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PubMed1994

Outcome of pregnancy after laparoscopy and chromotubation during cycles of conception: a report of three cases.

BACKGROUND: Diagnostic tubal patency procedures may displace an early pregnancy. Hysterosalpingography performed in the presence of an unrecognized pregnancy has been reported to result in an ectopic pregnancy. No such information on laparoscopy performed during a cycle of conception has been reported. CASES: Three cases of laparoscopy were performed during the luteal phase of an unrecognized pregnancy cycle. The three patients were counseled to avoid conception before surgery. All had an undetectable serum hCG level within 3 days of surgery and an undetectable urine hCG level on the day of surgery. The three pregnancies had an uneventful prenatal course, with delivery at term. CONCLUSION: Although follicular phase scheduling of tubal patency tests would avoid potential pregnancy complications, the risk from luteal phase laparoscopy and chromotubation to an unrecognized pregnancy may be less than expected.

Adult↗
PubMedDate not supplied

[Disturbed utero-tubal transport in hysterosalpingoscintigraphy as a predictive functional test for IVF therapy].

Hysterosalpingoscintigraphy (HSSG) is a simple method to evaluate the transport function of uterus and fallopian tubes. There is a quick uptake of radionuclides into the uterus and a transport to the side bearing the dominant follicle in 70 % of the patients in the late follicular phase of the cycle. Uptake and transport of the immotile radionuclides imitate the directed sperm transport through the female genital tract at the time of ovulation. 214 of 796 infertility patients with proven patency of fallopian tubes (27 %) showed only an uptake of the particles without a transport towards the fallopian tubes (negative HSSG). In these patients no spontaneous pregnancy occurred and pregnancy rate remained low by the means of timed intercourse or insemination. Indeed, the pregnancy rate (8.4 %) was significantly lower compared with the patients who became pregnant by timed intercourse, insemination or spontaneously and had a positive HSSG before (15 %; p=0.001). However, the pregnancy rate that could only be achieved by methods of ART was significantly higher in the group of patients with negative HSSG (57 % vs. 25 %, p=0.05). Our data suggest that HSSG is a new method to evaluate the integrity of the inner genital tract's transport function, especially in patients suffering from idiopathic infertility. Impaired transport function (negative HSSG) should be considered as an indication for IVF-treatment.

Fallopian Tubes↗
PubMed1994

Tubal sterilization by selective catheterization in an animal model.

RATIONAL AND OBJECTIVES: The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application. METHODS: Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated. RESULTS: Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. CONCLUSION: Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.

Animals↗
PubMed1980

Abortion incidence following fallopian tube repair.

The likelihood that ovum transport is altered after fallopian tube surgery for infertility is suggested by the high ectopic pregnancy rate that follows such surgery. To test the hypothesis that a primary (although undefined) disturbance of ovum transport may lead to faulty uterine implantation and so to abortion, the author examined the case records of 273 patients who underwent nonmicrosurgical bilateral tubal surgery for infertility at King George V Memorial Hospital, Sydney, between 1966 and 1975. An analysis of the nature of the first pregnancy in the 71 patients in whom conception occurred indicates an ectopic pregnancy rate of 8.5% and a spontaneous abortion rate among uterine pregnancies of 20.0%, both of which are higher than would be expected normally. It is suggested that the 3 specific reproductive difficulties that can follow technically successful tubal surgery are lasting infertility despite tubal patency, ectopic pregnancy, and abortion.

Abortion, Spontaneous↗
PubMed1997

Ultrasound-guided fallopian tube cannulation using Albunex.

OBJECTIVE: To test the role of transcervical fallopian tube catheterization under ultrasound (US) guidance using an ultrasound contrast agent. DESIGN: Catheterization was performed under US guidance in a patient with bilateral proximal tubal obstruction. SETTING: This study is a case report. PATIENT(S): Proximal tubal obstruction had been diagnosed on previous roentgenogram hysterosalpingography. INTERVENTION(S): Salpingography and tubal cannulation. MAIN OUTCOME MEASURE(S): Tubal patency was assessed using Albunex (Mallinckrodt Medical, St. Louis, MO) enhanced US. RESULT(S): Transvaginal catheterization was successful in achieving tubal patency. CONCLUSION(S): This catheterization technique should be investigated for possible use in the treatment of proximally obstructed tubes.

