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PubMed2005

Hysterosalpingography.

OBJECTIVE: To demonstrate the value of the hysterosalpingogram in the evaluation of infertility. CONCLUSION(S): Hysterosalpingography, which should be done in the follicular phase of the cycle, evaluates the contour of the uterine cavity, cervical canal, and tubal lumina. Other than being diagnostic, it can prove to be therapeutic. The instrument used to introduce the radio-opaque medium should be chosen to give the least discomfort and to cause no leakage of dye from the cervix. Water-soluble medium is usually used rather than an oil-based medium. Fluoroscopy with image intensification gives the best results. Insufficient dye injection will give an incomplete study. Too much dye injection, especially under pressure, might cause extravasation of the dye into the vascular system or conceal the fimbrial ends of the tubes.

Female↗

PubMed1985

The use of a low-osmolality contrast medium in hysterosalpingography: comparison with a conventional contrast medium.

Hexabrix 320 has been compared with Conray 280 in a randomised double-blind study of 97 patients undergoing hysterosalpingography. Although the lower osmolality and higher viscosity of Hexabrix should make it an ideal hysterosalpingographic agent, no differences were detected between the two contrast media, either in the incidence of side-effects or in radiographic image quality.

Abdomen↗

PubMed2000

A second hysterosalpingography reduces the use of selective technique for treatment of a proximal tubal obstruction.

OBJECTIVE: To assess whether a second hysterosalpingography (HSG) can permit tubal patency, reducing the use of selective salpingography in patients with proximal tubal obstruction. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): The study population consisted of 360 infertile women. INTERVENTION(S): In patients with unilateral or bilateral proximal tubal obstruction, a second HSG was performed after about 1 month. In those cases with persistent obstruction, an immediate selective salpingography and tubal catheterization were performed. MAIN OUTCOME MEASURE(S): Tubal opacification. RESULT(S): Forty patients underwent a second HSG procedure for proximal tubal occlusion. Among these, 24 achieved bilateral tubal patency. Thus, repetition of a conventional HSG after 1 month avoided unnecessary salpingography in 60% of patients. CONCLUSION(S): In infertile women with proximal tubal obstruction, we believe it is best to perform a second HSG. HSG is easy to carry out and subjects patients to a lower dosage of radiation and fewer risks than selective salpingography. The latter technique should be reserved for unsuccessful cases.

Adult↗

PubMed2000

Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: a prospective, randomized study.

OBJECTIVE: To compare the diagnostic accuracy, pain scores, and procedure length of outpatient hysteroscopy (OHS), hysterosalpingography (HSG), and saline infusion hysterosonography (SIS) for evaluation of the uterine cavity of infertile women. DESIGN: Prospective, randomized, investigator-blind study. SETTING: Tertiary infertility clinic. PATIENT(S): Forty-six consecutive infertile women. INTERVENTION(S): Outpatient HSG, OHS, and SIS, followed by operative hysteroscopy (HS). MAIN OUTCOME MEASURE(S): Uterine abnormalities, procedure length, and subjective pain. RESULT(S): Fifty-nine percent of infertile subjects were found to have an abnormality on at least one of three outpatient uterine evaluations. When compared with the case of definitive operative HS, 60% of abnormalities were correctly classified by HSG, 72% by OHS, and 52% by SIS (P: NS). When comparing all combinations of 2 outpatient screening tests to operative hysteroscopy, 68% were correctly classified by HSG/OHS, 58% by HSG/SIS, and 64% by OHS/SIS (P: NS). The average time length for the OHS was 9.1 min., which was significantly greater than for both HSG (average, 5.3 min) and SIS (average, 6.1 min.) (P<.0001 for both). HSG and SIS were not statistically different regarding procedure time length. The average pain score (0-10) for SIS was 2.7, compared with 5.8 and 5.3 for HSG and OHS, respectively. Both HSG and OHS mean pain scores were significantly greater than the SIS mean. CONCLUSION(S): OHS, SIS, and HSG were statistically equivalent regarding evaluation of uterine cavity pathology in infertile women.

Adult↗

PubMed2001

Cost-effectiveness of hysterosalpingography, laparoscopy, and Chlamydia antibody testing in subfertile couples.

