Interventional radiology in female infertility: technique and role

Abstract

The purpose of this paper is to describe the modifications in the radiologic approach to female infertility. The role of hysterosalpingography (HSG) has evolved from being the only source of information about the uterus to a more minor role, after ultrasound, that essentially deals with the morphology of the fallopian tubes. But if its diagnostic yield in the uterus is challenged by ultrasound and hysterosonography, it retains a major impact in the work-up of female infertility. Hysterosalpingography brings decisive diagnostic information concerning the state of the tubes and peritoneum. The interventional procedures of selective salpingography and tubal recanalization have a definite therapeutic effect and allow numerous pregnancies that would otherwise have required in vitro fertilization or tubal microsurgery.

The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients

“…Although only those films in which a technically adequate view of the uterus and tubes were included in our study, the results of Hofmann et al underline the importance of technical factors when performing and interpreting HSG films (23). This issue was discussed by the other authors (24)(25)(26)(27). Artefacts might include inadvertent insertion of the cannula, premature ending of the procedure, insufficient pressure because of vaginal reflux, or differences in muscle tonus of the tubes (4,27).…”

Radiogenic risks from hysterosalpingography

“…Hysterosalpingography may provide valuable information to the physicians involved in the evaluation and treatment of infertility, since it may effectively reveal anatomic problems such as fallopian tube obstruction or uterine abnormalities. The HSG may also be requested for the assessment of tubal patency following reversal of sterilization, for the investigation of fibroids, in the follow-up of Asherman's syndrome and prior to or following tubal surgery [3,4].…”

In vivo dosimetry to radiotherapy and radiology patient for error determination

“…It has been estimated that HSG is performed in 90 % of female patients who undergo for infertility consultation. Infertility, which is defined as an inability to conceive after one year of unprotected intercourse, has been estimated to occur in 8-20 % of couples [141,142].…”

“…Hysterosalpingography (HSG), also called uterosalpingography, is an efficient, quick and non-invasive reliable radiologic procedure for evaluating the anatomy of the female genital tract and assessing the function of the fallopian tubes and structural abnormalities that can contribute to infertility [141,142]. Blockage of one or both fallopian tubes causes about 35% of cases of infertility in women.…”

“…HSG, which is performed only for diagnostic purposes, can restore fertility due to the passage of the contrast medium under pressure into the tubes via uterine cavity and therefore enhance the fertility [141,142].…”