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PubMed1995

A prospective series of unruptured ectopic pregnancies treated by tubal injection with hyperosmolar glucose.

OBJECTIVE: To evaluate the safety and efficacy of hyperosmolar glucose injection in select unruptured tubal gestations with hCG levels less than 2500 mIU/mL. METHODS: In this prospective series, 16 patients with an hCG titer less than 2500 mIU/mL and an unruptured ectopic pregnancy were treated by tubal injection with hyperosmolar (50%) glucose. Hyperosmolar glucose was injected transabdominally into the antimesenteric site of the tubal pregnancy, using a 20-gauge spinal needle. The main outcome measures evaluated were duration of surgery, success rate, time to resolution, and follow-up tubal patency rates. RESULTS: Ninety-four percent (15) of the subjects were treated successfully with a median time to resolution of 24 days (range 5-78). The one treatment failure required methotrexate because of rising hCG titers and worsening pain 4 days after the patient was treated with hyperosmolar glucose. The mean (+/- standard error) duration of surgery was 45 +/- 6 minutes. So far, all ten patients undergoing postoperative hysterosalpingograms have demonstrated tubal patency in the treated tube. CONCLUSION: Laparoscopic injection with hyperosmolar glucose is an effective, systemically nontoxic alternative treatment for select unruptured ectopic pregnancies (hCG less than 2500 mIU/mL) that achieves tubal patency rates comparable to other conservative medical and surgical treatments.

Chorionic Gonadotropin↗
PubMed1988

Preliminary experience with transcervical balloon tuboplasty.

We developed a new technique, transcervical balloon tuboplasty, an adaptation of established balloon angioplasty techniques that facilitates recanalization of proximally occluded oviducts. Sixteen patients with obstruction of the proximal portion of one or two fallopian tubes (based on at least two hysterosalpingograms and one laparoscopic examination) were selected for the procedure. Four patients (25%) were found to have patent oviducts on intraoperative third tubal patency evaluation and were therefore excluded from study. Of the remaining 12 patients, tubal patency was achieved in at least one fallopian tube in 7 patients (58%), as demonstrated by hysterosalpingogram immediately after the transcervical balloon tuboplasty procedure. On follow-up 2 months to 1 year afterward, two pregnancies and one delivery occurred. We conclude that transcervical balloon tuboplasty appears to represent a useful and safe technique to achieve patency in selected cases of tubal interstitial obstruction. Reocclusion rates, long-term complication rates, and pregnancy rates after transcervical balloon tuboplasty remain to be established before the procedure should be considered a recommended alternative for either surgical tuboplasty or in vitro fertilization.

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↗
PubMed1977

An evaluation of etiologic factors and therapy in 665 infertile couples.

Six hundred and sixty-five unselected infertile couples were investigated and treated in a private clinic during a 15-year span. Male infertility factors were involved in 28%, ovulatory disturbances in 31.5%, tubal factors in 16.3%, and undiscovered factors in 17.6% (117 couples). In 50 couples (7.5%) fertility-reducing factors were found in both partners, with a 14% pregnancy rate, compared with a 54.3% pregnancy rate when only a female factor was involved. The chances of successful treatment of females decline steadily with age, correlating with the fact that the longer the exposure time before the start of treatment, the less the chance of pregnancy. Investigation following 1 year of exposure should be advised. Pregnancy rates were 50% in ovulatory disturbances and 30% with tubal factors. Predictably, a progressive increase in the pregnancy rate was noted during the span of this study.

Adult↗
PubMed1977

Relation between indices of semen analysis and pregnancy rate in infertile couples.

Both partners of 198 consecutive infertile couples were evaluated. Studies in the female included clinical evaluation of ovulation for a minimum of two menstrual cycles, investigation of tubal patency, and evaluation of sperm survival in cervical mucus. Six semen specimens were analyzed from each male. Laparoscopy, scrotal exploration, and testicular biopsies were performed as required. Where indicated, the female was treated intensively. The only therapy offered to the males was ligation of varicoceles, if present. The couples were grouped on the basis of sperm counts, total sperm counts, motile sperm counts, and total motile sperm counts, and the incidence of pregnancy was computed. Pregnancy rates of approximately 50% occurred in couples where sperm counts or total sperm counts were in the range of 5 to 60 million/ml or 25 to 200 million/ejaculate, respectively. When sperm counts were over 60 million/ml or total sperm counts over 200 million/ejaculate, pregnancy rates increased to above 70%. These observations emphasize the importance of considering infertility as a problem of a couple rather than as a specific disorder of one of the partners. These data also demonstrate a lack of direct correlation between sperm density in the ranges of 5 to 60 million/ml and pregnancy rates in couples where the wife is treated intensively.