Adult↗
PubMed2005

[Application of fertiloscopy in infertile women].

OBJECTIVE: To investigate the advantages of fertiloscopy in the examination and therapy of infertile women. METHODS: One hundred and fifteen infertile patients underwent fertiloscopy including transvaginal hydrolaparoscopy (THL), conventional dye-test, hysteroscopy, and dye-test using catheterization of the tubal ostium by hysteroscopy from May 2003 to Mar 2005. Access to the pouch of Douglas was achieved in 110 patients (95.7%). The primary infertile patients (primary group) and secondary infertile patients (secondary group) included respectively 49 and 61 cases. The patients of tubal occlusion in two groups were respectively 21 and 22 cases preoperatively. The fallopian tube patency, pelvic adhesions, complete evaluation (all pelvic organs seen) or not, and intra- and postoperative complications were observed. RESULTS: There was no significant difference in the percentage of uni- and bilateral tubal patency cases between two groups postoperatively (69.4%, 34/49 vs 68.9%, 42/61) (P > 0.05). Of the cases that were bilateral tubal occlusion in both groups preoperatively, the uni- and bilateral tubal patency cases accounted for respectively 47.6% (10/21) and 50.0% (11/22) (P > 0.05) postoperatively. There was no significant difference in the percentage of pelvic adhesions cases between two groups (42.9%, 21/49 vs 60.7%, 37/61; P > 0.05). The overall complete evaluation rate of pelvic organs was 69.1% (76/110), the rates of both groups were respectively 77.6% (38/49) and 62.3% (38/61, P > 0.05). The rate of additional transabdominal operative laparoscopy was 18.2% (20/110) after fertiloscopy, of which, the rate of primary group was only 8.2% (4/49), much less than that of secondary group (26.2%, 16/61; P < 0.05). Seventeen women underwent transabdominal operative minilaparoscopy after fertiloscopy. No complications including pelvic organ injury, rectum perforation, intra- and postoperative bleeding, and postoperative pelvic inflammation occurred. CONCLUSIONS: THL is simple, convenient, and complication-free for the infertile women. Fertiloscopy could be used as a first-line and one-stop procedure in the pelvic assessment of infertile women without clinical or ultrasound evidence of pelvic disease instead of transabdominal laparoscopy. Transabdominal laparoscopy should be only used as a complementary procedure after fertiloscopy.

Adult↗
PubMed1992

Spermatozoal characteristics from fresh and frozen donor semen and their correlation with fertility outcome after intrauterine insemination.

OBJECTIVE: To determine if conventional sperm parameters, specific characteristics of sperm motion determined by computer-aided semen analysis (CASA), sperm penetration assay (SPA), and/or spontaneous acrosome reaction assay could best predict fertility outcome after intrauterine insemination (IUI) from frozen donor sperm. DESIGN: A retrospective analysis of 2,245 cycles of therapeutic donor IUIs were initially studied; 1,147 cycles that met selection criteria were used in this report. SETTING: A university-based assisted reproductive technology center. PATIENTS, PARTICIPANTS: All IUIs were performed on women with documented patency of at least one fallopian tube, ovulatory cycles, and who did not receive human menopausal gonadotropins. Sperm donors had to be used for at least four different recipients (mean of 15) and at least 14 different cycles of insemination (mean of 41). INTERVENTIONS: None. MAIN OUTCOME MEASURE: Pregnancy. RESULTS: Statistical comparisons were made between donors of different relative fertility by using the Mann-Whitney test, Spearman's rank correlation, and multiple regression analysis. These analyses demonstrated that the most significant predictors of the fertility of frozen-thawed donor sperm were curvilinear velocity, straight line velocity, and the total number of motile sperm inseminated. The number of sperm with spontaneous acrosome reactions negatively correlated with fertility outcome, and SPA provided no predictive value. CONCLUSIONS: Our study supports the hypothesis that the study of sperm motion characteristics using CASA after thawing and washing of cryopreserved sperm is a better predictor of fertile outcome after IUI than analysis of fresh semen.

