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PubMed1993

Transcervical tubal cannulation and salpingoscopy in the treatment of tubal infertility.

Transcervical tubal cannulation and salpingoscopy are two recent techniques used for the evaluation of tubal patency and pathology. Selective tubal cannulation cannot determine the nature of the obstructive process, although it does allow for the demonstration of potential tubal patency. This may be important in deciding whether therapies requiring tubal patency may be used in specific clinical situations. Because currently there are no controlled studies in the literature evaluating this technique, the therapeutic value of the procedure must be considered unproven at this time. Salpingoscopy gives more detailed information concerning the tubal mucosa. The identification of specific tubal lesions has been described with this modality. The predictive value of salpingoscopy in cases of severe anatomic distortion, ie, fibrous obliteration, seems obvious. However, its predictive value in the presence of more subtle lesions needs to be studied further because its role as a therapeutic modality is as yet undefined.

Cervix Uteri↗
PubMed1995

Tubal cannulation.

While uterotubal chromopertubations were performed early in the 1970s with the introduction of hysteroscopy, cornual cannulation was extended and adapted to fluoroscopy. The disadvantages of fluoroscopy include the difficulty in ruling out tubal spasm, inability to evaluate distal tubal disease, and other pelvic abnormalities. Tubal cannulation has emerged as an excellent alternative to treat patients with cornual obstruction. Only those patients in whom cannulation fails should be subjected to microsurgical reconstruction. While cannulation with coaxial catheters began under fluoroscopy, the use of the hysteroscope simplifies the technique. With laparoscopy the hysteroscopic approach enables tubal cannulation and evaluation of the entire pelvis. Treatment of additional problems affecting the fallopian tubes, particularly adhesions and endometriosis, is possible. Laparoscopy helps in monitoring the procedure and visual assessment of tubal patency. The ability to observe the uterotubal junctions directly by hysteroscopy provides an excellent approach for tubal cannulation. There are two techniques to cannulate the fallopian tubes, either with coaxial catheters or catheters with distal balloons, but the result obtained with these two techniques is similar. The simplicity of coaxial catheters makes this approach more appealing, and with the hysteroscope one can avoid exposure to radiation. The results obtained with tubal cannulation are encouraging and this procedure should be offered as the initial method to attempt treatment of tubal cornual obstruction. Often it can represent an excellent alternative to microsurgical tubal anastomosis, avoiding a laparotomy and extended disability.

Anastomosis, Surgical↗
PubMedDate not supplied

[Experience in using kymographic pertubation in the diagnosis and treatment of infertility in a consultation office for women].

The paper describes the authors' experience in using a [symbol: see text]JITB-01 hysterotubator in the diagnosis of amphora at a women's dispensary from 1991 to 1995. All females who had complaints of being infertile for two years were examined with the hysterotubator. They included 290 females aged 21 to 43 years. Taking into account reexaminations, such studies were 317 altogether. Long-term outcomes could be followed up in 67% of the examinees undergone kymopertubation. Pregnancy occurred in 7% of cases within the first six months after kymoperturbation.

Adult↗
PubMedDate not supplied

[Experience in using the DLTB-01 hysterotubator for the diagnosis and treatment of tubal infertility].

The paper presents some experience in applying a DLTB-01 hysterotubator to diagnose and treat tubal infertility in females. The patients underwent kymoperturbation from either diagnostic or therapeutical points of view. A hundred seventy eight sessions were performed in 151 females. Analysis of the results of examinations and treatment suggests that the DLTB-01 hysterotubator is beneficial.

Adult↗
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↗
PubMed1977

Foley catheter for salpingography, pneumonography, tubal insufflation, and hydrotubation.

Using a pediatric Foley catheter, salpingography, CO2 insufflation, hydrotubation, pelvic pneumography, pelvic pneumoperitoneum for laparoscopy, and pneumohysterosalpingography were performed in more than 1000 cases. The Foley catheter technic was fully described and the advantages outlined. In general, the Foley catheter proved to be a simple and atraumatic technic, eliminating some of the difficulties associated with the use of the metal cannula.

Catheterization↗
PubMed1996

Loupe microsurgical tubal sterilization reversal. Experience at a community-level naval hospital.

