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PubMed1998

Radionuclide hysterosalpingography is not predictive in the diagnosis of infertility.

OBJECTIVE: To investigate whether radionuclide hysterosalpingography (radionuclide HSG), which has been suggested as a more functional approach to the diagnosis of tubal infertility than conventional patency tests, is predictive in the diagnosis of infertility. DESIGN: A retrospective analysis of data from an inquiry form containing questions about pregnancy outcome after radionuclide HSG. SETTING: University hospital-based, tertiary care infertility clinic. PATIENT(S): Two hundred sixteen women had an infertility work-up including radionuclide HSG performed between April 1986 and April 1993. Forty-one (18.9%) women were excluded from the study; 9 had moved to unknown addresses, 16 did not answer the inquiry, and 16 gave answers that were not interpretable. There were 175 (81.1%) women in the final study group. INTERVENTION(S): An inquiry form containing questions regarding pregnancy was sent to 207 women who undergone radionuclide HSG as a routine procedure in their infertility workup. MAIN OUTCOME MEASURE(S): Occurrence of pregnancy related to outcome of radionuclide HSG and its test properties calculated. RESULT(S): Bilateral or unilateral tubal transport was demonstrated by radionuclide HSG in 129 women, of whom 66 (51%) later became pregnant. Of the pregnant women, 36 (55%) had successful infertility treatment, whereas 30 (45%) reported spontaneous pregnancy. Forty-six women showed no transport at radionuclide HSG. Twenty-five (54%) of these women became pregnant, 14 (56%) with infertility treatment and 11 (44%) without infertility treatment. The predictive values of transport and no transport radionuclide HSG were 0.51 and 0.46, respectively. The sensitivity of radionuclide HSG was 0.25, and the sensitivity was 0.73. Likelihood ratios for pregnancy when radionuclide HSG showed transport and no transport were 1.03 and 0.93, respectively. CONCLUSION(S): Our data strongly indicate that a single radionuclide HSG investigation is not able to predict fertility potential.

Adult↗

PubMed1997

Radionuclide hysterosalpingography with radiolabeled spermatozoa.

OBJECTIVE: To evaluate the efficiency of radionuclide hysterosalpingography (HSG) by using 99mTc hexamethyl propyleneamine oxime (HMPAO)-labeled human spermatozoa in the assessment of fallopian tube patency in infertile couples. DESIGN: Fifteen infertile female patients were inseminated with their husbands' radiolabeled spermatozoa immediately after cessation of menses. SETTING: University-based academic hospital. MAIN OUTCOME MEASURE(S): The time course of radioactivity and scintigraphic images of the uterus and the parauterine tissues implying tubal patency were evaluated and compared by using laparoscopy and HSG. RESULT(S): We demonstrated Tmax (time to peak radioactivity at periovarian sites) for right and left tubes to be 6.74 +/- 2.66 and 5.91 +/- 2.93 minutes (means +/- SD), respectively. We also found 72% sensitivity and 75% specificity of spermatozoa labeled radionuclide HSG compared with laparoscopic findings for tubal patency. CONCLUSION(S): Radionuclide HSG with the husband's spermatozoa seems to be a potentially useful method of assessing patency of the fallopian tubes. The safety dose of this procedure is comparable to conventional HSG. However, more comparative studies are needed to evaluate advantages and disadvantages of this technique.

Adult↗

PubMed2003

Female sterilization with quinacrine using hysterosalpingography (HSG) as an endpoint after a single-insertion protocol in Caracas, Venezuela.

OBJECTIVE: To evaluate the intrauterine insertion of quinacrine as an alternative nonsurgical female sterilization method by confirming bilateral occlusion of the fallopian tubes using HSG in a group of women who desire permanent sterilization. METHODS: After doing hysterosalpingography to confirm patency of both fallopian tubes, 324 mg of quinacrine were introduced with a modified IUD inserter in 30 patients who came to Concepción Palacios Maternity Hospital seeking permanent sterilization, between June 2000 and September 2001. Follow-up with HSG was done 3 months later to verify occlusion of the fallopian tubes. RESULTS: 26 of 30 patients (86%) had bilateral tubal occlusion as determined by HSG. There were minor side effects such as: pain (66.7%), yellow discharge (100%) and menstrual abnormalities (13.3%). One woman became pregnant after HSG showed bilateral occlusion. HSG may interfere with the action of the quinacrine. CONCLUSION: QS is a simple and safe alternative to surgical sterilization with few side effects.

