Application and pregnancy outcomes analysis of hysteroscopy combined with hysterosalpingo-contrast sonography in intrauterine insemination
10.3760/cma.j.cn112141-20250416-00151
- VernacularTitle:宫腔镜检查联合子宫输卵管超声造影在宫腔内人工授精中的应用及妊娠结局分析
- Author:
Liang LIANG
1
;
Shuo YANG
1
;
Liying WANG
1
;
Yun REN
1
;
Haiyan WANG
1
;
Caihong MA
1
;
Rong LI
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心 国家妇产疾病临床医学研究中心 女性生育力促进全国重点实验室 生殖内分泌与辅助生殖技术北京市重点实验室，北京 100191
- Publication Type:Journal Article
- Keywords:
Insemination, artificial;
Hysteroscopy;
Pregnancy outcome;
Fertility;
Hysterosalpingo-contrast sonography
- From:
Chinese Journal of Obstetrics and Gynecology
2025;60(10):772-781
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare pregnancy outcomes between patients undergoing combined hysteroscopy and hysterosalpingo-contrast sonography (HyCoSy) versus hysteroscopy alone prior to intrauterine insemination, and to evaluate the safety and clinical value of the combined procedure in the diagnosis and treatment of infertility.Methods:A retrospective analysis was conducted on clinical data from 385 patients who underwent hysteroscopy at Peking University Third Hospital between October 1, 2020 and September 30, 2022, and subsequently received their first cycle of artificial insemination with donor sperm (AID) within six months. Pregnancy outcomes were compared between the group receiving combined hysteroscopy with four-dimensional HyCoSy (hysteroscopy+4D-HyCoSy group) and the group receiving hysteroscopy alone (hysteroscopy group). Multivariate logistic regression was used to analyze factors influencing pregnancy outcomes after AID.Results:Among the 385 patients included, 79 achieved clinical pregnancy. The clinical pregnancy rate (24.9%, 53/213) and live birth rate (21.1%, 45/213) in the hysteroscopy+4D-HyCoSy group were significantly higher than those in the hysteroscopy group [15.1% (26/172) and 12.8% (22/172), respectively; all P<0.05]. There was no significant difference in tubal patency between the two groups ( P>0.05); however, the time interval from tubal patency assessment to intrauterine insemination was significantly longer in the hysteroscopy group compared to the hysteroscopy+4D-HyCoSy group (median: 4.0 vs 2.0 months; P<0.001). Multivariate analysis showed that double insemination significantly increased clinical pregnancy rate compared to single insemination ( OR=2.42, 95% CI: 1.02-5.72; P=0.044). An interval exceeding 6 months between tubal patency assessment and intrauterine insemination was identified as a risk factor for reduced clinical pregnancy ( OR=0.35, 95% CI: 0.14-0.92; P=0.047). Additionally, neither the time interval from hysteroscopy to intrauterine insemination nor hysteroscopic findings and pathological diagnoses had significant effects on clinical pregnancy rates (all P>0.05). Conclusions:The combination of hysteroscopy and HyCoSy provides a safe and efficient approach for fertility assessment in infertile patients and improves clinical pregnancy rate and live birth rate in intrauterine insemination cycles. Hysteroscopy is recommended for patients with suspected endometrial or intrauterine abnormalities. If no previous tubal patency assessment has been performed or the last assessment was more than six months prior, combined hysteroscopy and HyCoSy may be considered to enhance the likelihood of clinical pregnancy.
