OBJECTIVES: According to the World Health Organization (WHO), infertility rates have been steadily rising worldwide. Identifying risk factors for contrast agent reflux into the myometrium during hysterosalpingo-contrast sonography (HyCoSy) is of clinical significance in reducing this complication and improving infertility treatment. However, there is currently no standardized pre-evaluation method for predicting intra-myometrial contrast reflux, with clinical assessment often relying on physician experience and patient symptoms. This study aims to identify imaging risk factors for contrast agent reflux into the myometrium using four-dimensional (4D) HyCoSy and to construct a nomogram-based predictive model to assist in clinical decision-making. METHODS: A retrospective analysis was conducted on 1 274 infertile women who underwent 4D HyCoSy at the Women and Children's Hospital of Hunan and the the Third Xiangya Hospital of Central South University from January 1, 2020, to December 15, 2022. Patients were divided into a reflux group (n=234) and a non-reflux group (n=1 040) based on the presence of intra-myometrial contrast reflux. Univariate and multivariable Logistic regression analyses were used to identify significant predictors, which were then used to construct a nomogram model. Internal validation was performed using 500 bootstrap resamples. RESULTS: The age of the reflux group was significantly higher than that of the non-reflux group [(31.82±5.27) years vs (30.66±4.83) years, P=0.001 1]. Primary infertility was more common in the non-reflux group (50.96%), while secondary infertility dominated in the reflux group (76.50%), with 72.65% having a history of gynecological surgery (P<0.001). Abnormal menstrual volume and discomfort during the procedure were more common in the reflux group, while the non-reflux group tolerated higher contrast agent doses (P<0.001). Imaging differences included endometrial thickness, tubal wall smoothness, and peritoneal contrast dispersion, with the non-reflux group showing thicker endometrium and smoother, more patent tubes. The nomogram model yielded an area under the curve (AUC) of 0.854, indicating good predictive performance. The AUC of the decision curve analysis (DCA) for internal validation of the model was 0.737. When the threshold probability for contrast agent reflux into the myometrium ranged from 0.05 to 0.95, the maximum net benefit reached 0.18. The net benefit of applying the nomogram predictive model exceeded that of either full intervention or no intervention, indicating that the model demonstrates good clinical predictive performance. CONCLUSIONS The nomogram model, based on infertility type, endometrial thickness, contrast agent dose, and discomfort symptoms, effectively predicts intra-myometrial contrast agent reflux after 4D HyCoSy. It provides a valuable tool for clinicians to implement early preventive measures and reduce the risk of contrast leakage and associated complications.
Humans ; Female ; Nomograms ; Contrast Media/adverse effects* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Hysterosalpingography/methods* ; Infertility, Female/diagnostic imaging* ; Myometrium/diagnostic imaging* ; Risk Factors

OBJECTIVE: To present our experience with laparoscopic tube-preserving surgery for ectopic tubal pregnancy and evaluate its feasibility and efficacy. METHODS: This was a prospective study of 57 consecutive patients with ectopic tubal pregnancies undergoing laparoscopic tube-preserving procedures including salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking. The outcome measures were treatment success rates and homolateral patency rates. RESULTS: Of the 57 surgical procedures, 55 (96.4%) were performed successfully without any additional intervention. The number of patients receiving salpingotomy, salpingostomy, segmental resection and reanastomosis, and fimbrial milking were 24 (42.1%), 25 (43.9%), 4 (7.0%), and 2 (3.5%), respectively. Two case was switched to salpingectomy because excessive bipolar coagulation was required to obtain hemostasis at the tubal bleeding bed. Over a mean β-human chorionic gonadotropin resolution time of 18.3±5.9 days, no persistent trophoblast or postoperative complications occurred. A tubal patency test using hysterosalpingography was performed in 15 cases at 3 months postoperatively. Among these, the homolateral tubal patency rate was 75% (11 of 15) and the contralateral patency rate was 80% (12 of 15). CONCLUSION: Tube-preserving surgery is a feasible and safe treatment option for ectopic tubal pregnancy. However, considering that the optimal goal of tube-preserving surgical procedures is not the treatment success, some caution is warranted in interpreting results of this study.
Chorionic Gonadotropin ; Female ; Hemorrhage ; Hemostasis ; Humans ; Hysterosalpingography ; Milk ; Outcome Assessment (Health Care) ; Postoperative Complications ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Prospective Studies ; Salpingectomy ; Salpingostomy ; Trophoblasts

OBJECTIVETo investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in assessing tubal patency with chromolaporoscopy.

METHODSA total of 157 infertile women underwent 3D-HyCoSy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test.

RESULTSAmong the 306 oviducts examined by 3D-HyCoSy, 99 (32.4%) were patent, 126 (41.2%) partially obstructed, and 81 (26.5%) completely obstructed. Diagnostic results with 3D-HyCoSy were not statistically different from those obtained in the 39 women (78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance (k=0.747, P=0.000). The 3D-HyCoSy procedure had a sensitivity of 84.8% (28/33), a specificity of 96.2% (25/26), and positive and negative predictive values of 93.3% (28/30) and 86.2% (25/29) respectively.