OBJECTIVE: To evaluate the success rates of loupe microsurgical tubal sterilization reversal procedures performed by a generalist obstetrician-gynecologist at a community-level naval hospital. STUDY DESIGN: Consecutive patients who underwent microsurgical tubal anastomosis under loupe magnification by the author during a 16-month period were subjected to a review for outcome in this case series report. RESULTS: Twenty-three patients who underwent reversal of tubal ligation by the author were examined for outcome. By 29 months after the last case studied, the overall conception rate was 78.3% and intrauterine pregnancy rate 68.6%. The miscarriage and ectopic rates were 13.0% and 8.7%, respectively. CONCLUSION: Loupe microsurgical tubal reversal by a properly trained generalist obstetrician-gynecologist at a community hospital rendered success rates comparable to those published in the literature.

Abortion, Spontaneous↗
PubMed1977

[Diagnosis and therapy of sterile marriages. Retrospective studies on the sterility of 500 childless couples].

In the retrospective analysis of 500 involuntarily childless couples the following results were observed: The pregnancy rate was 37.2%. The age of the women did not influence the conception rate significantly. Women with a sterility of less than 5 years duration had a statistically higher conception rate than those with longer lasting sterility. Patients with oligomenorrhea had a significantly higher pregnancy rate than those with normal menstrual cycle. Cyclofenil therapy resulted in a significantly higher conception rate than treatment without ovulation inducing compounds. Homologeous insemination had a pregnancy rate of 25,4%. The additional therapy with ovulation inducers did not influence the results significantly. Patients with uterine hypoplasia had a significantly higher conception rate than women with normal uterine size. Women who showed uterine hypoplasia before sterility treatment had taken oral contraceptives less often than women with normal uterine size. There was a significant correlation between uterine hypoplasia and cyclic disorders. Women with cyclic disorders had hirsutism more often than those with a normal cycle. In cases with normal sperm count (40 mill./ml) there was a significantly better pregnancy rate than in those with oligozoospermia (40 mill./ml). In cases of sperm motility of over 70% a significantly higher pregnancy rate was observed than in those with a motility below 70%. In spermiograms with more than 70% of normally configurated sperms the results were significantly better than in those with less than 70% normal sperms.

Contraception↗
PubMed1997

Ultrasound in the investigation of tubal patency. A meta-analysis of three comparative studies of Echovist-200 including 1007 women.

DESIGN: This study is a meta-analysis of the results of three clinical studies of the ultrasound echo-contrast agent Echovist-200 with transvaginal contrast sonography (HyCoSy) in the demonstration of tubal patency. Results from 1007 patients were included in the analysis, of whom 986 patients were examined for tubal patency. The HyCoSy findings were compared with those of chromolaparoscopy in 428 cases and with those of hysterosalpingography (HSG) in 202. RESULTS: The results of HyCoSy and chromolaparoscopy were identical in 294 of 428 patients (68.7%) or in 688 of 828 individual tubes (83.1%). HyCoSy showed "false" occlusion in 85 tubes (10.3%) and "false" patency in 55 (6.7%). The results of HyCoSy and HSG were identical in 138 of 202 patients (68.3%) or in 320 of 384 individual tubes (83.3%). HyCoSy showed "false" occlusion in 49 tubes (12.8%) and "false" patency in 15 (3.9%). The findings of chromolaparoscopy and HSG agreed in 49 of 77 patients (63.6%) or in 116 of 152 tubes (76.3%). HSG showed "false" occlusion in 19 (12.5%) tubes and "false" patency in 17 (11.2%). TOLERANCE: Echovist-200 was well tolerated. The most frequent adverse event was pain, which was mild in 42.3% of patients and severe in 10.1%. Pain was clearly related to tubal occlusion. Other adverse events such as vasovagal reactions or nausea occurred in 7.0% of patients, but the events required treatment in only 1.9%.

Clinical Trials as Topic↗
PubMed1976

The management of infertility.

Infertility remains a difficult clinical problem but with only a small amount of effort most clinics can improve facilities and streamline investigations. Lack of continuity remains one of the most trying problems for both patient and clinician. Reasonable time limits limits must be placed on investigations and the idea of adoption should be introduced at the appropriate time. Future developments may gradually help to eradicate the problem.

