy group (67.2%). No repeated ectopic pregnancy occurred in the salpingostomy group. After three months of treatment, 45 cases were randomly sampled for tubal patency test. Bilateral tubal patency rate in salpingostomy group was 93.3% and in drug treatment group was 20.0%. These results indicated that tubal patency is an essential factor for normal pregnancy. Prevention of post-operative adhesion and treatment of pelvic inflammatory disease are important for increasing intrauterine pregnancy rate and decreasing repeated ectopic pregnancy rate.
Hysterosalpingography (HSG) to assess tubal patency in the postoperative evaluation of the infertile patient has been well described. However, the sensitivity and specificity of HSG after tubal surgery has not been reported. We correlated HSG and laparoscopic findings in 25 patients who had tubal surgery (microsurgical tubal reanastomoses [11] and distal salpingostomies [14]). HSG provided a more reliable means of assessing tubal patency (sensitivity and specificity of 96% and 61% respectively) than in detecting pelvic adhesive disease (PAD) (sensitivity and specificity of 12% and 75% respectively) regardless of tubal surgical procedure. HSG was associated with a high false negative rate (60%) due primarily to the inability to detect PAD. Complete agreement between HSG and laparoscopy was noted in only 15% of cases. These data suggest that HSG is a sensitive means to determine tubal patency, but was not sufficiently sensitive or specific to detect PAD after tubal surgery. These limitations should be noted in the interpretation of HSG in any infertile patient with a history of tubal surgery, and severely limits the application of HSG to the management of the post-operative infertile patient.