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PubMed1980

[Use of endometrial biopsy on first day of cycle, CO2-hysterosalpingography, and PSP-hydrotubation in ambulatory diagnosis of female sterility (author's transl)].

Three techniques for ambulatory diagnosis of female sterility are compared and critically assessed for their potential benefits and drawbacks. They are endometrial biopsy on the first day of cycle, hysterosalpingography in combination with CO2 pertubation, and hydrotubation, using 0.06 per cent phenolphthalein (Speck's test). There were many more inherent benefits than drawbacks, primarily with regard to informative value and avoidance of undesirable side effects. Good economy, convenient technical applicability, and relief of ward and operation theatre personnel are additional factors in favour of the above ambulatory approaches.

Ambulatory Care↗
PubMedDate not supplied

The value of high-pressure hysterosalpingography with new cannula.

To achieve maximum dilatation of the Fallopian tubes so as to improve the pregnancy: non-pregnancy ratio of hysterosalpingography (HSG) treatment, a high-pressure injection technique was evaluated. For this purpose a disposable cannula and an adapted pair of tenacula were developed and a remote-control procedure using an auto-injector and an adapted pressure recorder was used to assure the safety of doctors and staff. 1780 cases who underwent 400 mmHg high-pressure HSG treatment were compared with 903 conventional HSG cases. Results indicated a higher pregnancy ratio for the high-pressure experimental group after treatment. In addition, it was found that side effects due to the use of disposable cannula and highly viscous water-soluble mediums developed for use in angiography were less common than for conventional materials.

Catheterization↗
PubMed1980

[Ambulatory hysterosalpingography in sterility control (author's transl)].

Modern X-ray diagnosis of hysterosalpingography and its use in sterility control of women are described in this paper. Pregnancy occurred in 19 of 154 cases (12.3 per cent). The pregnancy rate by selection was 22.1 per cent. The mechanism underlying the therapeutic action of the method is discussed.

Adult↗
PubMed1995

[Tube pregnancy treated with trichosanthin and followed up by hysterosalpingography].

Twenty cases of unruptured tube pregnancy were treated with Trichosanthin intramuscularly given. Only two cases were eventually operated, so the effective rate was 90%. The hysterosalpingography was taken in 14 of 18 cases who was willing to accept the procedure at 0.5-1.5 year after the conservative treatment. Both tubes were patent in 10 of 14 cases, the rate of patency was 71.4%.

Adult↗
PubMed1995

[Immediate and late complications of hysterosalpingography. A comparison between Madsen's obturator and intrauterine balloon catheter].

Forty females who underwent hysterosalpingography (HSG) were randomized to a procedure using either an external cervical obturator or an intrauterine balloon catheter. All patients were interviewed about adverse events during and after the examination (six days). The balloon catheter turned out to be easier to place correctly and caused the fewest adverse events as regards bleeding and pain. It is concluded that a balloon catheter for HSG is preferable both from the doctor's and the patient's viewpoint.

Catheterization↗
PubMed1993

Acute pelvic infection following hysterosalpingography at the Kenyatta National Hospital, Nairobi.

A total of 150 women who had hysterosalpingography (HSG) for investigation of infertility, at the Kenyatta National Hospital over a five month period, were recruited into the study to determine the prevalence of pelvic infection following the procedure. 44.0% of the total study group developed pelvic infection disease (PID) within the first week after the procedure. There were no obvious determining factors. It is possible that most women with infertility have quiescent genital tract infection, prior to HSG, with the latter only facilitating the entry of micro-organisms into the upper genital tract, thus causing pelvic infection or reactivating a pre-existing infections. Further studies should be conducted to determine the microbial patterns of the infection. There should be routine provision of prophylactic antimicrobial agent(s) to all women undergoing HSG in our unit to minimise the risk of developing pelvic infection and further damage to the uterine tubes which will worsen the prognosis.

Adolescent↗
PubMed1993

The predictive value of hysterosalpingography for tubal and peritoneal infertility factors.

