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At least 613 records · Page 34Linked to original sources
PubMed2002

Occlusion of the fallopian tube by selective transcatheter radiofrequency electrocoagulation: an experimental study in rabbits.

PURPOSE: To test the feasibility of performing transcervical fallopian tube occlusion in a rabbit model with use of unipolar radiofrequency (RF) electrocoagulation. MATERIALS AND METHODS: Under fluoroscopic guidance, transvaginal catheterization of the right or left fallopian tube was first performed with use of a coaxial technique in 20 rabbits. With a metal guide wire protruding from the catheter serving as the active electrode, RF electrocoagulation was performed. The power output was set to 200 W and the current was applied for 20 seconds. The fallopian tube on the contralateral side and the uterus were used as controls. Rabbits were randomly designated to be killed either 2 days (group I, n = 10) or 30 days (group II, n = 10) after the procedure, and tubal patency and histologic changes were evaluated. RESULTS: In group I, significant necrosis of the endosalpinx caused by RF electrocoagulation was found in all 10 rabbits. In group II, the occluded fallopian tube showed fibrosis of the wall in all 10 rabbits, but there was no tissue damage to adjacent organs. Histologic findings in the contralateral fallopian tubes were normal in all 20 rabbits. CONCLUSION: Transcatheter RF electrocoagulation proved to be a safe nonsurgical alternative for occlusion of the fallopian tubes in rabbits.

Animals↗
PubMed1992

Free autologous graft of fimbria to ampulla with subsequent oviductal function in the rabbit.

To test the hypothesis that a free, nonvascularized graft of fimbria would retain structure and function, fimbriae were transplanted autologously in 17 rabbits. Subsequently, the transplanted fimbrial tissue survived, with patency in almost all the animals, was capable of transporting surrogate cumulus oophorus but had reduced ovum capture capability. That the transplanted rabbit fimbria retains a degree of structure and function suggests that the technique warrants an investigation in women.

Animals↗
PubMedDate not supplied

Nonsurgical management of unruptured isthmic ectopic pregnancy: preliminary experience.

Five unruptured isthmic tubal pregnancies diagnosed at laparoscopy were treated with either methotrexate/citrovorum factor rescue (MTX/CF) (n = 4) or observation alone (n = 1). Entry criteria required that the ectopic be fully visualized, no greater than 3 cm in diameter, with intact serosa, and without active bleeding. Treatment selection was based upon preoperative levels of beta-hCG with MTX/CF given to subjects exhibiting a plateaued or rising pattern and observation alone given those with falling levels. Subjects were followed with serial measurements of beta-hCG, complete blood counts, and liver function tests. In all subjects the ectopic pregnancy resolved without further surgery. Time to resolution (first day of treatment to undetectable beta-hCG) ranged from 12 to 55 days. Of the five subjects studied, follow-up hysterosalpingograms in four demonstrated tubal patency on the side of the ectopic gestation.

Adult↗
PubMed2002

Investigation of the infertile couple: a one-stop outpatient endoscopy-based approach.

Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity that takes advantage of micro-endoscopic technology and uses aquaflotation for inspection of the tubo-ovarian structures. In infertility patients, THL is systematically combined with mini-hysteroscopy, chromopertubation, fimbrioscopy and, when indicated, salpingoscopy. Mini-hysteroscopy in combination with the chromopertubation test allows accurate assessment of the uterine cavity and tubal patency. The transvaginal access combined with the aquaflotation during THL facilitates detailed inspection of the tubo-ovarian structures and detection of subtle pelvic disease. This combined transvaginal endoscopic approach allows complete evaluation of the reproductive tract. THL is better tolerated than hysterosalpingography, less invasive than standard laparoscopy, and can be used safely as a first line investigation of the female partner in a one-stop infertility clinic.

Cost-Benefit Analysis↗
PubMed2005

ECHOVIST-200 enhanced hystero-sonography: a new technique in the assessment of infertility.