Acrosome↗
PubMed1995

The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis.

OBJECTIVE: To assess the value of hysterosalpingography (HSG) in diagnosing tubal patency and peritubal adhesions using laparoscopy with chromopertubation as the gold standard. DESIGN: Meta-analysis of 20 studies comparing HSG and laparoscopy for tubal patency and peritubal adhesions. PATIENTS: Four thousand one hundred seventy-nine patients with infertility in 20 studies. INTERVENTION: Hysterosalpingography and diagnostic laparoscopy as part of infertility workup. MAIN OUTCOME MEASURE: Tubal patency and peritubal adhesions. RESULTS: For tubal patency the reported sensitivity and specificity differed between studies. In a subset of studies that evaluated HSG and laparoscopy independently, a point estimate of 0.65 for sensitivity and 0.83 for specificity was calculated. For peritubal adhesions a summary receiver operating characteristic curve could be estimated. CONCLUSIONS: Although HSG is of limited use for detecting tubal patency because of its low sensitivity, its high specificity makes it a useful test for ruling in tubal obstruction. For the evaluation of peritubal adhesions HSG is not reliable.

Fallopian Tube Diseases↗
PubMed1997

Radionuclide hysterosalpingography does not distinguish between fertile women, before tubal sterilization, and infertile women.

The female genital tract is capable of active transport that can be demonstrated by serial scintigraphic imaging over time (radionuclide hysterosalpingography; RN-HSG). RN-HSG has been suggested to offer a more functional approach to tubal infertility diagnosis than conventional patency tests. However, before RN-HSG can be recommended as a routine method, its reliability in showing active transport in fertile women must be demonstrated. Therefore we compared RN-HSG in two groups: 38 fertile women before tubal sterilization and 38 women undergoing infertility work-up. Tubal transport demonstrated by RN-HSG was comparably distributed in both groups and classified as bilateral (17 versus 19), unilateral (12 versus 7) or no transport (6 versus 9). In each group three RN-HSG images were not interpretable. There was no association between patency test results and RN-HSG in the two groups. Our data suggest that RN-HSG in its present form does not seem to be a reliable method for infertility work-up. Because RN-HSG and patency tests most probably measure different properties of the genital tract, the phenomenon of active particle transportation should be studied further to enable the development of a reliable tool for the investigation of tubal function.

Adult↗
PubMed1989

[Conservative surgery in tubal pregnancy].

The results of 10 cases of tubal pregnancy treated by conservative surgery from Jan. 1983 to May 1987 were presented. A linear incision on the pregnant tube was used for evacuation of tubal conceptus in 8 cases, in which the incision were reclosed in 3 and left unapproximated as a "open-window" in 5 cases. In the remaining two cases resection + reanastomosis or resection + implantation of the tube into the cornu was done in each. Hysterosalpingography (HSG) was perl formed after operation in 9 cases. Tubal patency was confirmed in 6. One case with only the diseased tube left became pregnant soon after operation before a HSG could be done. The postoperative pregnancy rate was 77.8% in 9 patients desirous of childbirth. There was no repeat ectopic pregnancy. The liberal use of laparoscopy, ultrasound and serum hCG testing for early diagnosis was emphasized.

Adult↗
PubMed1988

[Dynamic ultrasonic hysteroscopy].

