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PubMed1985

Radionuclide hysterosalpingography for evaluation of fallopian tube patency.

A prospective study was undertaken to evaluate the efficacy of radionuclide hysterosalpingography (RNHSG) using a technique with some modifications, that was described by Iturralde and Ventner (1). As these investigators demonstrated, technetium-labeled human albumin microspheres (HAM) will normally migrate spontaneously from the vagina to the ovaries. This study confirms that in the presence of fallopian tube obstruction, fibrosis and/or lack of motility, this migration does not take place, and that the presence or absence of migration of HAM can be imaged with a gamma camera. In the evaluation of 52 tubes we found that the efficiency of RNHSG for evaluation of fallopian tube patency when compared with contrast hysterosalpingography and/or direct observation of surgical pathology was over 94%. RNHSG is an essentially innocuous technique for assessing functional and mechanical fallopian tube obstruction that can be performed with conventional nuclear imaging equipment.

Evaluation Studies as Topic↗
PubMed2004

Variables affecting immediate pain tolerance in X-ray hysterosalpingography.

OBJECTIVE: To determine the variables, which affect pain tolerance in x-ray hysterosalpingography (HSG). DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Radiology departments of Civil and Bismillah Taqee Hospitals and Delhi Mercantile Medical Centre, Karachi from January 1999 to June 2003. PATIENTS AND METHODS: The study included 250 patients who underwent x-ray HSG using small sized Leech Wilkinson cannula by the same radiologist. Informed verbal consent was obtained from all the patients. Pain was graded into tolerable and intolerable using a four-point visual analog scale (VAS) as well as the Pakistani coin scale after pre-medication with diclofenac (generic name). Standard procedures using day-light fluoroscopy was performed. Variables considered were age, indication of the procedure, type of infertility, whether primary or secondary, emotional state, motivation for investigation, presence or absence of cystocele, duration of procedure, type of contrast used, whether ionic or non-ionic, tubal patency and lastly the amount of contrast used in the procedure. Those patients having infection, cervical erosion, use of larger size of cannula and technical complications including excessive bleeding requiring the use of sanitary napkins and vascular intravasation were excluded. The obtained data was analyzed on SPSS version 10.0 using cross tabulation and Pearson's correlation coefficient. Significance was taken at p<0.05. RESULTS: The mean age of the patients was 30 years. Amenorrhea, secondary infertility, apprehension, prolonged procedure time (>15 minutes) and the use of ionic contrast media were the variables significantly associated with intolerable pain during the procedure. Primary infertility, calm emotional state, self-motivation, absence of cystocele and short procedure duration were associated with good pain tolerance. The amount of contrast used and tubal patency status had no significant association. CONCLUSION: In the setting of base line pre-medication with diclofenac and minimal cervical trauma, amenorrhea, primary infertility, emotional state, self-motivation, procedure duration, and the presence or absence of cystocele significantly affect pain tolerance during the procedure. Amount of contrast used and tubal patency does not affect pain tolerance. Effect of the type of contrast medium requires further confirmation on a larger number of patients.

Adult↗
PubMed2000

Oil-soluble versus water-soluble media for assessing tubal patency with hysterosalpingography or laparoscopy in subfertile women.

BACKGROUND: There has been debate in the literature for more than 40 years as to whether flushing of the Fallopian tubes enhances fertility and whether this presumed therapeutic effect is greater with oil-soluble media than with water-soluble media. A meta-analysis of the therapeutic role of oil-soluble contrast media at hysterosalpingography was published in March 1994 (Watson 1994). This Cochrane Review is an expansion and update of that overview. OBJECTIVES: To evaluate the effect of flushing the Fallopian tubes with oil- or water-soluble contrast media on subsequent pregnancy rates in infertility patients. SEARCH STRATEGY: 1. For randomised controlled trials (RCTs): we searched the Cochrane Subfertility Review Group specialised register of controlled trials. 2. For non-randomised controlled studies: Medline and manual search of eight relevant journals. SELECTION CRITERIA: Six RCTs and six non-randomised controlled studies. In two studies tubal flushing was compared with no treatment-controls. Eleven studies, comprising a total of 2635 subjects, compared oil- with water-soluble media. DATA COLLECTION AND ANALYSIS: Independently by first 2 authors for: 1. Methodological trial characteristics 2. Characteristics of participants 3. OUTCOMES: the main studied outcome was pregnancy rate per patient MAIN RESULTS: In comparison with no treatment, a significant benefit on pregnancy rates was seen by flushing the tubes with oil-soluble media (OR 1.80, 95% CI 1.29-2.50) but not with water-soluble media (OR 0.87, 95% CI 0.50-1.52). In the direct comparison of oil- and water-soluble media the former lead to significantly higher pregnancy rates (OR 1.92, 95% CI 1.60-2.29). The treatment effect appeared similar in RCTs and non-RCTs. Subgroup analysis suggested the therapeutic benefit was greatest for patients suffering from unexplained infertility and least for those with tubal factor infertility. REVIEWER'S CONCLUSIONS: Flushing of the tubes with oil-soluble media increases subsequent pregnancy rates in infertility patients. The hypothesis that tubal "plugs" are a cause of proximal tubal occlusion and that oil-soluble media may flush them out, is supported by new techniques such as falloposcopy. Clinicians should consider flushing the tubes with OSCM before contemplating more invasive therapies.