Adult↗

PubMed2000

Can hysterosalpingocontrast-sonography replace hysterosalpingography in the assessment of tubal subfertility?

INTRODUCTION: Hysterosalpingo-contrastsonography (HyCoSy) is a new method for assessing tubal patency using transvaginal ultrasound. It is thought to have several advantages over conventional hysterosalpingography (HSG). We prospectively evaluated the performance of HyCoSy and HSG in the diagnosis of tubal pathology. METHODS AND PATIENTS: One-hundred consecutive subfertile women underwent both HyCoSy and HSG in randomised order. Results of both tests were related to findings at laparoscopy with dye, which was used as the reference test. Each woman was asked to score the pain exsperienced at both procedures on a visual analogue scale. RESULTS: When laparoscopy with dye was used as reference test, the likelihood ratios of HyCoSy were slightly inferior to those obtained for HSG. Since the performance of HyCoSy was dependent on experience, the results were recalculated omitting the 50 initial procedures from the analysis. In that calculation, results of HyCoSy and HSG were comparable. There were no differences in pain experienced during the procedure, as there appeared also to be no differences in patient preferences. CONCLUSION: There appear to be no strong arguments either to replace HSG by HyCoSy, or to reject the use of HyCoSy. Both procedures can be used in the evaluation of tubal pathology.

Adult↗

PubMed1996

Comparison of hysterosalpingography and hysteroscopy in female infertility.

STUDY OBJECTIVE: To determine the diagnostic value of hysterosalpingography (HSG) and diagnostic hysteroscopy in infertility evaluations. DESIGN: Comparative 2-year study. SETTING: Outpatient infertility clinic of a tertiary medical center. PATIENTS: Two hundred sixteen women being investigated for infertility. INTERVENTIONS: An HSG was followed by a diagnostic hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The HSGs were interpreted as normal in 79 (36.9%) women and as showing some abnormalities of the uterine cavity in 135 (63.1%). In the former group, 51 patients had a normal uterine cavity, but 28 had abnormal findings on hysteroscopy, a false negative rate of 35.4%. Of 135 women with an abnormal HSG, hysteroscopy found a normal uterine cavity in 21, a false positive rate of 15.6%. The sensitivity of HSG was 80.3% in revealing intrauterine abnormality and its specificity was 70.1%. Although some abnormalities were identified by both methods in 114 women, findings of both procedures were similar in only 88 (77.2%). In 75 (35.0%), the findings of HSG differed from those of hysteroscopy. In only 139 (65%) patients were the findings (normal and abnormal) similar for both methods. CONCLUSIONS: We advocate hysteroscopy in the investigation of female infertility for its accuracy, safety, simplicity, and convenience.

Adolescent↗

PubMed1995

Comparison of patient reactions and diagnostic quality for hysterosalpingography using ionic and nonionic contrast media.

RATIONALE AND OBJECTIVES: We compared adverse reactions and image quality for hysterosalpingography (HSG) performed with ionic (diatrizoate meglumine combined with iodipamide meglumine [DM + IM]) and nonionic (iohexol) contrast media. METHODS: We performed a study of 95 patients who had HSG and were randomly selected to receive DM + IM or iohexol. Patients reported episodes of abdominal pain and other adverse reactions immediately and 24 hr after the procedure and categorized severity of symptoms on a subjective scale. Two radiologists evaluated image quality for diagnosis. RESULTS: Prevalence of abdominal pain and other reactions both immediately and 24 hr after HSG was lower in patients who received iohexol than in patients who received DM + IM. Moderate or severe abdominal pain was significantly lower in the iohexol group than in the DM + IM group (p < .05). Visualization of the uterine cavity and ampullary rugae was judged excellent with both contrast media (87% with iohexol and 92% with DM + IM). CONCLUSION: Iohexol and DM + IM are excellent contrast media for use during HSG; iohexol 300 may cause fewer episodes of more severe and prolonged abdominal pain.

Abdominal Pain↗

PubMedDate not supplied

Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal hysterosalpingography?