OBJECTIVE: To investigate a practical classification system of hysterosalpingogram (HSG) results that accurately identifies patients with severe pelvic disease or a normal pelvis to allow appropriate patient counseling of therapeutic options. DESIGN: Retrospective chart review from university teaching hospital. Hysterosalpingography results were classified as normal, abnormal (bilateral distal tubal obstruction), or suspicious (all others). At surgery, chromopertubation was performed, and pelvic disease was documented. RESULTS: From a total of 756 patients, HSGs were confirmed surgically in 96.6% of normals, 63.1% of suspicious, and 95.7% of abnormal. Associated moderate-severe pelvic disease was found in 16.2% of normals, 53.9% of suspicious, and 81.7% of abnormal. CONCLUSION: Abnormal HSGs are highly predictive of severe pelvic disease, and counseling of treatment options does not require diagnostic laparoscopy. Patients with suspicious HSGs frequently have normal tubes but also have a significant likelihood of tubal or associated pelvic disease, and they are responsible for the poor predictive value of the HSG. This group of patients requires confirmatory laparoscopy preferably by a physician qualified in pelviscopic surgery. Normal HSGs have a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful.

Fallopian Tube Diseases↗
PubMed1993

Hysterosalpingography contrast media and chromotubation dye inhibit peritoneal lymphocyte and macrophage function in vitro: a potential mechanism for fertility enhancement.

OBJECTIVE: To determine the effects of hysterosalpingography (HSG) contrast media (CM) and chromotubation dye on peritoneal lymphocyte proliferation and macrophage phagocytosis in vitro. DESIGN: Peritoneal fluid (PF) lymphocytes and macrophages were isolated from 40 subfertile women undergoing diagnostic laparoscopy and 12 fertile women having laparoscopic tubal ligation. Dilutions of renografin, ethiodol, methylene blue, and indigo carmine were added to peritoneal lymphocyte and macrophage cultures. Tissue culture media alone served as control. Lymphocyte proliferation was assessed by hemocytometer counts and 3H-thymidine incorporation. Macrophage function was determined by phagocytosis of fluorescent microspheres. RESULTS: Peritoneal lymphocyte proliferation and macrophage phagocytosis were significantly inhibited by renografin, ethiodol, methylene blue, and indigo carmine in a dose-dependent manner. CONCLUSION: Inhibition of PF immune cell function by HSG CM and chromotubation dye may provide a potential mechanism for fertility enhancement after these diagnostic procedures.

Cell Survival↗
PubMed1993

[Hysteroscopy and hysterosalpingography. Which examination to chose?].

The authors report 58 patients undergoing hysterosalpingography (HSG) then hysteroscopy (HC) for investigation of the uterine cavity. Comparison of HSG and HC findings revealed the following: In 26.9 per cent of cases HC disproved or rectified the result of HSG. Results of the two investigations were in agreement in 74.1 per cent of cases. In the light of our results, and after a review of the literature, HSG is indicated as the first line investigation for exploration of the uterine cavity and/or the tuboperitoneal level. HC alone is sufficient for exploration of the cervical canal and of the uterine cavity.

Evaluation Studies as Topic↗
PubMed1996

Comparison of magnetic resonance imaging and transvaginal ultrasonography with hysterosalpingography in the evaluation of women exposed to diethylstilbestrol.

OBJECTIVE: To compare the ability of magnetic resonance imaging (MRI) and transvaginal ultrasound (TV-US) with that of hysterosalpingography (HSG) in detecting uterine abnormalities caused by in utero diethylstilbestrol (DES) exposure. STUDY DESIGN: The study was a prospective MRI and TV-US blind comparison of DES-exposed and nonexposed subjects who had had previous HSG for infertility evaluation. RESULTS: MRI identified uterine constrictions in 60% of patients and T-shaped uteri in 25% of DES-exposed patients with HSG-confirmed abnormalities. TV-US did not identify uterine constrictions or T-shaped uteri in DES-exposed patients. CONCLUSION: HSG must still be considered the preferred method in evaluating DES-related uterine abnormalities. HSG-defined uterine abnormalities associated with in utero DES exposure were variably identified by MRI and not at all by TV-US.

Abnormalities, Drug-Induced↗
PubMed1996

[Comparative study on assessment of tubal patency among tubal insufflation, hydrotubation, hysterosalpingography and chromotubation under laparoscopy].