An attempt was made to establish Dynamic Echohysteroscopy (DEHS) diagnostic criteria for the study of female genital apparatus, as recently proposed. DEHS consists of a pelvic ultrasonography during and following an injection of physiological solution in the uterine cavity. Since this technique does not use X-rays, it has been proven useful to study female infertility. The authors have studied the normal and pathological aspects of 33 patients who underwent both DEHS and hysterosalpingography (HSG) (comparison diagnostic test). The results lead to the following conclusions: 1) DEHS can be considered a useful alternative to HSG, in the evaluation of uterine pathology; 2) in the evaluation of tubal pathology, DEHS has fewer diagnostic possibilities than HSG. Nevertheless, DEHS indirectly allows the patency of at least one tube.

Adult↗
PubMed1995

A challenge to the concept of tubal reflux to explain the rise and fall of CA125 in serum during the first trimester.

Although amniotic fluid concentrations of cancer antigen (CA) 125 rise during the first two trimesters of pregnancy, the serum concentrations of CA125 peak during the first trimester and drop to non-pregnant values in the second and third trimester. A previous hypothesis to explain this phenomenon was that in the early first trimester decidual CA125 gains access to the maternal compartment via 'tubal reflux' and subsequent absorption by peritoneal lymphatics. However, as pregnancy advances, the decidua capsularis fuses with the decidua parietalis, thus obliterating the endometrial cavity at 10-12 weeks; the Fallopian tubes thus become functionally obstructed. To test this hypothesis, we evaluated early first trimester CA125 concentrations in women conceiving by in-vitro fertilization (IVF) and embryo transfer with patent tubes (group 1) and in those conceiving by IVF and embryo transfer with bilateral tubal occlusion (group 2). We also compared those conceiving with human menopausal gonadotrophin therapy for ovulation induction without assisted reproduction (group 3) and those conceiving without fertility drugs in assisted reproduction (group 4). Mean CA125 concentrations were similar in groups 1-3; the mean CA125 concentration in group 4 was lower but this difference was not statistically significant, probably due to the small sample size. These data do not support the concept that tubal reflux explains the rise and fall of serum concentrations of CA125, since these were equal in IVF conceptions with or without tubal patency.

CA-125 Antigen↗
PubMed1990

[Comparative study of the diagnostic value of hysterosalpingography and laparoscopy].

A total of 100 women had either hysterosalpingography with watersoluble Verografin or lipidsoluble Jodlipol for the assessment of tubal patency. Of these, all had laparoscopy. Laparoscopy have been shown to be the best test of tubal abnormalities. Hysterosalpingraphy with lipidsoluble contrast medium is poorly informative while the method of investigating the tubal pathology and cannot be used in clinical practice.

Adult↗
PubMed1999

Pathophysiology and management of proximal tubal blockage.

OBJECTIVE: To review the physiology, pathology, and treatment of proximal tubal disease. DATA IDENTIFICATION: Relevant reports on the pathophysiology of proximal tubal disease were reviewed. All studies in English of microsurgery and macrosurgery, and of radiographic and hysteroscopic cannulation in women with proximal tubal blockage were identified through MEDLINE searches. STUDY SELECTION: All studies of therapy for proximal blockage that included pregnancy rates were considered. Series of sterilization reversals, series of unilateral or combined procedures, and series in which the location of tubal blockage was not given were excluded from the data analyses. DATA ANALYSIS: Raw data were assessed for homogeneity, then standardized and pooled. Total and ongoing pregnancy rates after microsurgery and macrosurgery, as well as radiographic and hysteroscopic transcervical cannulation, were compared by the chi2 test. Relative risks for total and ongoing pregnancies were calculated for all treatment methods. RESULT(S): This meta-analysis suggests that, overall, microsurgical anastomosis results in higher total and ongoing pregnancy rates than macrosurgery or radiographic tubal cannulation. However, pregnancy rates in selected series of transcervical tubal cannulation are similar to those reported for microsurgery. CONCLUSION(S): Ongoing intrauterine pregnancy rates near 50% can be achieved in patients with proximal blockage of the fallopian tube. Selective salpingography and transcervical cannulation under fluoroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives.

Anastomosis, Surgical↗
PubMed1978

Uterine tube abnormalities in cattle.