Tubal occlusion is one of the most common causes of infertility. Therefore, examination of tubal patency is a very important diagnostic tool. Our aim was to determine whether hysterosalpingo-contrast sonography is able to show tubal patency, whether it has any side effects and what role this technique may have in the future. Echovist-200 hysterosalpingo-contrast sonographic examinations have been used in our service in 195 cases since 1998. We found tubal patency in 157 cases (84.4%), and unilateral or bilateral occlusions in 34 instances (12.5%). In four cases we could not visualize the tubes because they were too long. In the last mentioned cases we performed a laparascopy-dye test for the control of our results. The most common side effect during the check-up procedure was abdominal pain. This the patients tolerated well. We did not experience any other serious side effect. Comparing our results with those reported from abroad, we found them similar to the latter. According to our experience, the HyCoSy method for the evaluation of infertility is quick and well tolerated.

Adolescent↗
PubMed1989

Prostaglandin injection for termination of tubal pregnancy: preliminary results.

A variety of conservative surgical techniques is available for the termination of ectopic pregnancy with preservation of the tube. We report on a new treatment by means of intratubal prostaglandin F2 alpha application followed by intramuscular administration of a prostaglandin E2 derivative (sulprostone) for 3 days. Only 5 of the 30 patients enrolled had to undergo laparotomy later. The results were compared with those obtained by different surgical procedures during the 2 preceding years. Hysterosalpingography was performed in 12 patients of the prostaglandin treated group and 14 of the surgically treated group. Tubal patency was demonstrated in 11 patients of the PG group but only in two patients of the surgically treated group.

Abortifacient Agents↗
PubMed1997

Relation between endometrial wavelike activity and fecundability in spontaneous cycles.

OBJECTIVE: To determine whether endometrial activity is related to the occurrence of pregnancy in spontaneous menstrual cycles. DESIGN: Prospective observational ultrasound evaluation of endometrial activity during fertility screening cycles. SETTING: University hospital-based infertility clinic. PATIENT(S): Fifty-nine fertility screening cycles (ultrasound monitoring of follicle growth and ovulation, postcoital test, semen analysis, midluteal P, Chlamydia antibody determination, and tubal patency testing) were performed in 47 couples complaining of infertility. In 33 couples (37 cycles), no fertility impairing factors were found. Endometrial activity was analyzed in these cycles. INTERVENTION(S): Ultrasound examination was performed transvaginally throughout the cycle. MAIN OUTCOME MEASURE(S): Endometrial activity, wave pattern, pregnancy. RESULTS(S): Nine women conceived within the cycle studied. Conception cycles showed less-activity compared with nonconception cycles. Endometrial wavelike activity increased throughout the follicular phase and decreased after ovulation in conception and nonconception cycles. CONCLUSION(S): Endometrial activity is related to fecundability in a spontaneous cycle.

Anovulation↗
PubMed1990

[Linear salpingotomy in the treatment of unruptured tubal pregnancy. Animal experiment study, comparison of 3 laser systems (CO2, Nd:YAG contact, argon)].

The efficacy of three different laser systems for linear salpingotomy was tested in an animal model. For that purpose, the uterus horns of 22 white New Zealand rabbits were incised with the CO2-Laser, the Nd: YAG contact laser and the argon laser using the "bare fiber" technique. The length of uterotomy was between twice and three times of the diameter of the uterine horn. Secondary healing of the incision site was investigated macroscopically (patency, fistulas, formation of adhesions) and microscopically (quantity and quality of the scars) six weeks after the operation. Despite the different primary tissue effect of the laser systems we did not find any significant difference in our postoperative controls.

Animals↗
PubMed2006

Saline sonohysterosalpingographic findings in infertile Nigerian women.