OBJECTIVES: To compare the diagnostic value of tubal insufflation, hydrotubation, hysterosalpingography (HSG) and chromotubation under laparoscopy for tubal patency assessment. METHODS: Among 258 women who underwent chromofubation during laparoscopy procedures for infertility assessment in our hospital, tubal insufflation were performed in 42 cases, hydrotubation in 70, HSG in 63, both insufflation and hydrotubation in 20, insufflation and HSG in 11, and hydrotubation and HSG in 22. The accuracy of each method was compared with that of chromotubation under laparoscopy. RESULTS: The accuracy rates of hydrotubation (87.1%) and HSG (73.0%) were significantly higher than that of insufflation (50.0%) (P < 0.01, P < 0.05 respectively). Similar results were shown when 2 different procedures in the same patient were compared with laparoscopy. CONCLUSIONS: Tubal insufflation has no longer its place in tubal patency assessment due to its grossly inaccuracy; Both hydrotubation and HSG can be used as screening methods. Laparoscopy is the most accurate procedure in assessing tubal patency, as well as in searching pelvic abnormalities.

Adult↗
PubMed1997

Hysteroscopy, hysterosalpingography and tubal ostial polyps in infertility patients.

OBJECTIVE: To compare the findings in infertility patients who underwent preoperative hysterosalpingography (HSG) followed by hysteroscopy and to determine the incidence of tubal ostial polyps, their HSG appearance and the results of hysteroscopic resection in our patient population. STUDY DESIGN: Sixty-eight infertility patients were evaluated by HSG followed by hysteroscopy. HSG diagnoses were divided into groups: group 1, normal; group 2, bilateral tubal occlusion; group 3, unilateral tubal occlusion; group 4, filling defects; and group 5, abnormal cavity. HSG findings were compared to the hysteroscopy findings. For patients in whom tubal ostial polyps were found, the findings were described, including postsurgical interval to conception. RESULTS: The agreement rates were 90%, 50%, 69%, 73% and 71% for groups 1-5, respectively. The positive predictive value of an abnormal HSG was 65%, and the negative predictive value of a normal HSG was 90%. Six of 68 patients (11.3%) had polyps at the fallopian tube ostium. Three of these patients (50%) had had the finding of proximal tubal occlusion on the ipsilateral side predicted by HSG; three had had normal HSGs. Four of the six conceived following polypectomy. The mean interval from surgery to conception was 4.5 months. CONCLUSION: HSG was a specific but not sensitive predictor of uterine pathology in our patient population. Tubal ostial polyps may occur in a significant proportion of infertility patients and can cause proximal tubal occlusion on HSG. Their possible contribution to infertility and clinical significance deserve further investigation.

Adult↗
PubMedDate not supplied

[Assessment of radiation dose to patients in hysterosalpingography].

INTRODUCTION: The optimization principle applied to the patient radioprotection, recently introduced in Italian legislation, requires a careful analysis of the working procedures and clinical protocols generally used in radiological practice, to avoid unnecessary exposures with no loss in diagnostic information. We carried out this analysis in hysterosalpingography, which is the radiological examination usually performed on fertile women to detect uterine and tubal conditions. MATERIALS AND METHODS: The dosimetric survey was carried out on 35 patients, 22 to 40 years old, to evaluate: a) entrance dose and dose x area product; b) doses to the most irradiated organs, that is ovaries and uterus; c) effective dose equivalent and effective dose. The doses were measured with LiF thermoluminescent dosimeters, while an ionization chamber enabled us to the calculate dose area product. Ovaries and uterus doses were calculated with a Monte Carlo program using skin entrance exposure data and some technical parameters of the examination. RESULTS: The good agreement of the results obtained with both dosimetric methods demonstrated their equivalence in this specific case where the use of a clinical protocol, with no lateral projection, made the dosimeters lie always within the X-ray beam. DISCUSSION AND CONCLUSIONS: The mean dose was 4.5 mGy for the ovaries and 6.2 mGy for the uterus. Following the recommendations of the International Commission on Radiological Protection, both effective dose equivalent, with a mean value of 2.0 mSv, and effective dose, with a mean value of 1.95 mSv, were estimated. In conclusion, our results show that the patient dose can be reduced by limiting the use of fluoroscopy, using small size films and decreasing the number of exposures.

