Implementation of hysteroscopy in an infertility clinic: The one-stop uterine diagnosis and treatment (original) (raw)
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Hysterosalpingography using Magnetic Resonance Imaging for infertility patients
JBRA Assisted Reproduction, 2020
Objective: Some studies have shown that it is possible to evaluate tubal permeability through MRI. Our aim is to perform a prospective study and to perform a comprehensive review in the literature regarding HSG-MRI. Methods: We carried out a PUBMED search using the following keywords: hysterosalpingogram, hysterosalpingography, magnetic resonance imaging and MRI. As inclusion criteria, we included only papers published in English, and exams ran on humans. We also conducted a prospective inclusion of patients who had visited a human reproduction clinic between May/2017 and April/2019 for laboratory image diagnoses using HSG-MRI. Results: Following the inclusion and exclusion criteria, we included seven original papers. Review papers and those written in a language other than English, were excluded. Between the period of May/2017 and April/2019, we selected ten patients for our study. The average exam duration was 30 minutes. Cervical catheterization was possible in all cases. There w...
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.
Initial results of magnetic resonance hysterosalpingography diagnostic performance
Imaging and Radiation Research
Objective: to determine the diagnostic performance of magnetic resonance hysterosalpingography (HSG-MRI), using laparoscopy as the reference method. Materials and methods: 22 patients were included. All underwent HSG-MRI with a 1.5 Tesla resonator and then laparoscopy with chromotubation. Two radiologists examined the MRIs, determining tubal patency by consensus. Descriptive and diagnostic performance analyses were performed. Results: HSG-MRI had a success rate of 91%. Study duration was 49 ± 15 minutes, volume injected 26 ± 16 cm3 and pain scale 30 ± 19 out of 100. Sensitivity and specificity of HSG-MRI were 100% for global and left Cotte test, and 25% and 93.3% for right Cotte test, respectively. There were 2 minor complications and no major complications. Discussion: our initial results demonstrated high sensitivity and specificity. Although other studies analyzed the ability of HSG-MRI to assess tubal patency with good results, the use of a flawed reference standard left room fo...
Human Reproduction, 1997
A total of 20 infertile women (confirmed ovulation; normal hormonal and ovarian cysts were detected using transvaginal scanprofile and semen analysis) undergoing L&D Ϯ H agreed to have ning; the endometrial polyp and a congenital uterine MRI and HyCoSy as well. Exclusion criteria included galactosaemia anomaly were identified using HyCoSy. These findings and active pelvic inflammatory disease. The use of HyCoSy was were detected using MRI, but in addition the technique approved by the Oxford ethics committee. distinguished the dermoid cysts from the endometriomas, All HyCoSy examinations were performed between days 10-13 of identified the two other cases of moderate-severe endomethe menstrual cycle using the new ultrasound contrast medium triosis, fibroids <2 cm (n ⍧ 2) and adenomyosis (n ⍧ 5), Echovist (Schering AG, Berlin, Germany), a galactose microparticle/ and interpreted the haemorrhagic corpus luteum as an air microbubble suspension. An Acuson 128-XP scanner (Acuson, Mountain View, CA, USA) with a 5 MHz vaginal probe (n ϭ 18) or endometrioma. Our data suggest that women with normal a Toshiba SSA 250A (Toshiba, Tokyo, Japan) with a 6 MHz probe HyCoSy and MRI findings have a normal pelvis and may (n ϭ 2) was used. After initial TVS to determine uterine position not need routine surgical investigation.
Journal of Obstetrics and Gynaecology Research, 2003
Aim: To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard. Methods: A prospective, comparative study included 336 patients undergoing both HSG and diagnostic hysteroscopy. Main outcome measures were sensitivity, specificity, positive and negative predictive value, and accuracy rate of HSG. Results: Intrauterine abnormalities were shown on HSG in 286 patients and confirmed in 200 at hysteroscopy. Contrarily intrauterine lesions were detected by hysteroscopy in 4 out of 50 patients in whom HSG were normal. The most common intrauterine finding of 336 patients on hysteroscopy were intrauterine adhesions (IUA) (74), followed by endometrial polyps (56), and submucous myoma, 26 patients. Statistical analysis revealed that HSG in the detection of intrauterine pathology had a sensitivity of 98.0%, specificity of 34.9%, positive predictive value of 69.9%, negative predictive value of 92.0%, and accuracy rate of 73.2% with falsepositive and false-negative rates of 30.1% and 8.0%, respectively. The common incorrect diagnoses of HSG were misdiagnosing a condition of cervical stenosis as severe IUA in 24 patients, endometrial polyps as submucous myoma in 22 out of 50 patients, and submucous myoma as endometrial polyps in 12 out of 72 patients. Conclusions: Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.
Niche role of MRI in the evaluation of female infertility
Indian Journal of Radiology and Imaging
Infertility is a major social and clinical problem affecting 13–15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero- salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono-hysterography (syn: hystero-sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in di...
Diagnostic hysteroscopy as a primary tool in a basic infertility workup
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2006
Objective: To assess the value of diagnostic hysteroscopy in a primary workup of infertility. Methods: We performed a retrospective analysis (Canadian Task Force Classification II-2) of 221 infertile patients referred to the Outpatient Center for Uterine Cavity Evaluation and the Tel-Aviv University affiliated Assaf Harofe Medical Center for evaluation of the uterine cavity. Patients underwent a diagnostic office hysteroscopy. Results: Hysteroscopy revealed an abnormal uterine cavity in 30% of women evaluated for either primary or secondary infertility. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. Conclusion: Routine diagnostic hysteroscopy should be part of an infertility workup in primary and secondary infertility.
Routine use of saline hysterosonography in 500 consecutive, unselected, infertile women
Human Reproduction, 1998
Saline hysterosonography was attempted as a routine, firstline screening test of uterine structure in 500 consecutive, unselected, infertile women. The procedure was completed in 96.8% (484/500) women and the observations were interpretable in 483 of these women. Intrauterine pathology was suspected in 67/499 (13.4%) women on plain ultrasound scan and 58/484 (12%) women with saline hysterosonography. Ultrasound alone had a superior specificity (96.3%) to sensitivity (81.8%) and better negative (97.6%) than positive (73.8%) predictive value for the detection of any intrauterine abnormality, using saline hysterosonography as the reference procedure. Suspected pathology at saline hysterosonography led to hysteroscopy in 20 women, after a median of 5.7 months (range, 1-14). The overall concordance rate between the two procedures was 65% with lesions suspicious of intrauterine polyps not present at subsequent hysteroscopy on six occasions. Criteria were established to help identify women with potentially self-limiting lesions, in whom a re-scan should be considered before resorting to hysteroscopy. The procedure was well tolerated with no significant complications. Saline hysterosonography appeared to be an acceptable first-line screening procedure for uterine structure which enhanced the predictive power of ultrasound alone for uterine anomalies and provided additional information which was potentially of value when planning operative hysteroscopy.