Contrast Media↗
PubMed2000

Magnetic resonance hysterography and hysterosalpingography using hyperpolarized (3)He: demonstration of feasibility in an animal model.

Assessment of the uterine cavity and patency of the fallopian tubes remains a difficult goal with magnetic resonance imaging (MRI). The purpose of this paper is to describe the development of a new magnetic resonance hysterography (MR-HG) and hysterosalpingography (MR-HSG) technique employing hyperpolarized (3)He. Two-dimensional (2D) and 3D gradient-echo imaging sequences were developed and optimized using a phantom. An optimized sequence was then applied in swine cadavers. J. Magn. Reson. Imaging 2000;12:1009-1013.

Animals↗
PubMedDate not supplied

MR hysterosalpingography in a rabbit model.

Our objective was to evaluate the efficacy of MR imaging as compared with conventional hysterosalpingography (HSG) for the detection of fallopian tube patency after uterine injection of contrast material. Rabbit uterine horns (n= 18) were catheterized transvaginally. Five fallopian tubes were ligated and 11 were left unaltered. T1-weighted gradient-echo MR images were obtained before, during, and after injection of 1.0-3.0 mL of a dilute gadolinium-containing contrast agent. Corresponding conventional studies were performed with an equivalent volume of iohexol. Images were evaluated by two blinded readers. Observers agreed in all cases on the presence (n = 11) or absence (n = 5) of peritoneal spill with conventional HSG. Interpretation of MR HSG concurred with conventional HSG in 14 of 16 cases for each observer (P > .05). Reasons for misdiagnosis included small amounts of spill (n = 2), artifact (n = 1), and subtle spill between bowel loops (n = 1). Sensitivity and specificity for MR HSG were 95.5% and 70%, respectively, for the diagnosis of tubal patency/occlusions. No statistical difference was found between MR HSG and conventional HSG for the diagnosis of fallopian tube patency/obstruction. Potential advantages of MR HSG include no ionizing radiation, potentially diminished local contrast toxicity, superior visualization of uterine fibroids and endometriosis, and visualization of ovaries. We conclude that this technique warrants further study, including the use of a primate model to better simulate human anatomy.

Animals↗
PubMedDate not supplied

Hysterosalpingography after hysteroscopic surgery.

We reviewed pre- and postoperative appearances of the uterine cavity on hysterosalpingography (HSG) in 28 patients who had hysteroscopic surgery. Twelve patients presented with primary infertility and 16 patients with secondary infertility. The uterine abnormalities included synechiae (12), septa (8), submucosal fibroids (7), and polyp (1). The size and number of lesions in the uterus, the extent of improvement after surgery, and the postoperative pregnancy rate were recorded. The uterine cavity was restored to a normal appearance in 23 (82%) of 28 patients. In patients after fibroid resection, all uterine cavities reverted to normal after surgery. Two patients developed adhesions after septal resection. Three patients with lysis of synechiae remained unchanged or had worsened intrauterine scarring. The postoperative pregnancy rate was 35% (six of 17) in those patients followed for more than 6 months. One patient had a spontaneous abortion. In the six patients who became pregnant, four had secondary infertility, and all had normal or substantial improvement in the appearance of the uterine cavity after surgery. Perforation of the uterus occurred in one patient after resection of a fibroid.

Adult↗
PubMed1995

Evaluation of the radiologic findings on hysterosalpingography by selective hydrotubation with flexible hysterofiberscope.