Cell Count↗
PubMed1979

The value of hysterosalpingography prior to donor artificial insemination.

The value of hysterosalpingography as a tool in the pretreatment evaluation of candidates for donor artificial insemination has been retrospectively evaluated. In 89 consecutive artificial inseminations by donor candidates, hysterosalpingograms were evaluated for genital tract abnormalities. In only four of these studies was there a failure of dye to spill into the peritoneal cavity. The low incidence of significantly abnormal hysterosalpingographic studies, and the failure of these studies to correlate with pregnancy outcome, strongly argues against the use of hysterosalpingography in the preliminary evaluation of the patient considered for donor artificial insemination.

Adult↗
PubMed1981

Improved separation of motile sperm in asthenospermia and its application to artificial insemination homologous (AIH).

A method is described for the separation of motile sperm from semen by "migration' into a diluent, providing a large area of interface between the semen and the diluent and resulting in a good yield of motile sperm (58%), with a mean percentage of motility of 95%. The method provides a specimen free of seminal plasma and debris and suitable for intrauterine insemination in less than two hours. The motile fraction was used for AIH treatment of 20 couples with a mean of 4 years' infertility, where the female factor had been excluded and the male was asthenospermic. After a mean of six cycles, three pregnancies were achieved. Improvement of the percentage of motility alone did not, in this study, give a significant improvement in conception rates when compared with accepted cycles with the placebo.

Adult↗
PubMed1984

Tubal patency and pelvic adhesions at early second-look laparoscopy following intraabdominal use of the carbon dioxide laser: initial report of the intraabdominal laser study group.

It has been suggested that the carbon dioxide (CO2) laser, by virtue of its hypothetical capabilities for precise incisions, minimization of tissue handling and bleeding, and shortened operating time, may improve the success rate of gynecologic infertility surgery. To assess this hypothesis, a multicenter prospective study was performed to assess tubal patency and adhesion formation at early second-look laparoscopy after intraabdominal laser surgery. Procedures performed included salpingoneostomy, fimbrioplasty, lysis of adhesions, vaporization of endometriosis, and ovarian wedge resection. The results were compared with those of another multicenter prospective study that utilized nonlaser reconstructive pelvic surgery. Use of the CO2 laser was found to result in a greater tubal patency rate at the time of the second-look procedure. Adhesions present at the time of the second-look procedure were reduced from initial presentation at most sites; however, nonlaser infertility surgery appeared to have equal or greater efficacy in the prevention of adhesion formation at most sites. Thus, the CO2 laser does not appear to be a panacea for the treatment of tuboperitoneal causes of infertility. Pregnancy rates following intraabdominal use of the CO2 laser remain to be established.

Adolescent↗
PubMed1985

Expectant management and hydrotubations in the treatment of endometriosis-associated infertility.

One hundred twenty-three infertility patients with laparoscopically documented endometriosis were managed expectantly for an interval of 1 to 25 months. Analysis revealed an overall pregnancy rate of 24.4% and a monthly fecundity rate (MFR) of 3.1%. Patients with mild disease had an overall pregnancy rate of 52.9% and an MFR of 5.7%. Women with moderate endometriosis did less well, but still demonstrated a pregnancy rate of 25% and an MFR of 3.2%. No pregnancies occurred with severe disease and expectant management. Postlaparoscopic hydrotubation was evaluated for its therapeutic effect with the use of multivariate analysis and maximum likelihood analysis. The results indicate that there is no decrease in the laparoscopy to conception interval, whereas a potential increase in cure rate cannot be adequately evaluated at this time.

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↗
PubMed1991

Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure.

OBJECTIVE: Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG). DESIGN: Prospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care. PATIENTS: One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure. INTERVENTION: Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube. MAIN OUTCOME MEASURES: Of 155 tubal ostia, 145 (94.2%) were catheterized. RESULTS: Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube. CONCLUSIONS: During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.

Adult↗