OBJECTIVE: To evaluate the cost-effectiveness analysis of hysterosalpingography (HSG), laparoscopy, and Chlamydia antibody testing (CAT) in subfertile couples. DESIGN: Cost-effectiveness analysis. SETTING: Decision analytic framework. PATIENT(S): Data of >2,000 subfertile couples in the Canadian Infertility Treatment Evaluation Study. Results of CA-125 measurement and CAT were simulated from baseline characteristics. INTERVENTION(S): Expectant management was considered to be the reference strategy (strategy 1). In strategy 2 and 3, IVF was offered either immediately or after 2.5 years. In strategy 4, the decision to offer or delay treatment was based on the couple's chance of spontaneous conception. Nine strategies incorporated combinations of CAT, CA-125 measurement, HSG, and laparoscopy. MAIN OUTCOME MEASURE(S): Expected live birth rates, expected number of IVF cycles, and expected total costs. RESULT(S): The strategy starting with CAT was the most cost-effective in couples whose 3-year chance of conception was >14%, whereas the strategy starting with HSG was the most cost-effective in couples with worse fertility prospects. CONCLUSION(S): The diagnostic work-up to detect tubal pathology in subfertile couples should start with CAT in couples with relatively good fertility prospects and immediate HSG in couples with relatively poor fertility prospects.

Adult↗

PubMed2001

Tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation.

OBJECTIVE: To compare the acceptance and tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy [THL] combined with minihysteroscopy) versus hysterosalpingography (HSG) for evaluating tubal patency and the uterine cavity in an outpatient infertility investigation. DESIGN: Randomized controlled study. SETTING: University hospital. PATIENT(S): Twenty-three infertile patients without obvious pelvic pathology. INTERVENTION(S): Women were randomly divided into two groups. One group underwent minihysteroscopy and THL with tube chromoperturbation as first investigation and HSG within the following 7 days, while in the other group the investigation sequence was inverted. Women reported pain experienced before and at the end of procedures. MAIN OUTCOME MEASURE(S): Mean duration of procedures, level of pain experienced, diagnostic agreement about tubal patency and uterine cavity normality. RESULT(S): THL and minihysteroscopy took significantly more time but was significantly less painful than HSG. Regarding tubal patency, in 95.5% of cases THL agreed with HSG. In one case, HSG diagnosed a bilateral obstruction of tubes, whereas at THL a bilateral spreading of methylene blue was seen. Agreement on intrauterine pathologies between minihysteroscopy and HSG was poor (43%); the number of intrauterine abnormalities found at hysteroscopy was significantly greater than at HSG. CONCLUSION(S): THL in association with minihysteroscopy provided more information and was better tolerated than HSG in an outpatient infertility investigation.

Adult↗

PubMed1976

A comparison of hysterosalpingography and endoscopy in evaluation of tubal function in infertile women.

A comparison of hysterosalpingography (HSG) with endoscopy in the evaluation of tubal function in 117 infertile women is presented. Results were in accord in 55% of the patients. Correction for endoscopic error and the limitations of HSG increased the positive correlation to 74%. Twenty-three patients (20%) with abnormal findings at HSG were normal with endoscopy. Ten patients (8%) had normal HSG but abnormal endoscopic findings. Fifteen patients (12%) with positive findings by HSG had different positive findings at endoscopy. Additional endoscopic findings in 47 patients are listed. Review of 26 patients with endoscopy-confirmed endometriosis revealed that 14 (54%) had a normal HSG and normal history and pelvic examination. Although HSG should be the method of choice as part of the basic evaluation, an infertile woman should undergo endoscopy before the evaluation is considered complete or final.

Culdoscopy↗

PubMed1983

Hysterosalpingography.

A brief review of the technique of hysterosalpingography is provided. It remains an important diagnostic study in searching for causes of infertility. HSG is a safe, simple procedure that enables the lumina of the uterine cavity and fallopian tubes to be outlined. Fundamentals in techniques have been stressed so as to limit the errors of omission and commission. During the course of many years, I have been honored by my colleagues, who have requested me to review interesting HSGs. Thus, I have been able to accumulate a series of x-rays that I can share with the readers of Modern Trends. Although these photographs seemed unique, many of them probably have been seen by other investigators. They are presented because of their important diagnostic features.

Cysts↗

PubMed1983

Hysterosalpingography with oil contrast medium enhances fertility in patients with infertility of unknown etiology.

