Role of hysterolaparoscopy in evaluation and management of infertility

Background: This study was conducted to evaluate the role of hysteron-laparoscopy in evaluation and management of infertility.Methods: Prospective observational study was conducted in department of obstetrics and gynaecology, LLRM medical college, SVBP hospital Meerut from May 2019 to June 2020. It included 58 women aged 22-40 years with primary and secondary infertility with normal hormone profile without male factor infertility.Results: Out of total 58 cases for infertility evaluated, primary infertility were 42 (72.41%) and secondary infertility were 67 (27.59%). In hysteroscopy deep seated ostium (12.06%), followed by endometrial polyp (6.89%) ,intrauterine synechiae (6.89%) were the most common pathologies while common abnormalities in laparoscopy were tubal pathology (20.68%), endometriosis (15.51%), and PCOD (12.06%) .Some of the diagnosed pathologies were dealt surgically in same sitting.Conclusions: Hystero-laparoscopy is a feasible and acceptable procedure and it can be used as “one time approach” in the assessment of female infertility caused due to pelvic and uterine pathology. It helps in diagnosis of certain factors causing infertility, which cannot be diagnosed by any other method such as by USG, HSG and reveals whether surgery is possible and if so the nature of surgery most suited for patient which can be performed in the same sitting.

Diagnostic evaluation of tubal patency in a tertiary care hospital

Background: Infertility has always been one of the most elusive symptom complexes that perplex the best gynecologists. Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. Aim of the study was to compare hysterosalpingography and laparoscopy in the diagnosis of tubal patency in infertile patients.Methods: In this study 50 patients of infertility were evaluated prospectively in the Department of Obstetrics and Gynecology, Government Medical College, Jammu from April 2019 to March 2020. The findings of HSG and laparoscopy were compared.Results: Mean age at presentation for primary infertility was 28.6±4.20 years and for secondary infertility it was 32.1±3.84 years. Majority of patients of primary (77.6%) and secondary infertility (54.5%) had duration of infertility of 1-5 years in our study. The sensitivity of HSG was 90.91% and specificity was 77.78 % with positive predictive value of 83.33% and negative predictive value of 87.50%, when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided.Conclusions: HSG demonstrates high sensitivity in our study. So, it should be used as the initial investigation for identifying tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy.

Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities

Tubal and peritoneal disease are the main causes of infertility. Tubal pathology can be either congenital malformation or acquired, proximal or distal, unilateral or bilateral and transient or permanent. Several imaging methods such as laparoscopy, fluoroscopy, saline infusion sonography, and hysterosalpingography (HSG) have been used in the assessment of tubal and peritoneal pathology. Although laparoscopy is the modality of choice for investigating tubal patency and pelvic structure in many infertility centers, HSG is usually the initial diagnostic method for infertility workup because of its ease of performance, accuracy, and minimal risk of complications. This method provides useful information about size, contour, and anatomy of the inner surface of the fallopian tubes and is the gold standard for evaluation of tubal lumen. Tubal and peritubal pathology show various imaging manifestations on HSG. This review illustrates the radiographic features of congenital and acquired structural abnormalities of the proximal tubal pathology and along with etiology of proximal obstruction or occlusion will be described.

Can Previous Associations of Single Nucleotide Polymorphisms in the TLR2, NOD1, CXCR5, and IL10 Genes in the Susceptibility to and Severity of Chlamydia trachomatis Infections Be Confirmed?

Clear inter-individual differences exist in the response to C. trachomatis (CT) infections and reproductive tract complications in women. Host genetic variation like single nucleotide polymorphisms (SNPs) have been associated with differences in response to CT infection, and SNPs might be used as a genetic component in a tubal-pathology predicting algorithm. Our aim was to confirm the role of four genes by investigating proven associated SNPs in the susceptibility and severity of a CT infection. A total of 1201 women from five cohorts were genotyped and analyzed for TLR2 + 2477 G > A, NOD1 + 32656 T −> GG, CXCR5 + 10950 T > C, and IL10 − 1082 A > G. Results confirmed that NOD1 + 32656 T −>GG was associated with an increased risk of a symptomatic CT infection (OR: 1.9, 95%CI: 1.1–3.4, p = 0.02), but we did not observe an association with late complications. IL10 − 1082 A > G appeared to increase the risk of late complications (i.e., ectopic pregnancy/tubal factor infertility) following a CT infection (OR = 2.8, 95%CI: 1.1–7.1, p = 0.02). Other associations were not found. Confirmatory studies are important, and large cohorts are warranted to further investigate SNPs’ role in the susceptibility and severity of a CT infection.

