Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging (original) (raw)
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Facts, views & vision in ObGyn, 2014
Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hyster...
Human Reproduction, 1998
To assess the efficiency of transvaginal ultrasonography (TVUS) in the screening of pelvic pathologies in the initial workup of infertile women, we carried out a prospective comparison of sonographic diagnosis with laparoscopic and pathological findings. Between February 1994 and April 1995, 133 premenopausal non-pregnant women underwent TVUS on the day before laparoscopy. The efficiency of TVUS in detecting pelvic pathologies was 90.2% with a sensitivity of 86.2%, a specificity of 97.8% and positive and negative predictive values of 98.6 and 78.8% respectively. If the six false-negative cases with a histological diagnosis of minimal endometriosis were defined as 'normal pelvis', sensitivity and specificity could be corrected to 92.5 and 98.6% respectively. Endometriomas were diagnosed by TVUS with an efficiency of 96.4%, with a sensitivity and a specificity of 90 and 96.7% and with positive and negative predictive values of 75 and 99.1% respectively. The sensitivity of vaginal sonographic characterization of pelvic adhesions was 61.1% with a specificity and positive predictive value of 98.2 and 84.6%. The negative predictive value of TVUS was 94.1%. These data suggest that it is not possible to characterize pelvic adhesions, especially filmy adhesions, with acceptable accuracy. However, in the initial workup of infertile women, if the patient is young, if both hysterosalpingography and TVUS are negative, laparoscopy could be postponed. In couples with severe male factor infertility and for whom in-vitro fertilization or intracytoplasmic sperm injection is the treatment of choice, laparoscopy might be avoided where the TVUS is negative.
IOSR Journals , 2019
Aim: A prospective observational study was conducted to evaluate and to compare Hysterosalpingo contrast sonography (HyCoSy) with diagnostic laparoscopy and hysteroscopy as a method to assess tubal patency and uterine cavity lesions in patients with infertility. Methods: From September 2012 to March 2014, 45 infertile women of age 20 to 40 years were recruited in the study and all the patients underwent both techniques i.e. Hysterosalpingo contrast sonography and diagnostic laparoscopy and hysteroscopy and the results were compared in terms of sensitivity, specificity, positive predicted value, negative predicted value and kappa value. Results: Forty five women were recruited in this study. The study showed that HyCoSy had sensitivity of 88%, specificity of 85%, PPV of 88% and NPV of 85% for diagnosing tubal factor infertility and a sensitivity of 75%, specificity of 100%, PPV of 100%, NPV of 95.6% for diagnosing uterine cavity lesions. Conclusion: HyCoSy is a simple, safe, sensitive, less time consuming, non invasive and inexpensive preliminary screening procedure with good concordance in diagnosing uterine cavity lesions, tubal patency and tubal blocks when compared to diagnostic laparo-hysteroscopy.
Human Reproduction, 2002
BACKGROUND: The aim was to evaluate and compare inter-observer reproducibility by magnetic resonance imaging (MRI), transvaginal ultrasonography (TVS), hysterosonographic examination (HSE) and hysteroscopy (HY). METHODS: Different observers consecutively evaluated MRI, TVS, HSE and HY independently in 51 premenopausal women, who underwent hysterectomy for benign diseases. RESULTS: Inter-observer agreement (kappa) was as follows: Exclusion of uterine cavity abnormalities: MRI 0.97, TVS 0.68, HSE 0.48 and HY 0.63; submucous myomas: MRI 0.97, TVS 0.59, HSE 0.60 and HY 0.67; polyps: MRI 0.49, TVS 0.48, HSE 0.35 and HY 0.50; identification of myometrial myomas: MRI 0.97, TVS 0.74; adenomyosis: MRI 0.73 and TVS 0.38. Mean difference between observers in number of observed myomas was (absolute values) MRI 0.58, TVS 0.93. Agreement on evaluation of abnormalities in the uterine cavity, submucous myomas, number of myomas and adenomyosis was significantly greater by MRI than by any of the other techniques, whereas agreement was in line by TVS, HSE and HY. CONCLUSIONS: Inter-observer disagreement reached substantial levels only for exclusion of uterine cavity benign abnormalities by HY, TVS and HSE. Strategies should be adopted to reduce observer variation of common gynaecological imaging techniques or the less observer-dependent MRI technique could be favoured.