A total of 250 reproductive tracts from nonpregnant cows were obtained from a slaughterhouse. Uterine tubes were tested for patency by infusing methylene blue solution, and gross lesions were recorded. Of the 500 uterine tubes, 24 were occluded (unilateral in 20 tracts and bilateral in 2 tracts), and 26 had gross lesions (unilateral in 16 tracts and bilateral in 5 tracts). Approximately one-half of the occluded tubes were not associated with gross lesions. Approximately one half of the tubes with gross lesions were patent.

Adnexal Diseases↗
PubMedDate not supplied

Complementary use of hysterosalpingography, hysteroscopy and laparoscopy in 100 infertile patients: results and comparison of their diagnostic accuracy.

While there is no disputing the invaluable role of laparoscopy in the study of the infertile woman, the function of hysterosalpingography (HSG) and hysteroscopy is still left open to debate. Our research concerns 100 infertile women undergoing HSG, hysteroscopy and laparoscopy; the aim of the study was to check the diagnostic accuracy of the three tests. The sensitivity and specificity of HSG vs hysteroscopy were 74.2% and 91.3% respectively. The sensitivity and specificity of HSG vs laparoscopy were 64.5% and 63.3% as regards tubal patency and 6.9% and 92.8% in the diagnosis of tubal phimosis and pelvic pathology. Despite the limits HSG revealed, our results show that a correct study of the infertile woman can only be accomplished by a combination of all three tests; we therefore recommend a combined approach using all three procedures in all infertile patients.

Adult↗
PubMed1989

The infertility workup and diagnosis.

Infertility affects a significant number of couples. The traditional workup of the infertile couple involves performing a semen analysis, assessing ovulation with a postcoital test to evaluate sperm-mucus interaction, obtaining a hysterosalpingogram to assess uterine structure and tubal patency, and performing laparoscopy to rule out endometriosis and pelvic adhesive disease. In 1988 new techniques were added to our armamentarium, including the use of the sperm penetration assay (hamster test) to rule out occult male factors, the combination of multiple ovarian sonograms and luteinizing hormone surge detection kits to evaluate subtle problems of dysfolliculogenesis, labelled antiimmunoglobulins for the evaluation of sperm antibodies and diagnostic hysteroscopy for evaluating occult uterine pathology.

Fallopian Tube Diseases↗
PubMed1996

Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology.

The aim of the study was to estimate the inter- and intra-observer reproducibility of the interpretation of hysterosalpingography (HSG) in the diagnosis of tubal pathology, and associate reproducibility with diagnostic accuracy. Four observers evaluated 143 HSGs twice, on proximal tubal obstruction, distal tubal obstruction, hydrosalpinx and peritubal adhesions. Diagnostic laparoscopy with chromopertubation was considered to be the reference strategy. Reproducibility (inter- and intra-observer agreement) was expressed in terms of kappa-values. Accuracy was expressed in terms of sensitivity, specificity and likelihood ratios. kappa-values for reproducibility between observers were almost perfect for proximal obstruction, substantial for distal obstruction and hydrosalpinx, and moderate for adhesions. kappa-values for reproducibility within observers were almost perfect for proximal obstruction and substantial for distal obstruction, hydrosalpinx and adhesions. HSG had a high specificity for proximal obstruction, but a low sensitivity. Distal obstruction, absence of hydrosalpinx and adhesions had a poor accuracy. The likelihood ratio for the presence of hydrosalpinx was high. In conclusion, proximal tubal obstruction detected on HSG changes the pre-test probability of proximal tubal obstruction from 16 to 50%. Proximal tubal patency detected on HSG changes the pre-test probability of proximal tubal patency from 16 to 9%. It is unlikely that a lack of reproducibility of the interpretation of proximal tubal patency is responsible for the low sensitivity; alternative explanations are artefacts occurring while performing HSG or an imperfect reference strategy diagnostic laparoscopy. HSG is of limited use in diagnosing distal tubal obstruction and hydrosalpinx, and has no value in the detection of peritubal adhesions.

Fallopian Tube Diseases↗