A STUDY ON THE ROLE OF SALINE SONOSALPINGOGRAPHY AS A TEST FOR TUBAL PATENCY IN THE ASSESSMENT OF INFERTILITY

Background: Tubal pathology is one of the major causes of infertility and evaluation of fallopian tubes forms an essential part of work up of infertility patients. The aim of the study was to evaluate tubal patency by Saline Sonosalpingography and compare the results with that of hysterosalpingography. Methods: A total of 22 patients with primary infertility and 13 patients with secondary infertility attending our Obstetrics and Gynecology department were recruited for the study from July 2019 to June 2020. All the study subjects underwent Saline Sonosalpingography on day 7 to day 9 and Hysterosalpingography on 7th to 11th day of the menstrual cycle. Data was collected and compared to assess the sensitivity and specicity of Sonosalpingography with Hysterosalpingography as reference standard. Results: Sonosalpingography (SSG) has 98.18% sensitivity and 66.67% specicity in comparison to hysterosalpingography (HSG). Analysis of the raw data gave positive predictive value of 91.52% and negative predictive value of 90.9%. Near perfect agreement (Cohen's Kappa coefcient =0.9) was seen between the results of the two methods (SSG and HSG). Conclusions: Sonosalpingogrpahy has a high sensitivity for tubal patency and is less invasive. It is found to be a reliable and relatively less expensive diagnostic procedure in the management of infertility in females. Easy availability and accessibility of ultrasound in all primary health care centres denitely can prove superior to conventional method of diagnosis of tubal patency in such patient.

Comparative evaluation of tubal patency by hysterosalpingography and laparoscopic chromopertubation

Background: Infertility is defined as one year of unprotected intercourse without pregnancy, primary in which no previous pregnancies have occurred and secondary in which a prior pregnancy not necessarily a live birth has occurred. The objective of the study was to compare the relative efficacy of hysterosalpingography (HSG) and laparoscopy with chromopertubation in the diagnosis of tubal factors in infertile women.Methods: 90 infertile women attending the infertility clinic at Dharmapuri Medical College and Hospital were selected for this study. The study period was from April 2016 to July 2017 these patients were initially counseled along with their partners and a thorough history of both the partners was obtained followed by a general and pelvic examination of female partners.Results: HSG results indicated that 48 patients had tubal pathology and 11 patients had uterine pathology. Of those 11 patients with uterine pathology, 6 patients with synechiae had both tubal and uterine pathology. The remaining 5 had only uterine pathology and tubes were patent in them. The site of tubal occlusion in all those blocked tubes shows that more number of the tubal blockage was seen in mid segment of the tube (24 cases) followed by the fimbrial block in 16 cases. Diagnostic laparoscopy with chromopertubation was performed in all 90 patients and the findings were recorded.Conclusions: HSG has reasonably good sensitivity and specificity in diagnosing tubal pathology of infertile women. But given the high rate of false-positive diagnosis of tubal pathology (29%) in HSG, a follow-up laparoscopy is warranted.

EVALUATION OF HYSTEROSALPINGOGRAPHY VERSUS LAPAROSCOPY IN THE DETERMINATION OF TUBAL FACTORS IN FEMALE INFERTILITY: A HOSPITAL BASED COMPARATIVE STUDY.

Objectives: Hysterosalpingography and laparoscopy both are the diagnostic methods for assessment of female infertility. The present study was to compare the evaluation of hysterosalpingography (HSG) versus laparoscopy in determination of tubal factors in female infertility. Methods: Detailed assessment, physical examination and clinical investigations were performed in all 100 infertile female with age 20 years to 40 years. All patients were advised to perform digital HSG. Patients with an abnormal HSG underwent laparoscopy without delay, whereas in patients with a normal HSG, laparoscopy was performed three months after HSG. HSG is best scheduled during the 2nd -5th day interval immediately following the end of menstruation, to minimize risk for infection, avoid interference from intrauterine blood and clot, and to prevent any possibility that the procedure might be performed after conception. Results: Data was analysed by using IBM SPSS version 23 software. All data was tabulated and percentages were calculated. Mean ± standard deviation was observed. Conclusions: Diagnostic laparoscopy is the gold standard in diagnosing tubal pathology and other intra-abdominal causes of infertility. Other hand, Hysterosalpingography is a frequently utilized diagnostic tool in the assessment of tubal status and detection of uterine anatomical defects in infertility. Hysterosalpingography and laparoscopy are not alternatives but complimentary investigations. But, inadequacy of hysterosalpingography (HSG) in determining the state of tubal patency, emphasizes the need for laparoscopy. Laparoscopy provides both a panoramic view of the pelvic reproductive anatomy and a magnified view of pelvic organs and peritoneal surfaces. Keywords: Female infertility, Tubal patency, HSG, Laparoscopy