The advantage of hysteroscopy (HSC) over hysterosalpingography (HSG) in the accuracy of the diagnosis of uterine cavity abnormalities that may cause or contribute to infertility has been shown by numerous studies. The aim of this study was to analyse the results obtained from diagnostic HSC performed routinely during diagnostic laparoscopy in the investigation of the infertile women, to evaluate the effectiveness of the procedure in the diagnosis of uterine causes of female infertility. Ninety-three infertile patients with normal uterine cavity as demonstrated in HSG underwent diagnostic laparoscopy and hysteroscopy in this infertility unit. The hysteroscopy showed a normal cavity in 80 cases (88%), giving a false-negative rate of 12% for HSG. The pathologies found included small adhesions (two cases), an arcuate fundus (two cases), an endometrial polyp (three cases), and endometrial hyperplasia was diagnosed in four cases. In the absence of a positive history or a radiographical suggestion of endometrial abnormalities, or both, HSC made little diagnostic contribution towards elucidating the cause of female infertility or to finding a pathology that could affect the chances of achieving a normal pregnancy. However, in view of the low complication rates, minimal time requirement, and a negligible effect on the post-operative course, HSC could be performed on all infertile patients undergoing diagnostic laparoscopy.

Female↗

PubMed1996

A comparison of patient tolerance of hysterosalpingo-contrast sonography (HyCoSy) with Echovist-200 and X-ray hysterosalpingography for outpatient investigation of infertile women.

The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 +/- 5.2 and 9.5 +/- 4.8 min and 9.4 +/- 5.2 and 11.5 +/- 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2 h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy 14/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 85%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time.

Ambulatory Care↗

PubMed1999

The assessment of endometrial pathology and tubal patency: a comparison between the use of ultrasonography and X-ray hysterosalpingography for the investigation of infertility patients.

OBJECTIVES: The aim of the present study was to examine the role of hysterosalpingocontrast sonography (HyCoSy) as a screening test for endometrial and tubal pathology at the start of the infertility investigation protocol. METHODS: HyCoSy was compared with X-ray hysterosalpingography (HSG) for the assessment of the endometrial cavity and Fallopian tube patency. A total of 103 women with a history of at least 1 year's infertility were included. Each woman underwent both HyCoSy and HSG on the same day. Laparoscopy was performed in 43 cases. For HyCoSy examinations, saline was used for evaluation of the endometrial cavity and Echovist contrast medium to assess Fallopian tube patency. RESULTS: The concordance between HyCoSy and HSG for the presence of endometrial cavity pathology was 90%, but for tubal patency the concordance was lower (72%). HyCoSy classed more examinations of tubal patency as uncertain. HSG more frequently classified tubes as occluded. In the subset of patients in whom all three techniques were used, HSG and HyCoSy demonstrated a high concordance with laparoscopy (83% and 80%, respectively). The prevalence of occluded tubes according to laparoscopy as the reference standard was 13%. The two methods had a high negative predictive value for tubal disease (HSG, 94%; HyCoSy, 88%), and the positive predictive values were 47% and 75%, respectively. The detection rate for occluded tubes was 73% and 27%, and specificity 87% and 90%, respectively. CONCLUSIONS: Our data demonstrate that HyCoSy obtains similar information about the status of the endometrial cavity and Fallopian tube patency to that of HSG. It is possible that in some cases HyCoSy may replace HSG in order to select women with patent tubes who may be suitable for further infertility treatment without more invasive investigation.

Adolescent↗

PubMed2000

Paracetamol as a prophylactic analgesic for hysterosalpingography: a double blind randomized controlled trial.

