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PubMedDate not supplied

MR hysterosalpingography in a rabbit model.

Our objective was to evaluate the efficacy of MR imaging as compared with conventional hysterosalpingography (HSG) for the detection of fallopian tube patency after uterine injection of contrast material. Rabbit uterine horns (n= 18) were catheterized transvaginally. Five fallopian tubes were ligated and 11 were left unaltered. T1-weighted gradient-echo MR images were obtained before, during, and after injection of 1.0-3.0 mL of a dilute gadolinium-containing contrast agent. Corresponding conventional studies were performed with an equivalent volume of iohexol. Images were evaluated by two blinded readers. Observers agreed in all cases on the presence (n = 11) or absence (n = 5) of peritoneal spill with conventional HSG. Interpretation of MR HSG concurred with conventional HSG in 14 of 16 cases for each observer (P > .05). Reasons for misdiagnosis included small amounts of spill (n = 2), artifact (n = 1), and subtle spill between bowel loops (n = 1). Sensitivity and specificity for MR HSG were 95.5% and 70%, respectively, for the diagnosis of tubal patency/occlusions. No statistical difference was found between MR HSG and conventional HSG for the diagnosis of fallopian tube patency/obstruction. Potential advantages of MR HSG include no ionizing radiation, potentially diminished local contrast toxicity, superior visualization of uterine fibroids and endometriosis, and visualization of ovaries. We conclude that this technique warrants further study, including the use of a primate model to better simulate human anatomy.

Animals↗
PubMed1985

Evolution and reversibility of damage to rabbit fallopian tubes after five sterilization methods.

The authors used a scanning electron microscope to study epithelial damage to the rabbit fallopian tube after sterilization with different methods and its subsequent capacity to regenerate after recanalization. Thirty female NZW rabbits were divided into five groups and sterilized using the following methods: 1) Madlener 2) Pommeroy, 3) clips, 4) unipolar coagulation, 5) bipolar coagulation. Each group was divided into subgroups of two and submitted at differing intervals to a second laparotomy, during which one tube was removed and the other anastomosed according to Winston's method. Four weeks after the second laparotomy all the rabbits were sacrificed, the remaining tube removed, and all tubes examined with the scanning electron microscope. The results indicate that mechanical methods of occlusion such as clips offer greater recovery possibilities than those in which the lesion is extended to the mesosalpinx. There further exists a correlation between the time that elapses after sterilization and regeneration of the epithelium.

Animals↗
PubMed1987

Comparison between tubouterine implantation and tubouterine anastomosis for repair of cornual occlusion.

Forty-four patients with partial or complete cornual occlusion of their tubes had undergone microsurgical repair in the form of either tubouterine implantation or tubouterine anastomosis. Eighteen of these patients had undergone the implantation procedure and 26 the anastomosis procedure. None of the patients in the implantation group had previous tubal sterilization, while in the anastomosis group 16 had tubal cauterization and 10 had other causes blocking the cornual end of their tubes. The patency rate in the implantation group was 70% and the pregnancy rate was 39%, while in the anastomosis group the rates were 94% and 69%, respectively. It is concluded that, when feasible, tubouterine anastomosis should be the procedure of choice for the repair of the cornual occlusion of the tube irrespective of the cause of obstruction.

Fallopian Tube Diseases↗
PubMed1995

Evaluation of the radiologic findings on hysterosalpingography by selective hydrotubation with flexible hysterofiberscope.

PURPOSE: The objective of this study was to assess further the significance and accuracy of hysterosalpingography (HSG) by comparing the radiologic findings on HSG to selective hydrotubation (SHT) using a hysterofiberscope in 106 women with tubal occlusion. RESULTS: Patency was successfully observed by SHT in 72 of 134 tubes and 62 of 106 patients. Proximal obstruction was divided into three groups according to the shape of cornual obstruction (sharp, dull, defect) on HSG. The success rate for SHT in unilateral obstruction (64%) were significantly higher than those in bilateral obstruction (39%). In the three groups of proximal obstruction, the success rates for SHT were 24, 75, and 30% in sharp, dull, and defect, respectively. The group of dull had significantly higher success rate than the groups of sharp and defect. Thirteen of 62 patients who successfully recanalized became pregnant at 9-month follow-up interval. CONCLUSION: Careful evaluation of the cornual obstruction in radiologic findings on HSG may be important for the decision on further treatment. Furthermore, SHT using a hysterofiberscope is an effective method for evaluating tubal obstruction and for managing it in a selected group of patients with tubal obstruction.