Previous studies have suggested increased fertility rates following hysterosalpingography (HSG) using oil as compared with aqueous contrast medium. To compare the possible fertility-enhancing effects of two agents used for HSG, this prospective randomized study evaluated the subsequent fertility rates in 121 patients who underwent HSG, in which either oil or aqueous contrast medium was used. After random assignment to either agent, patients were observed for four menstrual cycles after HSG without resorting to any therapy other than clomiphene citrate where indicated. The pregnancy rates for the four cycles after HSG were compared with chi-square analysis in the total study and in the diagnostic subgroups. The subgroup with infertility of unknown cause had a significantly higher pregnancy rate after HSG with oil than after HSG with aqueous contrast medium. No significant difference was seen for any other subgroup or for the overall cohort.

Contrast Media↗

PubMed1984

Comparison of diagnostic accuracy of laparoscopy, hysteroscopy, and hysterosalpingography in evaluation of female infertility.

The diagnostic accuracy and therapeutic value of hysterosalpingography (HSG), laparoscopy, and hysteroscopy were evaluated in 77 women who underwent these procedures as part of their infertility evaluation. HSG revealed in 32 women (42%) evidence of tubal or peritoneal disease, and 16 other women (21%) had radiographic evidence of intrauterine abnormalities. These findings were confirmed by laparoscopy in 84% of patients and by hysteroscopy in 69%, giving false-positive rates of 16% and 31% for HSG. HSG had a false-negative rate of 13% for tubal or peritoneal disease as subsequently uncovered by laparoscopy, and 1.3% for intrauterine lesions as revealed by hysteroscopy. The data suggest that while laparoscopy is of value in detecting previously unsuspected tubal disease, hysteroscopy adds little information in the management of the infertile patient. For optimum evaluation, a combined approach using all three procedures is recommended, especially in patients with a history of uterotubal and peritoneal lesions.

Adult↗

PubMed1986

Comparison of real-time ultrasonography, hysterosalpingography, and laparoscopy/hysteroscopy in the evaluation of uterine abnormalities and tubal patency.

In a study to assess real-time ultrasonography (US) as an alternative to hysterosalpingography (HSG) in the evaluation of uterine abnormalities and tubal patency, 61 women underwent US immediately before hysteroscopy/laparoscopy. Saline was instilled into the uterus to provide contrast during US. The findings were compared with surgical and preoperative HSG findings. With surgical findings as the standard, US was as accurate (sensitivity 98%, specificity 100%) as HSG (sensitivity 98%, specificity 92%) in demonstrating uterine abnormalities and provided a more complete assessment of the abnormality. US was as accurate (sensitivity 100%, specificity 91%) as HSG (sensitivity 96%, specificity 94%) in demonstrating the presence of tubal patency but less accurate in establishing which tubes were patent. Thus real-time US with fluid instillation provides an accurate alternative to HSG in screening for uterine abnormalities and tubal patency.

Fallopian Tube Patency Tests↗

PubMed1993

Initial experience of a new linear everting falloposcopy system in comparison with hysterosalpingography.

OBJECTIVE: To assess the endolumenal portion of the fallopian tube from ostium to fimbria using a specially designed linear everting catheter and microendoscope. The study compared falloposcopy results with those obtained with hysterosalpingography (HSG) in the same patients and explored the system's ability to classify internal tubal conditions. DESIGN: A prospective study of a new diagnostic technique, falloposcopy, versus conventional means of evaluating tubal status. SETTING: A tertiary university infertility center. PATIENTS: Eighteen infertile patients with a previous history of infertility of at least 2 years duration. INTERVENTION: Diagnostic falloposcopy was performed on a total of 31 tubes. RESULTS: Although the results of HSG and falloposcopy were in agreement in 19 cases, falloposcopy findings were at significant variance with HSG in 12 cases (40%). Seventeen of the tubes visualized by falloposcopy were considered to be normal, 10 showed mild disease, and 4 were severely damaged. CONCLUSION: Falloposcopy using the linear everting catheter is rapid and atraumatic. It provides more complete information concerning tubal status than HSG and as such constitutes an important advance in diagnosis and therapy planning.

Adult↗

PubMed1994

Chlamydia trachomatis antibody testing is more accurate than hysterosalpingography in predicting tubal factor infertility.