AIM: To evaluate the effectiveness of paracetamol as a prophylactic analgesic for hysterosalpingography (HSG). DESIGN: A prospective double blind randomized controlled trial comparing one 1 g of paracetamol (SmithKline Beecham, Brentford, U.K.) to placebo taken 30 min before HSG. One hundred consecutive out-patients were studied prospectively. The analgesic effectiveness during the procedure and at 24 h and 1 week post procedure was analysed by a postal pain score questionnaire. Additional data on the ethnicity of the patient, sex and level of experience of the radiologist performing the hysterosalpingogram, the parity of the patient, the ease of the procedure, and whether pathology was identified were also recorded. RESULTS: Eighty-eight patients (88%) replied, 39 (44%) received paracetamol and 49 placebo (56%). During the procedure 3/39 (7%) of women in the paracetamol group were pain-free compared to 9/49 (18%) in the placebo group, which was not significant (P = 0.11). At 24 h, 15/39 (38%) of women in the paracetamol group were pain-free compared to 20/49 (41%) in the placebo group, which was not significant (P = 0.82). At 1 week, 27/39 (69%) of women in the paracetamol group were pain-free compared to 29/49 (59%) in the placebo group, which was not significant (P = 0.33). No significant difference in mean pain scores was determined during the procedure (P = 0.91), or at 24 h post procedure (P = 0.94). Similarly, no difference in mean pain scores was identified with regard to the ethnicity of the patient, the sex of the radiologist performing the procedure, the level of experience of the radiologist performing the procedure, or whether pathology was present or not. Difficult cannulations were associated with higher mean pain scores, however, there was no difference in mean pain scores between the paracetamol or placebo groups for both easy and difficult cannulations. CONCLUSION: Paracetamol is not effective as a prophylactic analgesic for HSG. If a prophylactic analgesic is considered necessary for pain relief during HSG we recommend that a non-steroidal anti-inflammatory drug (NSAID) is used.

Acetaminophen↗

PubMed1997

[Radiologic versus ultrasound fallopian tube imaging. Painfulness of the examination and diagnostic reliability of hysterosalpingography and hysterosalpingo-contrast-ultrasonography with echovist 200].

UNLABELLED: Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. PATIENTS AND METHODS: 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). RESULTS: Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). CONCLUSION: Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.

Contrast Media↗

PubMed1990

[Hysterosalpingography: synechiae? Gartner's ducts?].

A linear shadow parallel to the uterus longitudinal axis, was observed in a hysterosalpingography (HSG) and has set up a controversy between synechiae and Gartner's ducts, without reaching a definitive conclusion. A case like this does not seem to have been published previously.

Adult↗

PubMed1992

[Radiation dosage during hysterosalpingography using a digital image intensifying technique].

Hysterosalpingography using a digital and conventional image intensification technique was carried out on two groups of 32 patients as part of investigation for infertility. Radiation dose was recorded as surface dose. In 51.7% of digital images and 54.8% of conventional images the findings were normal. Surface dose with conventional technique was 442 +/- 144 cGy/cm2, significantly higher than 207 +/- 113 cGy/cm2 with digital image intensification. The number of exposures was also significantly higher when using the conventional technique. The digital images showed no lack of diagnostic detail when compared with the conventional 100 mm films.

Adult↗

PubMed1981

[Ranking of hysterosalpingography (HSG) in the physician's consultation-room practice concerning sterility problems (author's transl)].

In the following up of the diagnosis of the female sterility we practised 123 hysterosalpingographies (HSG) from 1972--1978. Presupposition was the proof of the ovulation by base temperature. The HSG is the beginning of the diagnosis to recognize the intracanalicular changes of the uterus and to avoid senseless treatment with hormones. 34.9% of the patients showed absolutely normal uteri or tubes. Pathological results were be found in 17.7% by the uterus and 47.4% by the tubes. Without any treatment we have had a success of pregnancy after HSG in 26.8%. Further pregnancies we got by operative intervention or medicamentous treatment in only 4,8%. 23 patients = 18,7% could not be evaluated because they were missing. The HSG is an important and supplementary method for a diagnosis of the female sterility and it does not compete with the method of the useful pelviscopy.

Body Temperature↗

PubMed2006

Investigation of infertility management in primary care with open access hysterosalpingography (HSG): a pilot study.