PURPOSE: The objective of this study was to assess further the significance and accuracy of hysterosalpingography (HSG) by comparing the radiologic findings on HSG to selective hydrotubation (SHT) using a hysterofiberscope in 106 women with tubal occlusion. RESULTS: Patency was successfully observed by SHT in 72 of 134 tubes and 62 of 106 patients. Proximal obstruction was divided into three groups according to the shape of cornual obstruction (sharp, dull, defect) on HSG. The success rate for SHT in unilateral obstruction (64%) were significantly higher than those in bilateral obstruction (39%). In the three groups of proximal obstruction, the success rates for SHT were 24, 75, and 30% in sharp, dull, and defect, respectively. The group of dull had significantly higher success rate than the groups of sharp and defect. Thirteen of 62 patients who successfully recanalized became pregnant at 9-month follow-up interval. CONCLUSION: Careful evaluation of the cornual obstruction in radiologic findings on HSG may be important for the decision on further treatment. Furthermore, SHT using a hysterofiberscope is an effective method for evaluating tubal obstruction and for managing it in a selected group of patients with tubal obstruction.

Adult↗
PubMed1992

Sensitivity of hysterosalpingography after tubal surgery.

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.

Fallopian Tube Patency Tests↗
PubMed1991

Hysterosalpingography.

During the past decade, there has been a dramatic increase in the number of women seeking infertility evaluation. Hysterosalpingography (HSG) is an invaluable procedure for evaluating internal architecture of the female reproductive tract. Utilizing HSG, it may be possible to minimize the use of invasive procedures, such as hysteroscopy and laparoscopy, in defining such problems as peritubal adhesions, leiomyomas, and congenital anomalies. This review re-emphasizes the wide range of available information and advantages of HSG which can be extremely useful in the diagnosis and management of infertile patients.

Female↗
PubMed1987

Molding of the uterus following intrauterine contraceptive device removal: documentation by hysterosalpingography.

Intrauterine contraceptive devices (IUDs) distort the uterine cavity. We report 2 cases of endometrial molding demonstrated by hysterosalpingography (HSG) following removal of an IUD. Other processes may cause filling defects in the uterine cavity including inflammatory synechiae (Asherman's syndrome), tuberculosis, endometrial hyperplasia, and polyps. Whenever filling defects are seen, the history of IUD usage should be determined.

Adult↗
PubMedDate not supplied

Diagnosis of chronic ectopic gestation by hysterosalpingography.

Pelvic ultrasound and human chorionic gonadotropin assays are currently the standard methodology to detect tubal pregnancy. We report a case of infertility investigated by hysterosalpingography in which a clinically unsuspected chronic tubal pregnancy was identified with the predisposing factor of bilateral salpingitis isthmica nodosa. The radiographic findings of this very rare cause of tubal filling defect are shown.

Adult↗
PubMed2003

Radiogenic risks from hysterosalpingography.

The aim of this study was to determine ovarian dose, effective dose and associated radiogenic risks from hysterosalpingography (HSG), and to provide data for the estimation of radiogenic risks related to HSG studies performed in any laboratory. The fluoroscopy time, number of radiographs taken and entrance surface dose were measured in a series of 78 consecutive patients undergoing HSG as part of their infertility work-up. Organ-dose values per radiograph and per minute of fluoroscopy were separately determined using an anthropomorphic phantom and thermoluminescence dosimetry. The radiogenic risk for deleterious effects on a possible future embryo and the radiogenic risk for cancer induction on the patient undergoing HSG were estimated. The average HSG procedure in our laboratory involves a mean fluoroscopic time of 0.3 min and a mean number of radiographs of 3.2. The dose to female gonads from an average HSG procedure was 2.7 mGy and the patient effective dose was 1.2 mSv. The risk for radiogenic anomalies in a future embryo of the woman undergoing an average HSG procedure and the risk for radiogenic fatal cancer induction in the exposed woman were estimated to be less than 10(-3) of the correspondent nominal risks. Radiation risks from a typical HSG are low, but they may be elevated if fluoroscopic and/or radiographic exposures are prolonged for any reason. Present data allow the estimation of radiogenic risks associated with HSG procedures performed in other laboratories with use of different equipment, screening time and number of radiographs taken.

Abnormalities, Radiation-Induced↗
PubMed2004

Hysterosalpingography with gadolinium.