OBJECTIVE: To compare the likelihood of abnormal Chlamydia trachomatis antibody test results with that of abnormal hysterosalpingography (HSG) test results in patients with tubal factor infertility. DESIGN: Anti-C. trachomatis immunoglobulin G antibodies were determined prospectively in 211 consecutive infertility patients by means of an indirect fluorescent antibody technique. The results were compared with the results of HSG with respect to their predictive value of tubal factor infertility. Likelihood ratio calculations were used. SETTING: University hospital-based, tertiary care infertility clinic. PATIENTS: A series of 211 consecutive infertility patients. INTERVENTIONS: C. trachomatis antibody testing, HSG, laparoscopy. MAIN OUTCOME MEASURES: Likelihood ratios for abnormal C. trachomatis antibody test results and abnormal HSG results in infertility patients, as assessed by laparoscopy. RESULTS: The positive likelihood ratio for C. trachomatis antibody testing was 9.1, indicating a patient with tubal factor infertility to be 9.1 times more likely to have abnormal serology results than a patient without tubal factor infertility. This was superior to HSG, which had a positive likelihood ratio of 2.6 in our study and of 1.6 to 6.1 in the literature. The odds ratio of C. trachomatis antibody testing was 31.5 in our study. Its 90% confidence interval (8.3 to 138.5) did not overlap that of HSG as calculated from a meta-analysis of literature reports (5.3 to 7.9). CONCLUSIONS: C. trachomatis antibody testing is simple, inexpensive, and causes minimal inconvenience to the patient. It is more likely than HSG to be abnormal in patients with tubal factor infertility. C. trachomatis antibody testing deserves to become an integral component of the initial fertility work-up.

Antibodies, Bacterial↗

PubMed1994

A comparison of pain experienced during hysterosalpingography and in-office falloposcopy.

OBJECTIVE: To determine patient perception of the intensity of pain during in-office falloposcopy compared with hysterosalpingography (HSG). DESIGN: A prospective quality assurance study using a formal pain scale to compare two procedures. SETTING AND PATIENTS: Patients attending a tertiary level infertility clinic. INTERVENTIONS: In-office falloposcopy or HSG using analgesics. MAIN OUTCOME MEASURES: The mean pain score and area under the pain curve experienced during each investigation. RESULTS: Using our technique, in-office falloposcopy was associated with a significantly lower mean intensity of pain and with a longer procedure. The duration of the falloposcopic examination declined significantly with physician experience. Flushing adjacent to the uterotubal ostium, ostial cannulation, and rapid eversion provoked episodes of acute pain during falloposcopy. CONCLUSION: These results support the patient acceptability of in-office falloposcopy.

Adult↗

PubMed1994

Chlamydia trachomatis antibody titers and hysterosalpingography in predicting tubal disease in infertility patients.

OBJECTIVE: To determine if the number of diagnostic laparoscopies done on women without tubal adhesive disease could be reduced by testing for tubal disease with Chlamydia trachomatis antibody titers and hysterosalpingography (HSG), either singly or together. DESIGN: Historical prospective chart review. SETTING: The Colorado Kaiser Permanente Reproductive Endocrinology Clinic. PATIENTS: All 703 infertility patients who had C. trachomatis antibody titers done from March 2, 1988 to April 30, 1992. The final study group was comprised of 218 patients who had antibody titers, HSG, and laparoscopy. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sensitivity, negative predictive value, and false-positive rate were the test characteristics of interest. Tubal disease was identified by laparoscopy. RESULTS: For HSG testing, the sensitivity was 78% and the negative predictive value was 85%. For C. trachomatis titers, the sensitivity was also 78% and the negative predictive value was 82%. Ninety-five percent confidence intervals for sensitivity and negative predictive value overlapped, indicating that there was no significant difference. However, false-negative rates were the same for the two tests, but false-positive rates were lowest for HSG and series testing. CONCLUSIONS: To minimize false-positive tests and thus, to minimize unnecessary laparoscopies, HSG testing either alone or combined with the C. trachomatis antibody titer as series tests yielded a significantly lower false-positive rate. In our study group, if both tests were negative, tubal disease was identified on laparoscopy in only 5% of cases. Choice of most cost-effective test sequence will depend on who bears the cost. Further studies of cost-benefit using well-defined testing sequences are needed to determine if C. trachomatis antibody titers in series with HSG would be more cost effective than HSG alone in detecting tubal disease.