Infertility affects one in seven couples in the United Kingdom. The National Institute for Clinical Excellence (NICE) issued guidance on the management of the infertile couple in February 2004, which included the statement "for the assessment of tubal damage, women not known to have co-morbidities (pelvic inflammatory disease, endometriosis or previous ectopic pregnancy) should be offered hysterosalpingography (HSG)". We made HSG available to six general practices in Newcastle upon Tyne as an open access investigation. Our aim was to evaluate the uptake of open access HSG, speed of access to specialist services and the quality of the information recorded in the referral letter. Using hospital clinical records we tracked the outcome of all infertile couples from the six pilot practices over a nine-month period. Of the 39 referrals identified, 10 women were eligible for open access HSG, of which six HSGs were organized by GPs. Couples who had open access HSG reached a diagnosis and management plan four weeks earlier than those who were referred directly (mean difference 4.0 weeks, 95% confidence interval (CI) -8.8 to 0.4 weeks). The information recorded in the referral letter was generally poor. However, all referrals made via the open access HSG service had the prerequisite tests done. Open access HSG allowed prompter access to specialist services with more complete information passed on in the referral letter. Open access HSG was used in 15% of all infertile couples and 60% of those who fitted the criteria for its use. Open access HSG together with semen analysis and endocrine blood tests may allow GPs to manage the initial stages of the infertile couple and make a diagnosis.

Adult↗

PubMed1998

Hysterosalpingography with a balloon catheter versus a metal cannula: a prospective, randomized, blinded comparative study.

A prospective, randomized, blinded study was conducted to compare the use of a balloon catheter for performing hysterosalpingography (HSG) with the use of a traditional metal cannula. Sixty-one consecutive women who underwent HSG for evaluation of infertility were prospectively randomized to undergo the procedure with either a metal cannula (n = 31) or the balloon catheter (n = 30). The HSG procedure was identical in both groups. HSG using the balloon catheter, compared to the metal cannula, required significantly less fluoroscopic time (57.4 +/- 17.6 versus 75.6 +/- 40.5 s), smaller amounts of contrast medium (7.8 +/- 3.9 versus 20.1 +/- 15.8 ml), produced less pain (3.8 +/- 2.0 versus 5.6 +/- 2; on a scale of 1-10), and was easier for the physician to perform (8.8 +/- 1.1 versus 6.4 +/- 1.9; on a scale of 1-10) (P < 0.01). Eight patients (13%) were diagnosed as having proximal tubal occlusion. It was possible to offer an immediate transcervical tubal catheterization for further diagnosis and treatment of the occlusion only to the five patients with this condition from the balloon catheter group. We conclude that the balloon catheter is superior to the traditional metal cannula for performing HSG. Furthermore, if proximal tubal occlusion is diagnosed, an immediate selective salpingography and transcervical tubal catheterization can be performed without the need to replace the cannula or to reschedule the patient.

Adult↗

PubMed1999

Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome.

In this study, we compare the prognostic significance of hysterosalpingography (HSG) and laparoscopy for fertility outcome. In a prospective cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study (CITES), consecutive couples who registered between 1 April 1984 and 31 March 1987 for the evaluation of subfertility and who underwent HSG and laparoscopy were included. Unilateral and bilateral tubal occlusion at HSG and laparoscopy were related to treatment-independent pregnancy. Cox regression was used to calculate fecundity rate ratios (FRR). Of the 794 patients who were included, 114 (14%) showed one-sided tubal occlusion and 194 (24%) showed two-sided tubal occlusion on HSG. At laparoscopy, 94 (12%) showed one-sided tubal occlusion and 96 (12%) showed two-sided tubal occlusion. Occlusion detected on HSG and laparoscopy showed a moderate agreement beyond chance (weighted kappa-statistic 0.42). The adjusted FRR of one-sided tubal occlusion at HSG was 0.80, whereas two-sided tubal occlusion showed an FRR of 0.49. For laparoscopy, the FRR were 0.51 and 0.15 respectively. After a normal or one-sided occluded HSG, laparoscopy showed two-sided occlusion in 5% of the patients, and fertility prospects in these patients were virtually zero. If two-sided tubal occlusion was detected on HSG but not during laparoscopy, fertility prospects were slightly impaired. Fertility prospects after a two-sided occluded HSG were strongly impaired in cases where laparoscopy showed one-sided and two-sided occlusion, with FRR of 0.38 and 0.19 respectively. Although laparoscopy performed better than HSG as a predictor of future fertility, it should not be considered as the perfect test in the diagnosis of tubal pathology. For clinical practice, laparoscopy can be delayed after normal HSG for at least 10 months, since the probability that laparoscopy will show tubal occlusion after a normal HSG is very low.

Adult↗

PubMed2002

Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?

Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.

Endometriosis↗