Is hysteroscopy a routine investigation before assisted reproductive techniques
Caspian Journal of Reproductive Medicine , 2015
Background: Infertility is a common problem as it is observed in 10-15% of couples to whom developing approaches for treatment is an issue of utmost importance. The aim of the current study was to determine the accuracy of diagnostic transvaginal ultrasongraphy (TVS) for the investigation of uterin pathologies in women before the application of assisted reproductive technique (ART). Methods: In this observational, cross-sectional study, TVS and diagnostic hysteroscopy were performed consecutively on 100 infertile women, who were candidates for ART. All the findings of TVS were compared with hysteroscopic appearance of uterine cavity. The sensitivity, specificity, and positive and negative likelihood ratios were also calculated for diagnostic polyp and uterine anomalies. Results: Polyp was detected through diagnosis hysteroscopy in 6 cases (6.0%), out of whom 4 were diagnosed by TVS. The sensitivity and specificity ratios with TVS, diagnosed for polyp, were 50.00% and 98.94%, respectively. In addition, the sensitivity and specificity ratios with TVS, diagnosed for uterine abnormalities were 27.78 % and 98.78%, respectively. Conclusion: The researchers concluded that TVS allows for the diagnosis of polyp uterine in the most cases, but its sensitivity for diagnosis of uterine anomalies is low. Therefore, TVS is not useful technique, compared with hysteroscopy, in patients who are candidates for ART. Thus, hysteroscopy is highly recommended.
Eastern Journal of Medicine, 2012
To compare the accuracy of transvaginal sonography (TVS), hysterosalpingography (HSG) and hysteroscopy (HS) for uterine pathologies among infertile women. 168 women with diagnosis of infertility were enrolled in this study and assessed with TVS, HSG and HS. TVS, HSG and HS were carried out in all cases, in the 5 th-8 th days of follicular phase of the cycle. Operative hysteroscopy with directed biopsy was considered as the gold standard. HSG, TVS, and HS were conducted by specialized gynecologists, who were blinded to the results of the other examinations. Endometrial polyp (n=66, 39%), submucous myoma (n=46, 28%), endometrial hyperplasia (n=29, 17%) and suspect of intrauterine synechia (n=27, 16%) were detected with TVS. In the evaluation with HSG results, submucous myoma or polyp (n=42, 25%), irregular uterine contour (n=29, 17%), intrauterine synechia (n=24, 15%) were detected. 73 patients (43%) had normal HSG results. HS (with or without resection) results detected endometrial polyp (n=59, 35%), submucous myoma (n=47, 28%), endometrial hyperplasia (n=35, 21%) and intrauterine synechia (n=27, 16%). Endometrial biopsy revealed no atypical hyperplasia of the endometrium. TVS is the primary investigative method for evaluating every infertile couple by means of uterine cavity and ovaries. TVS seems to be additional and superior to HSG. It is a candidate to be an easy and useful method in the detection of uterine abnormalities among infertile women including polypoid lesions, endometrial hyperplasia and submucosal myoma with respect to hysteroscopy as the gold standard. It can be suggested that HSG should be replaced by the diagnostic hysteroscopy as a first-line investigation for intrauterine pathologies in infertile patients.
Fertility and Sterility, 2016
The comprehensive ''one-stop shop'' ultrasound evaluation of an infertile woman, performed around cycle days 5 to 9, will reveal abundant information about the anatomy and morphology of the pelvic organs and thereby avoid costly radiation and iodinated contrast exposure. We propose a two-dimensional and three-dimensional ultrasound to examine the appearance and shape of the endometrium, endometrial cavity, myometrium, and junctional zone, to assess for m€ ullerian duct anomalies fibroids, adenomyosis, and polyps. We then evaluate the adnexa with grayscale ultrasound and Doppler, looking for ovarian masses or cysts, and signs of tubal disease. The cul-de-sac is imaged to look for masses, endometriosis, and free fluid. We then push gently on the uterus and ovaries to assess mobility. Lack of free movement of the organs would suggest adhesions or endometriosis. The sonohysterogram then allows for more detailed evaluation of the endometrial cavity, endometrial lining, and any intracavitary lesions. Tubal patency is then assessed during the sonohysterogram in real time by introducing air and saline or contrast and imaging the tubes (HyCoSy). With this single comprehensive ultrasound examination, patients can obtain a reliable, time-efficient, minimally invasive infertility evaluation in their own clinician's office at significantly less cost and without radiation.
Hysterosalpingo contrast sonography (HyCoSy): let’s make the point!