Adult↗

PubMed1995

Accuracy of hysterosalpingography and laparoscopic hydrotubation in diagnosis of tubal patency.

OBJECTIVE: To compare the diagnostic accuracy of two methods of assessment of tubal patency, viz, hysterosalpingography (HSG) and laparoscopic hydrotubation. DESIGN: One hundred four infertile women who were investigated with both HSG and laparoscopy in King Khalid University Hospital were selected for the study. Complete history of factors that may predispose to tubal occlusion was obtained. Patients with problems of ovulatory failure or poor semen analysis that may contribute to their infertility were excluded. RESULTS: The overall agreement between the two methods was 62.5%. However, the diagnostic accuracy of the two methods differed significantly. CONCLUSION: It would appear that laparoscopic hydrotubation, despite its invasive nature, had an edge in diagnostic accuracy when compared with HSG. It would be advantageous to subject patients in whom HSG has shown tubal blockage to laparoscopy or any of the newer techniques of hysteroscopy or sonographic hydrotubation.

Adult↗

PubMed1995

The limited value of hysterosalpingography in assessing tubal status and fertility potential.

DESIGN: To determine whether the diagnostic accuracy and prognostic value of hysterosalpingography (HSG) could be improved if routine spot films were replaced by an on-line recorded gynecoradiologic study. SETTING: Medical school-affiliated private infertility center. PATIENTS: In 1992, a review of 152 infertile women with infertility who demonstrated a normal HSG, by standard criteria of spot film evaluation, in 117 (77%). They were further investigated by gynecoradiologic study if the HSG revealed asymmetrical tubal filling, an increased perfusion pressure, and/or evidence for abnormal tubal spill. In 1993, 47 women with normal HSG by spot film criteria underwent bilateral selective salpingography and were subdivided into those with normal (group I, n = 23) and abnormal (group II, n = 24) tubal perfusion pressures. INTERVENTION: Patients in both study groups then were treated for their infertility independently of pressure perfusion measurements. MAIN OUTCOME MEASURE: Clinical pregnancy rates (PRs) over the ensuing 6 to 10 months. RESULTS: Among 117 women with apparently normal spot film HSG, 64 (55%) demonstrated asymmetrical tubal filling, 32 (27%) demonstrated abnormal spillage into the peritoneal cavity, and 55 (47%) demonstrated abnormally elevated injection pressures. Among 98 women who underwent bilateral selective salpingography, 43 (44%) demonstrated bilaterally normal tubal perfusion pressures and 55 (56%) showed an abnormally elevated pressure in at least one oviduct. Of 47 women that were followed prospectively in 1993, patients with normal perfusion pressure (group I) demonstrated a significantly higher PR than women with elevated tubal pressure (group II) from 2 months and on after the procedure. CONCLUSIONS: Routine spot film HSG is of limited value in assessing tubal status beyond the determination of tubal patency. Especially with regard to fertility potential, HSG should be replaced by gynecoradiologic study.

Adult↗

PubMed1996

Color Doppler hysterosalpingography in the diagnosis of tubal patency.

OBJECTIVE: To assess tubal patency by color Doppler hysterosalpingography (HSG). DESIGN: Comparative study of color Doppler HSG with roentgenogram HSG and chromolaparoscopy in infertile women of childbearing age. SETTING: Clinical environment. PATIENTS: Sixty female patients (22 to 39 years) with long-lasting infertility problems. INTERVENTION: Sterile saline was transcervically injected into the uterine cavity through a catheter and color Doppler HSG was performed. All the patients were submitted to roentgenogram HSG and chromolaparoscopy. MAIN OUTCOME MEASURES: The diagnostic efficacy of color Doppler HSG and its concordance with "gold standard" chromolaparoscopy were analyzed. RESULTS: Correlation between color Doppler HSG and roentgenogram HSG with chromolaparoscopy occurred in 86% versus 93% of all women studied. CONCLUSIONS: Color Doppler HSG with its accuracy and safety results a promising alternative technique to roentgenogram HSG in diagnosing tubal status in infertile patients.

Adult↗