CONCLUSIONTransvaginal 3D-HyCoSy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.

Contrast Media ; Fallopian Tube Patency Tests ; methods ; Fallopian Tubes ; diagnostic imaging ; Female ; Humans ; Hysterosalpingography ; Imaging, Three-Dimensional ; Infertility, Female ; diagnostic imaging ; Laparoscopy ; Ultrasonography

OBJECTIVE: To investigate the value of stimulated intrauterine insemination (IUI) in women with unilateral tubal occlusion. METHODS: Superovulation and IUI was performed during 2003-2010 and the medical records were reviewed retrospectively. Thirty-seven infertile women (52 cycles) with unilateral tubal occlusion diagnosed by hysterosalpingography and without other causes of infertility were selected. One-hundred fourteen patients with unexplained infertility served as a control group (182 cycles). The main outcome was the clinical pregnancy rate per cycle. RESULTS: The pregnancy rate per cycle was similar, 17.3% for the unilateral tubal occlusion group and 16.5% for the unexplained infertility group. The rate of miscarriage (11.1% vs. 23.3%) and ectopic pregnancy (11.1% vs. 6.7%) was similar between the two groups. The pregnancy rate was higher in patients with proximal occlusion (25.0%) compared with distal occlusion (13.9%) or unexplained infertility, but not statistically significant. CONCLUSION: Stimulated IUI can be suggested as the initial treatment option in women with unilateral proximal or distal tubal occlusion.
Abortion, Spontaneous ; Fallopian Tube Diseases ; Female ; Humans ; Hysterosalpingography ; Infertility ; Insemination ; Medical Records ; Pregnancy ; Pregnancy Rate ; Pregnancy, Ectopic ; Retrospective Studies ; Sterilization, Tubal ; Superovulation

OBJECTIVE: To evaluate the effect of hysterosalpingo-contrast sonography (HyCoSy) on natural conception in the infertile patient. METHODS: We conducted a prospective observational study recruiting 180 patients admitted to Infertility Center of Ferrara University from January 2010 to February 2012. The essential inclusion criteria was the couple's desire to perform only diagnostic evaluation on infertility causes and to wait for natural conception before proceeding with further management. Couples were investigated with hormonal profile, semen analysis and HyCoSy. Expected time for spontaneous pregnancy was 180 days from HyCoSy. First datation sonography of pregnancy was used calculating time elapsed from HyCoSy at conception. RESULTS: Forty patients (22.2%) obtained spontaneous pregnancy within 6 months after HyCoSy. The mean of "conception time" was 75 days. The pregnancy rate was significantly higher in the first 30 days (45%) compared to other the months of observation (p<0.0005). Multiple linear regression analysis showed that maternal age and sterility duration proved independent variables in detecting the "conception time" after HyCoSy (t=3.742, p=0.001, t=2.371, p=0.02, respectively). CONCLUSION: A possible beneficial effect of HyCoSy is feasible especially in the days following its execution. This temporal correlation supports its therapeutic use.
Fallopian Tubes ; Family Characteristics ; Female ; Fertilization ; Humans ; Hysterosalpingography ; Infertility ; Linear Models ; Maternal Age ; Pregnancy ; Pregnancy Rate ; Prospective Studies ; Semen Analysis

To compare the accuracy of transvaginal ultrasound, hysterosalpingography and hysteroscopy in the detection of intrauterine lesions that may be associated with infertility, the medical records of 452 women who each underwent all three procedures from January 2007 to July 2010 were reviewed. Hysteroscopy appears to have the highest sensitivity for the diagnosis of endometrial polyp, submucous myomas and endometrial hyperplasia. On the other hand, hysterosalpingography has the highest specificity for the diagnosis of endometrial polyp, submucous myomas, endometrial hyperplasia, and intrauterine septa. Combination of procedures improved diagnostic accuracy in terms of specificity.
Human ; Female ; Middle Aged ; Adult ; ULTRASONOGRAPHY ; HYSTEROSALPINGOGRAPHY ; HYSTEROSCOPY

OBJECTIVE: To evaluate the significance and efficacy of trans-cervical fallopian tube catheterization (TFTC) in diagnosis and optimal treatment modality for tubal blockage. METHODS: The retrospective study was performed in those underwent TFTC from January 2005 to December 2009. A total of 342 fallopian tubes in 215 patients which showed tubal blockage in hysterosalpingography (HSG), were subjected to TFTC. Recanalization rate (RR) was compared according to portion of tubal blockage; proximal, isthmic and distal portion and blockage type; tapering, concave, and convex type. RESULTS: In total, RR was 72.5% (248/342 tube). According to the portion of tubal blockage, RR was 83.8% in proximal, 45.6% in isthmic and 100% in distal portion. RR was 92.3% in tapering, 80.2% in concave and 25.5% in convex type, respectively. There were 98 pregnancies in 156 patients after successful recanalization, which shows 62.7% pregnancy rate. CONCLUSION: TFTC were capable of recanalizing tubal blockage in 248 of 342 tubes in 156 of 215 patients (72.5%). The RR was increased with proximal portion and tapering type tubal blockage.
Catheterization ; Catheters ; Fallopian Tubes ; Female ; Humans ; Hysterosalpingography ; Infertility ; Pregnancy ; Retrospective Studies