Adult↗
PubMed1996

Sonohysterography to Evaluate Uterine Defects on Hysterosalpingography and Its Correlation with Hysteroscopy

Sonohysterography (SHG) may replace hysteroscopy as the standard method to evaluate intrauterine filling defects noted on hysterosalpingography (HSG). Twenty-six patients with evidence of intrauterine filling defects on HSG underwent SHG in the office with transvaginal ultrasonography before diagnostic or operative hysteroscopy. Polyps were identified in 11 women by SHG and were confirmed by hysteroscopy and histology. Adhesions seen on SHG in four women were also confirmed by hysteroscopy. Thus SHG not only correctly identified myomas in all six patients, but helped determine which ones could be resected by hysteroscopy and which might benefit from preoperative gonadotropin-releasing hormone analog treatment. Five patients with intrauterine filling defects on HSG were subsequently shown to have normal endometrial cavities at SHG and hysteroscopy. We believe SHG is a useful technique for evaluating patients with abnormal HSGs, reducing the requirement for more expensive and invasive diagnostic hysteroscopy. In addition, it provides more thorough assessment before operative hysteroscopy.

Journal Article↗
PubMed1997

Radionuclide hysterosalpingography does not distinguish between fertile women, before tubal sterilization, and infertile women.

The female genital tract is capable of active transport that can be demonstrated by serial scintigraphic imaging over time (radionuclide hysterosalpingography; RN-HSG). RN-HSG has been suggested to offer a more functional approach to tubal infertility diagnosis than conventional patency tests. However, before RN-HSG can be recommended as a routine method, its reliability in showing active transport in fertile women must be demonstrated. Therefore we compared RN-HSG in two groups: 38 fertile women before tubal sterilization and 38 women undergoing infertility work-up. Tubal transport demonstrated by RN-HSG was comparably distributed in both groups and classified as bilateral (17 versus 19), unilateral (12 versus 7) or no transport (6 versus 9). In each group three RN-HSG images were not interpretable. There was no association between patency test results and RN-HSG in the two groups. Our data suggest that RN-HSG in its present form does not seem to be a reliable method for infertility work-up. Because RN-HSG and patency tests most probably measure different properties of the genital tract, the phenomenon of active particle transportation should be studied further to enable the development of a reliable tool for the investigation of tubal function.

Adult↗
PubMed2006

Difficulties in recruitment for a randomized controlled trial involving hysterosalpingography.

BACKGROUND: The usefulness of hysterosalpingography (HSG) as routine investigation in the fertility work-up prior to laparoscopy and dye had been assessed in a randomized controlled trial. Recruiting subjects to the study was more difficult than anticipated. The objective of this study was to explore possible reasons for non-participation in the trial. METHODS: All newly referred subfertile women admitted to the Reproductive Medicine Clinic of Leiden University Medical Centre between 1 April 1997 and 31 December 1999, were eligible for the study. The reasons for non-participation were evaluated by scrutinizing the medical records. RESULTS: Out of 759 women, a total of 127 (17%) agreed to participate in the trial. The most important reason for non-participation was because of exclusion criteria (73%). Other reasons were inattentive clinicians (3%) and patient-associated reasons (24%). Patient refusal and indecisiveness to enroll in the study were the most common patient-associated reasons. The most frequently stated reason for trial refusal was reluctance to undergo laparoscopy and dye mainly due to issues related to anesthesia and scheduling of procedure. CONCLUSION: Almost three-quarters of recruitment difficulties in this study were due to unavoidable reasons. To overcome the remaining avoidable reasons for non-participation, attention should be paid to appropriate instruction of the study protocol to the participating doctors and to provide adequate information, in layman's terms, to the patients. Reminding patients by notes or telephone calls for attending the clinic are helpful. It may be contingent upon tracing the reasons of clinicians and patients for non-participation to improve enrollment during a trial.

Journal Article↗
PubMed1993

Ultrasound contrast hysterosalpingography--evaluation as an outpatient procedure.

Ultrasound contrast hysterosalpingography (HSG) uses intrauterine contrast media to increase the diagnostic value of plain transvaginal ultrasound enabling the uterine cavity contour to be assessed and allowing tubal patency to be determined. We present our experience using both negative (sterile saline) and positive (Echovist, Schering) contrast media in 27 patients presenting with a wide range of gynaecological disorders. This is the first report comparing the use of the two contrast media with plain ultrasound on a purely outpatient basis. We have found ultrasound saline HSG to be superior for the delineation of the uterine cavity and we predict that this will become a first line investigation for assessing the configuration of the uterine cavity. However, although Echovist could be demonstrated flowing through patent fallopian tubes, we found ultrasound contrast HSG to be insufficiently accurate in the determination of tubal patency and do not feel that it can replace conventional X-ray HSG. We review the literature on this technique and discuss its future role in gynaecological imaging.

Adult↗