This paper describes the findings in the first 100 women who underwent saline sonohysterosalpingography (SHG) at two privately owned health facilities in Enugu, South East Nigeria. This was a prospective study of the first 100 consecutive women presenting with infertility to the authors at Mbanefo Hospital and Hansa Clinics, both in Enugu, South-East geopolitical zone of Nigeria from 1 May 2005 to 20 January 2006. Saline sonohysterosalpingography was carried out in the standard way in these women. The findings were analysed using simple percentages and means +/- SD. The procedure was completed in 98 women, while in two others it was not possible to cannulate the uterine cavity. A total of 61 of the women had normal uterine musculature, 37 had interstitial fibroids and two had sonographic features of adenomyosis. Regarding the endometrial cavity, 93 women had a normal endometrium, four had a submucosal fibroid, one had intrauterine adhesions, while the endometrial cavity could not be assessed in two women who could not be cannulated. No case of submucosal polyp or uterine septa or other congenital uterine anomalies was seen. As assessed sonologically, 77 of the study subjects had bilateral patent tubes, while five had unilateral tubal patency. In one woman, there was uncertainty about tubal patency or blockage; in two women, the tubes could not be assessed because of non-cannulation of the uterine cavity and in 15 women, both tubes were blocked. A total of 74 women had normal ovaries; 15 had polycystic ovaries; five had atrophic ovaries consistent with ovarian failure and six women had ovarian cysts. In 18 women, the findings at sonosalpingography (SSG) were confirmed at laparoscopy in 11 women or laparotomy (two women) or by the fact that the patients became pregnant (five women). In 15 (83.3%) of these 18 women, the findings at SSG and laparotomy/laparoscopy or of the woman becoming pregnant were compatible. SSG is a useful screening test for assessing endometrial, tubal and ovarian factors in infertile Nigerian women, thereby obviating the need for laparoscopy and hysteroscopy in the majority of cases.

Adult↗
PubMed2006

Tubal pathology: the role of hormonal contraception, intrauterine device use and Chlamydia trachomatis infection.

BACKGROUND: The aim of the present study was to identify a possible association between tubal pathology and the contraceptive methods previously used, especially third generation copper intrauterine devices (IUDs). METHOD: In this retrospective unmatched case-control study, use of contraceptive methods and Chlamydia trachomatis antibody titres were compared in women with tubal occlusion (n = 84) and infertile women with tubal patency (n = 253) demonstrated by hysterosalpingography. Contraceptive methods were also compared to primiparous women with natural pregnancy. RESULTS: A significantly higher percentage of women with tubal occlusion had previously used an IUD. Positive C. trachomatis antibody testing was found significantly more often in women with tubal occlusion. Neither hormonal contraceptives nor condoms were associated with an increased risk for uni- or bilateral tubal occlusion. CONCLUSION: In the present study, we observed an increased rate of tubal occlusions in previous IUD users. This should be considered in the contraceptive counseling of young and nulliparous women.

Adult↗
PubMed1998

Heterotopic pregnancy complicating in vitro fertilization.

A review was undertaken of the cases of heterotopic pregnancy resulting from in vitro fertilization/embryo transfer (IVF/ET) and frozen embryo replacement (FER) in a 6-year cohort of women at National Women's Hospital in Auckland. The incidence of heterotopic pregnancy was 2.9% (5 cases) in 173 clinical pregnancies resulting from 901 embryo replacements. Of the 5 women with heterotopic pregnancy, 1 had unilateral tubal patency and 4 had bilateral tubal blockage; 3 had 'high responder' peak serum oestradiol levels (greater than 9,000 pmol/L) prior to oocyte pick-up (OPU); 3 had a serum human chorionic gonadotrophin beta subunit (beta-HCG) level greater than 600 IU/L on Day 14 following embryo transfer (ET) in the absence of a multiple intrauterine gestation on subsequent ultrasound scan. In the 4 women in whom unequivocal diagnosis of heterotopic pregnancy was not made on the initial ultrasound scan, there was delay in appropriate management, in 1 for more than 5 months. In conclusion, early IVF pregnancies require a transvaginal ultrasound scan performed by a sonographer experienced in the diagnosis of ectopic pregnancy and management of early pregnancy complications by clinicians in close consultation with the IVF centre itself. No single risk factor, laboratory test or combination of these is sensitive or specific enough to predict the occurrence of heterotopic pregnancy. The first-line surgical treatment of heterotopic pregnancy should be laparoscopic salpingectomy with excision of all except the intramural portion of the affected Fallopian tube.

Adult↗
PubMed1986

Segmental uterine horn replacement in the rat using a biodegradable microporous synthetic tube.

