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

Author(s): Zeynep Ozturk Inal*, Hasan Ali Inal, Aysegul Altunkeser, Ender Alkan, Fatma Zeynep Arslan.

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 8 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

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.

Keywords: Infertility, female, investigation, hysterosalpingography, patients, uterine pathologies.

[1]
Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 2009; 92(5): 1520-4.
[http://dx.doi.org/10.1016/j.fertnstert.2009.09.009] [PMID: 19828144]
[2]
Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. Isr Med Assoc J 2011; 13(1): 51-4.
[PMID: 21446238]
[3]
Inal HA, Kahyaoglu I, Yilmaz N, Turkkani A, Tuzluoglu D. Retrospective comparison of intracytoplasmic sperm injection outcomes of sperm retrieved from a testicular biopsy and freshly ejaculated semen in oligozoospermia. Rev Int Androl 2018; 16(4): 131-6.
[4]
Schankath AC, Fasching N, Urech-Ruh C, Hohl MK, Kubik-Huch RA. Hysterosalpingography in the workup of female infertility: Indications, technique and diagnostic findings. Insights Imaging 2012; 3(5): 475-83.
[http://dx.doi.org/10.1007/s13244-012-0183-y] [PMID: 22802083]
[5]
Inal HA, Ozturk Inal ZH, Tonguc E, Var T. Comparison of vaginal misoprostol and dinoprostone for cervical ripening before diagnostic hysteroscopy in nulliparous women. Fertil Steril 2015; 103(5): 1326-31.
[http://dx.doi.org/10.1016/j.fertnstert.2015.01.037] [PMID: 25712577]
[6]
Chalazonitis A, Tzovara I, Laspas F, Porfyridis P, Ptohis N, Tsimitselis G. Hysterosalpingography: technique and applications. Curr Probl Diagn Radiol 2009; 38(5): 199-205.
[http://dx.doi.org/10.1067/j.cpradiol.2008.02.003] [PMID: 19632497]
[7]
Sotrel G. Is surgical repair of the fallopian tubes ever appropriate? Rev Obstet Gynecol 2009; 2(3): 176-85.
[PMID: 19826575]
[8]
Akande V, Turner C, Horner P, Horne A, Pacey A. Impact of Chlamydia trachomatis in the reproductive setting: british fertility society guidelines for practice. Hum Fertil (Camb) 2010; 13(3): 115-25.
[http://dx.doi.org/10.3109/14647273.2010.513893] [PMID: 20849196]
[9]
European society of human reproduction and embryology,. 2008.Available from: http://www.eshre.eu/ESHRE/English/Guidelines-Legal/Guidelines/Good-clinical-treatment-position-paper/page.aspx/255
[10]
Lim CP, Hasafa Z, Bhattacharya S, Maheshwari A. Should a hysterosalpingogram be a first-line investigation to diagnose female tubal subfertility in the modern subfertility workup? Hum Reprod 2011; 26(5): 967-71.
[http://dx.doi.org/10.1093/humrep/der046] [PMID: 21357604]
[11]
Gorkem U, Kucukler FK, Kocabas R, et al. The water-soluble iodinated contrast medium used for hysterosalpingography might increase the probability of development of subclinical thyroid diseases. Int J Clin Exp Med 2016; 9(10): 20008-13.
[12]
Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril 1995; 64(3): 486-91.
[http://dx.doi.org/10.1016/S0015-0282(16)57781-4] [PMID: 7641899]
[13]
Mumusoglu S, Yazıcıoglu A, Yucel OS, Kasapoglu DZ, Bozdag G. Should hysterosalpingography routinely or selectively performed as a first step in the evaluation of infertile couples? J Gynecol Obstet Neonatol 2017; 14(3): 114-7.
[14]
Anserini P, Delfino F, Ferraiolo A, Remorgida V, Menoni S, De Caro G. Strategies to minimize discomfort during diagnostic hysterosalpingography with disposable balloon catheters: A randomized placebo-controlled study with oral nonsteroidal premedication. Fertil Steril 2008; 90(3): 844-8.
[http://dx.doi.org/10.1016/j.fertnstert.2007.07.1302] [PMID: 17953950]
[15]
Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril 2011; 95(7): 2171-9.
[http://dx.doi.org/10.1016/j.fertnstert.2011.02.054] [PMID: 21457959]
[16]
Practice Committee of American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: A committee opinion. Fertil Steril 2012; 98(2): 302-7.
[http://dx.doi.org/10.1016/j.fertnstert.2012.05.032] [PMID: 22698637]
[17]
Assessment and treatment for people with fertility problems nice clinical guidelines, No: 156 National Collaborating Centre for Women’s and Children’s Health (UK). London: Royal College of Obstetricians & Gynaecologists 2013.
[18]
Obejide AO, Ladigo OA, Otolorin FO, Makamagola JDA. Infertility in Nigerian women. A study of related physiological factors. J Obstet Gynaecol East Cent Africa 1986; 5(4): 61-3.
[19]
Chatfield WR, Suter PE, Bremner AD, Edwards E, McAdam JH. The investigation and management of infertility in East Africa. A prospective study of 200 cases. East Afr Med J 1970; 47(4): 212-6.
[PMID: 5424987]
[20]
Aziz MU, Anwar S, Mahmood S. Hysterosalpingographic evaluation of primary and secondary infertility. Pak J Med Sci 2015; 31(5): 1188-91.
[http://dx.doi.org/10.12669/pjms.315.7545] [PMID: 26649011]
[21]
Bello TO. Tubal abnormalities on hysterosalpingography in primary and secondary infertility. West Afr J Med 2006; 25(2): 130-3.
[PMID: 16918185]
[22]
Malik A, Jain S, Rizvi M, Shukla I, Hakim S. Chlamydia trachomatis infection in women with secondary infertility. Fertil Steril 2009; 91(1): 91-5.
[http://dx.doi.org/10.1016/j.fertnstert.2007.05.070] [PMID: 18635168]
[23]
Inal ZO, Inal HA, Aksoy E, Kucukkendirci H. Spermiogram test results of patients presenting to our IVF center due to infertility. J Clin Anal Med 2017; 8(5): 365-9.
[24]
Bukar M, Mustapha Z, Takai UI, Tahir A. Hysterosalpingographic findings in infertile women: A seven year review. Niger J Clin Pract 2011; 14(2): 168-70.
[http://dx.doi.org/10.4103/1119-3077.84008] [PMID: 21860133]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 8
Year: 2019
Page: [777 - 784]
Pages: 8
DOI: 10.2174/1573405614666180913114802
Price: $65

Article Metrics

PDF: 20
HTML: 2
EPUB: 1
PRC: 1

Special-new-year-discount