We report a case of diagnostic hysterosalpingography performed using gadoteric acid (1,350 mOsm) in a patient with a prior severe generalized adverse reaction to iodinated contrast media.

Adult↗
PubMed2006

Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses.

AIM: To evaluate the accuracy and acceptability of hysterosonography (HS) in the diagnosis of uterine anomalies in patients with recurrent pregnancy loss. METHOD: Sixty non-pregnant patients with a history of at least three previous recurrent miscarriages were submitted to the HS, HSG and hysteroscopy (HTC) exams. The findings fall into three categories: synechiae, polypoid lesions and abnormal uterine cavity shape. The HTC exam was used as the gold standard. The findings of the HS and the HSG were compared to the HTC's and the agreement was evaluated using the Kappa coefficient. Significance was established at < 0.05. Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULT: Uterine anomalies were present in 38.3% (23) of the patients: 16 (26.7%) with synechiae, 3 (5.0%) with polypoid lesions and 8 (13.3%) with abnormal uterine cavity shape. Accuracy of the HS and the HSG was 90.9 and 85.2%. General sensitivity of the HS was superior to the HSG (90.5 vs. 75.0%). It also had a higher degree of agreement with the HTC (Kappa = 0.81 vs. 0.68). The HS caused significantly less pain than the other two methods. CONCLUSIONS: The HS had higher diagnostic accuracy in the detection of uterine cavity anomalies and it was better tolerated by the patients when compared to hysterosalpingography and hysteroscopy.

Abortion, Habitual↗
PubMed1996

A comparison of hysteroscopy and hysterosalpingography.

OBJECTIVE: The aim of this study was to assess the diagnostic reliability of hysteroscopy (HSC) and hysterosalpingography (HSG) in patients suffering from primary and secondary infertility. METHOD: Seventy women (50 with primary and 20 with secondary infertility) undergoing HSC and HSG were prospectively studied and the diagnostic capacity of the two techniques was compared. RESULTS: HSG proved to have a sensitivity of 79.1% and a specificity of 81.8%, with an 18.1% false-positive rate and a 18.9% false-negative rate. CONCLUSION: HSG is of exclusive importance in the assessment of tubal morphology and function and has a secondary and complementary role to HSC in the inspection of the uterine cavity and tubal ostia.

Adult↗
PubMed1988

Oil or aqueous contrast media for hysterosalpingography: a prospective, randomized, clinical study.

In this prospective randomized clinical study the pregnancy rate and the quality of the images obtained by hysterosalpingography (HSG) in 175 women with fertility problems have been compared using an oil-soluble contrast medium and an aqueous contrast medium. After the HSG there was a follow-up period of 6 months. No statistically significant difference in pregnancy rate was found. With both contrast media good images were obtained. The oil-soluble contrast medium gave a more sharply outlined uterine cavity, the aqueous contrast medium showed more tubal details. Furthermore, the control picture with the aqueous contrast medium can be prepared after ten minutes. We conclude that the use of an aqueous contrast medium for routine HSG is preferable.

Adult↗
PubMed1996

Pain relief during and following outpatient curettage and hysterosalpingography: a double blind study to compare the efficacy and safety of tramadol versus naproxen. Cobra Research Group.

OBJECTIVE: To compare the analgetic efficacy and side-effects of Naproxen and Tramadol following the outpatient VABRA aspiration or hysterosalpingography. SETTING: Ninety-one patients from the gynaecology clinics of two university hospitals and one municipal-teaching hospital. DESIGN: Multicentre double blind randomized clinical trial. Computerised randomisation, stratification per-centre. METHODS: Semiquantitative assessment of the two drugs was performed by the patient and the gynaecologist using a 1- to 6-point scale. Pain, stress and well-being was scored by the patient using the visual analog scale (VAS) and the verbal description scale (VDS), ranging from 0 (good) to 100 (bad). Side-effects during the first 24 h postoperatively were recorded by the patient in a diary. RESULTS: The analgetic efficacy (pain, stress and well-being) of Naproxen and Tramadol was identical. Subjective assessment by the patient and the doctor also revealed no differences between Naproxen and Tramadol. Side-effects of Tramadol, however, were significantly more severe than those of Naproxen and this phenomenon was responsible for a lower ability to proceed with normal activities in the Tramadol group. CONCLUSION: Tramadol is a good alternative for Naproxen at outpatient VABRA or HSG procedures when Naproxen is contra-indicated.

Adult↗