Adult ; Female ; Foreign-Body Migration ; Humans ; Hysterosalpingography ; Sterilization, Tubal ; adverse effects ; Surgical Instruments ; adverse effects

OBJECTIVE: To investigate the clinical characteristics of symptoms, diagnostic procedures, infertility, obstetrical complications, and surgical corrections in women with congenital uterine anomalies. METHODS: Between January 1990 and December 2007, 110 patients diagnosed with uterine anomalies from Kangnam St. Mary's Hospital, the Catholic University of Korea were included in this study. The charts of patients were reviewed retrospectively for uterine anomaly type, clinical symptom, diagnostic workup, fertility, fetal presentation, and uteroplasty. Congenital anomaly was categorized according to classification by the American Fertility Society (1988). RESULTS: Uterine anomaly was noticed in 1 in 752 patients (0.13%) who visited the inpatient department. The diagnosis was made by pelvic ultrasonography and manual examination (45.5%), incidental discovery during Cesarean section (24.5%), and other surgical procedures and salpingography. Most common types of uterine anomaly were bicornuate uterus (42 cases, 38.2%) and uterine didelphys (39 cases, 35.5%). Renal anomaly was accompanied in 21 patients (19.1%), frequently associated with bicornuate uterus and uterine didelphys. Uteroplasty was performed in 26 patients with 9 cases of bicornuate uterus (34.6%) and 8 cases of septate uterus (30.8%). The cases diagnosed incidentally during prenatal ultrasound examination were 35.5%. Other initial symptoms were dysmenorrhea, pelvic pain and habitual abortion. Primary infertility was reported in 3 cases (2.7%) which was fewer than abortion. Primary dysmenorrhea was observed in 2 cases (1.8%). One case of PID (0.9%) and one asymptomatic case were noted. Among 241 pregnancies, there were 46.9% full term birth, 24.34% abortion, 9.5% preterm birth, and 0.83% ectopic pregnancy. Fetal presentations were 16.67% breech and 1.51% transverse lie. Cesarean section rate was 81.3%. CONCLUSIONS: Women with uterine anomaly complain symptoms such as dysmenorrhea and pelvic pain, but most are aymptomatic and diagnosed incidentally. They are frequently accompanied with urologic anomalies and complicated with obstetrical challenges such as preterm labor, habitual abortion, malpresentation, intrauterine growth retardation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss sufficiently with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly.
Abortion, Habitual ; Cesarean Section ; Dysmenorrhea ; Female ; Fertility ; Fetal Growth Retardation ; Humans ; Hysterosalpingography ; Incidental Findings ; Infertility ; Inpatients ; Korea ; Labor Presentation ; Obstetric Labor, Premature ; Pelvic Pain ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Ectopic ; Premature Birth ; Prognosis ; Retrospective Studies ; Term Birth ; Urogenital Abnormalities ; Uterine Inertia ; Uterus

OBJECTIVE: To analyze the tubal patency in the young-aged women underwent diagnostic laparoscopy with Fitz-High-Curtis Syndrome (FHCS). METHODS: Clinicopathologic results of young-aged women who underwent diagnostic laparoscopy with pelvic inflammatory disease from March 2005 through April 2007 were reviewed. Twenty six patients aged 19-29 years old and preserved their both tubes after diagnostic laparoscopy were included in this study. All were underwent chromopertubation test (CPT) during laparoscopy and postoperative hysterosalpingography (HSG) 3 months later. RESULTS: Of 26 patients, eight patients were diagnosed with FHCS and the others were not. There was no significant difference in mean age, mean hospitalization days, and frequency in past-history of parturition, abortion, chlamydia and gonococci infection between patients with FHCS and with non-FHCS (P>0.05). There was no significant difference in frequency of tubal obstruction in laparoscopic CPT (P>0.05) but not in postoperative outpatient HSG (P<0.05). CONCLUSION: The tubal obstruction may be more frequent in FHCS than non-FHCS and the reliability of laparoscopic CPT for diagnosing the tubal obstruction is supposed to be low. Therefore, as for FHCS patients, HSG should be executed to investigate tubal factor which is helpful to forecast the fertility.
Aged ; Chlamydia ; Fallopian Tube Diseases ; Female ; Fertility ; Hospitalization ; Humans ; Hysterosalpingography ; Laparoscopy ; Outpatients ; Parturition ; Pelvic Inflammatory Disease