Hysterosalpingo-contrast sonography: is possible to quantify the therapeutic effect of a diagnostic test?

Abstract

ObjectiveTo evaluate the effect of hysterosalpingo-contrast sonography (HyCoSy) on natural conception in the infertile patient.MethodsWe conducted a prospective observational study recruiting 180 patients admitted to Infertility Center of Ferrara University from January 2010 to February 2012. The essential inclusion criteria was the couple's desire to perform only diagnostic evaluation on infertility causes and to wait for natural conception before proceeding with further management. Couples were investigated with hormonal profile, semen analysis and HyCoSy. Expected time for spontaneous pregnancy was 180 days from HyCoSy. First datation sonography of pregnancy was used calculating time elapsed from HyCoSy at conception.ResultsForty patients (22.2%) obtained spontaneous pregnancy within 6 months after HyCoSy. The mean of "conception time" was 75 days. The pregnancy rate was significantly higher in the first 30 days (45%) compared to other the months of observation (p<0.0005). Multiple linear regression analysis showed that maternal age and sterility duration proved independent variables in detecting the "conception time" after HyCoSy (t=3.742, p=0.001, t=2.371, p=0.02, respectively).ConclusionA possible beneficial effect of HyCoSy is feasible especially in the days following its execution. This temporal correlation supports its therapeutic use.

Effect of Hydrotubation in Unexplained Infertility – A Randomized Controlled Trial

“…Hysterosalpingocontrast sonography (carried out like hydrotubation but with contrast medium) has a higher conception rate (22%). 8 The pregnancy rate was higher in the first month compared to other months which is in accordance to this study. 8 The increased infection rate was not there in this study neither in international studies and database review.…”

“…The success rate is lower in studies where lesser amount of fluid is used for hydrotubation. 8 The hydrostatic effect of the amount of fluid used can remove the obstructive elements in the tube and washing of tube with normal saline can dilute toxic and inflammatory factors. In this study, 50cc fluid was used daily to wash the tubes for 3days .There was a slight increase in discomfort of the patient in terms of lower abdominal pain, nausea and vomiting and right shoulder tip pain but greater chance of achieving the pregnancy makes even these complications agreeable to the womens compared to unsuccessful treatment with lesser fluid volume injected and lesser pain experienced.…”

“…This technique has been used to test the patency of fallopian tubes and has been found to improve conception rate in infertile couples for about 50 years. 8 Patency of tubes is confirmed by lack of resistance to the passage of fluid through the cervix and right shoulder tip pain. This technique is cost effective, cheap, easy to perform and does not require special arrangements like theatre facilities.…”

Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications

“…In our infertility centre we noticed that spontaneous pregnancies often occurred in patients who underwent HyCoSy in the previous 3–6 months [24]. Lindborg et al [25], recently suggested a valid explanation for this phenomenon: the passage of the fluid through a partially occluded tube (minor adhesions, mucus plugs) could remove minor adhesions or buildup material caused by inflammatory processes and hence restore tubal patency.…”

Effect of Saline Sonosalpingography in Unexplained Infertility

“…Significantly improved conception rate has been achieved by saline sonosalpingography in unexplained infertility [5][6][7] . Tubal flushing has previously proved to be one way of increasing the chance of acheiving pregnancy for couples with increased infertility and early stage of endometriosis 8 . Hydrotubation treatment can be administered in an outpatient clinic and represents a less invasive treatment alternative 9 .…”