To investigate the possible use of a biodegradable microporous synthetic tube for fallopian tube replacement, polyetherurethane/poly-L-lactide (PU/PLLA) grafts in the uterine horn of the rat were studied and their patency and healing characteristics compared with those of nonbiodegradable polytetrafluoroethylene (PTFE; Teflon) grafts as well as with those of reanastomosed uterine horns. Regarding the healing characteristics, the PU/PLLA grafts were superior to the PTFE graft, as was indicated by the regeneration of endometrium and the extensive perigraft tissue ingrowth. However, the graft/uterine anastomoses of the PU/PLLA and PTFE grafts became obstructed by a plug of mucosal folds, all reanastomosed, uterine horns in the control experiments remaining open. In conclusion, although biodegradable microporous PU/PLLA uterine horn grafts have better healing characteristics than PTFE grafts, they easily obstruct at the graft/uterine junction. Mucosal suturing and/or the use of splints may contribute to the feasibility of biodegradable microporous artificial fallopian tubes in tubal surgery.

Animals↗
PubMed1979

Dispensability of fimbriae: ovum pickup by tubal fistulas in the rabbit.

This study was carried out to test the general belief that fimbriae should be considered almost indispensable to ovum capture. Surgical procedures, including resection of the mesotubarium superius and infundibulum tubae together with the creation of a fistula, are described. An attempt to enhance tubal patency by temporarily using estrogens is discussed. Ovum pickup was determined by flushing both tubes and the uterus 2 days following ovulation induction. The prior use of estrogens did not appear to have increased subsequent ovum pickup in control animals; on the contrary, it even seems possible that estrogens had negatively influenced pickup by the fistulas. With five fistulas, however, three recovered ova represented a pickup rate of 7% to 14% of all ova available following one human chorionic gonadotropin-induced ovulation. These figures suggest that ovum pickup by terminal ampullary fistulas is not negligible; they might indicate that absence of fimbriae offers neither good protection against pregnancy following sterilization nor a hopeless prognosis for fimbriectomy reversal when a distal patent tube is present.

Animals↗
PubMed1997

The accuracy of serum chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis.

OBJECTIVE: To assess the discriminative capacity of Chlamydia antibody titers in the diagnosis of tubed pathology in subfertile patients. DESIGN: Meta-analysis of studies comparing Chlamydia antibody titers and laparoscopy for tubal patency and peritubal adhesions. PATIENTS: A total of 2,729 patients with subfertility in 23 studies. INTERVENTION(S): Chlamydia antibody titer and laparoscopy as part of subfertility work-up. MAIN OUTCOME MEASURE: Sensitivity and specificity of Chlamydia antibody titers in the diagnosis of tubal pathology using laparoscopy with chromopertubation as the reference standard. RESULT(S): The discriminative capacity of Chlamydia antibody titers depended on the type of assay that was used. Summary receiver operating characteristic (ROC) curves of studies using ELISA or (micro)immunofluorescence revealed a better discrimination than the summary ROC-curve of studies using immunoperoxidase assay. CONCLUSION(S): The discriminative capacity of Chlamydia antibody titers by means of ELISA, microimmunofluorescence, or immunofluorescence in the diagnosis of any tubal pathology is comparable to that of hysterosalpingography (HSG) in the diagnosis of tubal occlusion. Chlamydia antibody testing involves little burden but provides no details on the anatomy of uterus and tubes. Whether or not Chlamydia antibody testing can replace HSG depends on the perspective taken in the diagnostic work-up of subfertility.

Antibodies, Bacterial↗
PubMed1979

Treatment of female infertility due to tubal obstruction by operative laparoscopy.