Adult↗
PubMed1997

Direct gamete uterine transfer in patients with tubal absence or occlusion.

PURPOSE: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. DESIGN: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. METHODS: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram- and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. RESULTS: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. CONCLUSIONS: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.

Adult↗
PubMedDate not supplied

The management of female infertility by tubal microsurgical reconstruction: a ten year review.

The outcome of 368 consecutive tubal microsurgical operations excluding reversal of sterilizations, over a ten year period at the Rotunda Hospital, is presented. One hundred and ten conceptions resulted giving a pregnancy rate of 29.9% per procedure. The 'take home baby rate' was 24.2%, with miscarriage and ectopic pregnancy rates of 2.7% and 3% respectively.

Abortion, Spontaneous↗
PubMed2006

Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population.

PURPOSE: The purpose of this study was to determine the recurrence rate of hydrosalpinges after cuff neosalpingostomy in poor prognosis candidates. METHODS: Forty consecutive patients with hydrosalpinx treated with cuff neosalpingostomy were included. Main outcome measures were recurrence rate of hydrosalpinx after cuff neosalpingostomy, intrauterine and ectopic pregnancy rates. RESULTS: Intraoperatively, the mean size of the hydrosalpinx was 1.9+/-0.7 cm, and 77% of patients had evidence of pelvic adhesions. Recurrence of hydrosalpinx, whether unilateral or bilateral was 70% (28/40) per patient. Intrauterine and ectopic pregnancy rates were 5% (2/40) and 2.5% (1/40), with a total pregnancy rate of 7.5% (3/40). CONCLUSIONS: Most patients experience recurrence of hydrosalpinx after cuff neosalpingostomy, thus requiring additional surgery such as salpingectomy prior to in vitro fertilization (IVF). In a poor prognosis population, salpingectomy should be considered as the primary treatment for hydrosalpinx prior to IVF.

Adult↗
PubMed1984

Hysteroscopic sterilization with the use of formed-in-place silicone plugs.

Hysteroscopic sterilization with the use of a formed-in-place silicone plug is an office procedure which can be done with paracervical block anesthesia. It appears to be an effective method of sterilization. The present study is a review of 206 of the author's patients who chose this procedure. Thirty-four patients (16.5%) had more than one procedure for a total of 244 cases. Sterilizations were achieved in 188 patients (91.3%). The sterilization was accomplished in 166 patients (80.6%) at the time of the first procedure, in 20 of 40 patients (9.7%) at the second procedure, and in two of four patients (1.0%) at the third procedure. The primary reason for failure to achieve sterilization was tubal spasm. Of the 18 patients (8.7%) who were not sterilized, 16 were considered as failures and dropped from the study and two are awaiting a repeat procedure. No patients have become pregnant and there have been no significant complications.

Adult↗
PubMed1986

Adhesion formation and uterine tube healing in the rabbit: a controlled study of the effect of ibuprofen and flurbiprofen.

To determine if the prostaglandin synthetase inhibitors ibuprofen and flurbiprofen can suppress postoperative adhesion formation, New Zealand White rabbits that had uterine tubal ligation underwent uterine tube reanastomosis and were given either saline solution (controls), 75 mg of ibuprofen intravenously every 6 hours, or 12.5 mg of flurbiprofen intravenously every 6 hours for 8 doses after operation. Both ibuprofen and flurbiprofen significantly reduced postoperative adhesions (p less than 0.025). With histologic indices of tissue reunion, ibuprofen and flurbiprofen were associated with significantly less scar thickness than controls (p less than 0.001) but did not have any significant effect on mucosal regeneration, foreign body reaction, and muscularis disruption. When all four histologic indices were compared, flurbiprofen but not ibuprofen had a significantly lower score than controls, indicating the greater potency of flurbiprofen over ibuprofen. Our findings show that ibuprofen and flurbiprofen can suppress perioperative and postoperative surgically induced inflammatory response associated with healing and thereby reduce adhesion formation and scar thickness.

Animals↗
PubMed1986

Pathological changes in fallopian tubes following three different kinds of occlusive techniques in primates.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.

Animals↗