Archives of Gynecology and Obstetrics, 2014
Introduction The accurate evaluation of tubal patency as well of the morphologic characteristics of the uterine cavity is a fundamental step in the diagnostic work-up for infertility. Hysteroscopy and laparoscopy and dye have long been regarded as the reference methods to assess uterine morphology and tubal patency, respectively. However, their technical and clinical limitations have supported the introduction of an emerging technique: hysterosalpingo contrast sonography (HyCoSy), which has recently been improved with the use of modern contrast agents and threedimensional resolution.
Human Reproduction, 1998
The performance of hysterosalpingo contrast sonography (Hy Co Sy) as a first-line, outpatient investigation of tubal patency was examined in 500 consecutive, infertile women, at one centre. Hy Co Sy was completed in 463 (92.6%) cases, using a galactose microbubble contrast agent (Echovist ® -200) and transvaginal sonography. Initial plain scanning identified adnexal pathology in 198 women (39.6%). Examination with Echovist was attempted for 905 tubes and only 67 (7.4%) were not assessable; after the first 100 women this decreased to 35 tubes (4.8%). A sonographic appearance compatible with blocked tubes was found on 118 (14.1%) occasions but it was also possible to identify variations in the appearance/filling/spilling patterns of individual tubes which increased the number assessed as abnormal to 193 (23.0%). Comparison with laparoscopy and dye chromopertubation findings from the past three years was possible for 185 (37%) women, representing 282 tubes, which gave Hy Co Sy an overall concordance rate of 85.8%, sensitivity of 90.4%, specificity of 70.3%, positive predictive value of 91.2% and negative predictive value of 68.2%. Some 51.0% of women described only mild discomfort and there were no significant postprocedure complications. Hy Co Sy appears to be an acceptable first-line screen and may select out women in whom more invasive investigations are likely to reveal pathology.
Role of Diagnostic Laparoscopy and Hysteroscopy in Infertility
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND The aim of the study is to detect the role of diagnostic laparoscopy and hysteroscopy in detecting uterine, ovarian and pelvic pathologies. It should be offered to all infertility cases who have completed a basic infertility evaluation including ovulation studies, ultrasound, ovarian reserve and hysterosalpingogram for the female and semen analysis for the male. It provides direct visualisation of the pelvic organs and more importantly the tubal status as compared to only ultrasonography and HSG. 1 Minor procedures like PCOD cauterisation, endometrial ablation, adhesiolysis, salpingectomy for hydrosalpinx also help to improve the infertility outcomes. It enhances the ART outcomes also. 2 MATERIALS AND METHODS The retrospective study included 155 infertility women. It was conducted in the Department of Obstetrics and Gynaecology at Nawrosjee Wadia Memorial Hospital, Mumbai from 2002-2003. After clinical examination, necessary investigations were done and written consent was taken before doing laparoscopy. Patients were kept fasting for 24 hours before laparoscopy and it was done under general anaesthesia. The data was collected on prescribed proforma and the results were tabulated and percentages calculated to show the results. RESULTS The age of the patients ranged from 20-38 yrs. with a mean age of 26 years. The maximum patients had infertile union of 3-5 years. Cases of primary infertility were 72% and of secondary infertility were 28%; 87% had no menstrual irregularities; 56.8% patients had abnormal laparoscopic findings and 15% had abnormal hysteroscopic findings. No tubal pathology was found in 75% of cases. Tubal pathology was found in 25% of cases. Of these, bilateral tubal blockage was found in 9% and unilateral block in 7.7% cases. In 8.5% cases, bilateral block with beaded appearance (TB) was found; 15.5% cases had PCOD, 9.6% had endometriosis. Pelvic adhesions were found in 18% patients. Myomas were found in 6.4% cases. Bicornuate uterus was seen in 1.2% cases. Uterine hypoplasia was seen in 1.9% cases; 15% had abnormal hysteroscopy findings. Asherman's syndrome was found in 0.65% patients. CONCLUSION Hysteroscopy and laparoscopy are very valuable tools both diagnostically and therapeutically. They should be offered to all patients with infertile union of more than three years, especially unexplained infertility. Cundiff in 1995 reported that pathologic abnormalities were found in 21-68% of patients with unexplained infertility at the time of diagnostic laparoscopy. 3 Operative procedures like lysis of adhesions, endometrial ablation, PCOD cauterisation, salpingectomy for hydrosalpinx positively affect the outcome for ART procedures also. Mean prevalence of uterine malformations in general population is approximately 2.3%, 5.3% in infertile patients and 13% in recurrent pregnancy losses. 4 Laparoscopy and Hysteroscopy is a safe and cost effective procedure in infertility patients.