The advent in recent years of safe endocoagulation (thermocoagulation within the abdomen) has permitted operative laparoscopic treatment of the tubal factor in infertility in selected cases. This paper reviews the results of operative laparoscopy in 223 cases treated for infertility between 1971 and 1976. Tubal occlusion was present in 133 patients before surgical intervention. Following operative laparoscopy, tubal patency was demonstrated in 67% on testing at the time of operation and in 12% at the first postoperative hydrotubation. In only 21% of cases was tubal patency not achieved by these methods. Those cases requiring isthmic salpingostomy, ampullary or isthmic-tubal implantation, or end-to-end anastomosis were further treated by laparotomy and microsurgery. Ninety cases of pelvic endometriosis were treated by a combination treatment of thermocoagulation, ovarian cyst resection, and the antigonadotropin agent, danazol. Ovariolysis, salpingolysis, fimbrioplasty, and salpingostomy can easily be performed using operative laparoscopy as the method of choice with a minimum of complications, shortened hospitalization time (2 days), and the potential for a repeat procedure or a follow-up laparotomy should this be necessary. The pregnancy rate following laparoscopic treatment for the correction of distal tubal occlusion was 30.5% and for endometriosis genitalis externa, 40%. These rates compare favorably with the rates following procedures involving laparotomy and microsurgery for correction of similar lesions.

Adult↗
PubMed1996

Chlamydia trachomatis antibody titres by enzyme-linked immunosorbent assay are useful in predicting severity of adnexal adhesion.

The aim of this study was to investigate the relationship between chlamydia infection and adnexal adhesion. A total of 131 infertile women who were otherwise asymptomatic underwent chlamydia antibody testing and laparoscopy. These women had additional infertility factors. Serum concentration of anti-Chlamydia trachomatis immunoglobulins G and A were determined prospectively by means of an enzyme-linked immunosorbent assay (ELISA). Results were compared with the tubal patency and severity of adnexal adhesion. Sensitivity, specificity, positive and negative predictive value, and likelihood ratios of anti-C.trachomatis antibody titres for the presence of adnexal adhesion were calculated. Patients who were positive for chlamydia antibody had a significantly higher incidence of tubal occlusion than those who were negative (47.1 versus 25.0%). Adnexal adhesion scores were significantly higher in the patients who were positive for chlamydia antibody than those in patients who were negative (17.1 versus 8.5). Adnexal adhesion scores were significantly correlated with anti-chlamydia antibody titre by ELISA [immunoglobulin (Ig) G: r = 0.60, Ig A: r = 0.61]. As the antibody titre by ELISA rose, the specificity, positive predictive value and the positive likelihood ratio all increased. In conclusion, C.trachomatis antibody testing is a simple and inexpensive means of predicting pelvic damage and laparoscopic examination may be recommended for patients with high anti-C.trachomatis antibody titres by ELISA.

Adnexal Diseases↗
PubMed2002

Reliability of clinicians versus radiologists for detecting abnormalities on hysterosalpingogram films.

OBJECTIVE: To evaluate the consistency of the identification of abnormal findings on hysterosalpingogram (HSG) and compare the reliability of clinicians to that of radiologists. DESIGN: Evaluation of reliability of diagnostic test. PATIENT(S): Women undergoing evaluation for infertility.INTEVENTION(S): Retrospective review of 50 HSG films by three reproductive endocrinologists and three radiologists. Each film was reread 30 days later in a blinded fashion. MAIN OUTCOME MEASURE(S): The consistency of each individual reader, the reliability of detecting specific abnormalities, and the consistency of clinicians compared with radiologists was evaluated with a kappa (K) statistic and interclass correlation coefficient (ICC). RESULT(S): Average intrareader reliability was high for the detection of normal uterus, normal tubes, and tubal obstruction and low for the detection of hydrosalpinx, uterine adhesions, and pelvic adhesions. Inter-reader reliability was high in the detection of normal uterine contour, normal tubal patency, and uterine filling defect and lower for the detection of a hydrosalpinx. The reliability of detecting pelvic adhesion or salpingitis isthmica nodosa was poor. CONCLUSION(S): Intrareader reliability was generally good, especially for the detection of normal findings. Agreement among different readers is lower in detecting rare outcomes such as hydrosalpinx and pelvic adhesion and salpingitis isthmica nodosa. Clinicians more reliably diagnose hydrosalpinx and tubal obstruction, while radiologists more reliably detect the more subtle findings of salpingitis isthmica nodosa or uterine adhesions.

Fallopian Tube Diseases↗
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↗