STUDY OF OPERATIVE OUTCOME OF CORNUAL CANNULATION IN HYSTEROLAPAROSCOPY

Tubo-Peritoneal disease is the cause of infertility in approximately 30% of women, and 10–25% of these are due to proximal tubal obstruction. Hysterosalpngography(HSG) can diagnose the proximal tubal block but confirmation needed by hysterolaparoscopic chromopertubation before subjecting patient to expensive reproductive techniques. In our study of 48 cases, we find out the success rate of cornual cannulation by catheter-guidewire system is almost 81.25% with false positive rate of HSG is 27.2% and sensitivity of 86.4%. We also find out that pelvic inflammatory disease and tuberculosis contributes to 43.9% cases of proximal tubal block and success rate was approximately 50% can be achived in this cases. Hysterolaparoscopic cornual cannulation is simple, cost effective and promising treatment for proximal tubal pathology than tubo-cornual anastomosis with minimal complications. So we conclude that it should be offer on priority basis to treat infertile patients.

ROLE OF HYSTEROSALPINGOGRAPHY IN MANAGEMENT OF FEMALE INFERTILITY AND ITS LAPAROSCOPIC CORRELATION

BACKGROUND : Infertility nowadays has become a medical as well as social problem.Laboratory findings alone is inconclusive in diagnosing infertility.HSG is the radiographic technique for evaluation of uterine cavity & fallopian tubes..Direct visualization of abdominal and pelvic organs in laparoscopy allows a definite diagnosis where clinical examination & less invasive techniques such as ultrasound & HSG fail to identify the abnormality. AIMS & OBJECTIVES :To determine the role of HSG in the evaluation of infertility & to correlate its findings with laparoscopy. METHODS : 75 infertile females aged between 20-40 years were included. HSG & laparoscopy was performed in all patients & findings were analysed. RESULTS : Sensitivity of HSG was 80 %,specificity was 76 % with positive predictive value 63%, negative predictive value 88 % in detecting tubal pathology. Sensitivity of HSG in detecting uterine pathology was 67%, specificity 73%, positive predictive value 39% and negative predictive value 89%. CONCLUSION : HSG has reasonably good sensitivity & specificity in diagnosing tubal & uerine pathology while laparoscopy has diagnostic as well as therapeutic approach.Hence they are complimentary to each other in infertility work up.

Hysterosalpingographic Findings of Infertile Patients Presenting to Our Reproductive Endocrinology Department: Analysis of 1,996 Cases

Background: To evaluate the hysterosalpingography (HSG) findings of women with infertility in a tertiary center located in central Turkey. Methods: A total of 1,996 patients undergoing the HSG procedure for the investigation of infertility from April 2012 to 2017 were retrospectively evaluated using the archives of the reproductive endocrinology and radiology departments. Demographic and clinical characteristics of patients with normal HSG findings (n = 1,549) and patients with abnormal HSG findings (n = 447) were compared, and the distribution of pathologies on the HSG examinations was evaluated as well. Results: There were statistically significant differences between patients with normal and abnormal HSG findings in terms of age (25.68 ± 4.54 vs. 35.87 ± 2.65, p < 0.001), type (for secondary) and duration of infertility [43.1% vs. 50.6% (p = 0.006); 7 (1-22) vs. 2 (1-12) (p < 0.001), respectively], and baseline follicle stimulating hormone and estradiol levels [7.22 ± 1.38 vs. 7.55 ± 1.42 (p < 0.001); 45.54 ± 9.92 vs. 44.40 ± 9.99 (p < 0.001), respectively]. Among a total of 1,996 HSG examinations, 447 (22.39%) showed abnormalities, of which 237 (11.87%) were associated with tubal pathologies, 163 (8.17%) with uterine pathologies, and 47 (2.35%) with a combination of both. While the most common tubal pathology was one-sided distal tubal occlusion (2.91%), the most common uterine pathology was filling defects (4.16%). Conclusion: HSG is the most commonly used, well-tolerated, low-cost, and safe radiological procedure to use for the investigation of the causes of female infertility.