Adoption↗
PubMed1998

Intramural tubal polyps--a villain in the shadows?

BACKGROUND: Intramural tubal polyps are commonly described in association with subfertility. However, there is unfamiliarity among clinicians about the investigations available for making a diagnosis of this condition. The objective of this paper was to highlight the suitable investigations for diagnosis and thus increase awareness of this condition and its relationship with subfertility. METHOD: A retrospective review of 14 patients with intramural tubal polyps was done for the period from January to December 1996. An attempt was made to correlate the radiographic findings on hysterosalpingography with transvaginal ultrasound examinations and hydrochromotubation performed under laparoscopic observation. The fertility history of these patients was also examined. RESULTS: The review demonstrated a prevalence of 3.8% of intramural tubal polyps in a selected population of predominantly subfertile women. Only hysterosalpingography was useful in making the diagnosis in-vivo. Fifty percent of the patients did not have any other obvious pathology to explain their subfertility. CONCLUSION: We conclude that meticulous hysterosalpingography is useful as a diagnostic investigation and that consistent reporting is needed for good follow-up.

Coloring Agents↗
PubMed1998

[A case of air embolism during tubal insufflation].

Air embolism occurred immediately after tubal insufflation in a 40-yr-old female patient following abdominal total hysterectomy under general anesthesia. Abrupt decreases in Etco2, Spo2, and blood pressure were observed. Blood gas analysis revealed a marked difference between PaCO2 and EtCO2. The patient recovered soon and was extubated in the operating room. The post operative course was uneventful. Monitoring of EtCO2 was effective for early detection of air embolism.

Adult↗
PubMed2000

MR hysterosalpingography: protocol development and refinement for simulating normal and abnormal fallopian tube patency--feasibility study with a phantom.

PURPOSE: To develop and refine a pulse sequence and protocol for testing the feasibility of magnetic resonance (MR) hysterosalpingography in a phantom model. MATERIALS AND METHODS: A phantom simulating the uterus, fallopian tubes, and surrounding pelvic cavity was constructed. T2-weighted acquisition strategies-breath-hold fast spin-echo, rapid acquisition with relaxation enhancement (RARE), and haff-Fourier RARE-were refined to acquire sequential 70-mm coronal imaging volumes. Contrast agent was injected into the introducing catheter entering the os of the simulated uterus. Interacquisition interval, type of contrast agent (eg, sterile saline solution or water), and quantity of contrast agent (eg, 1-5 mL per acquisition) were varied. Digital image subtraction was used to enhance image quality. Images were qualitatively analyzed and rated good, fair, or poor for temporal resolution, spatial resolution, fallopian tube conspicuity, and free spill conspicuity. Once the technique was refine, the phantom was reconfigured to simulate unilateral and bilateral hydrosalpinx. RESULTS: The RARE sequence with an 8-second interacquisition interval and a 5-mL interacquisition of sterile water produced good images of the simulated fallopian tubes and free spill. Depiction of unilateral and bilateral hydrosalpinx was also reliably demonstrated. CONCLUSION: This study with a phantom model demonstrates the feasibility of MR hysterosalpingography to depict normal and diseased fallopian tubes.

Constriction, Pathologic↗
PubMed2001

The study of ovarian artery hemodynamics in patients with infertility by color Doppler energy.

Seventy-four cases of infertility were examined to study the hemodynamics of the bilateral ovarian arteries at 21st day during the corpus luteum phase by color Doppler energy(CDE) and color Doppler flow imaging (CDFI). All the patients were verified by laparoscopy, fallopian tube patency examination and ovarian function test. Twenty-two healthy women served as controls. The results showed that the difference of resistance index(RI) and pulsatility index (PI) of bilateral ovarian arteries between the infertility and the normal controls had statistical significance (P < 0.01), and the PI showed negative correlation with the thickness of endometrium (left side: r = 0.724, P < 0.01; right side: r = 0.756, P < 0.01). The results also showed that CDE was more sensitive than CDFI in displaying the ovarian arteries. It could be concluded that the elevated resistance of ovarian artery during the corpus luteum phase was one of the important factors that resulted in infertility.

Adult↗