The outcomes of controlled ovarian hyperstimulation/intrauterine insemination in patients with unilateral tubal occlusion on hysterosalpingograph

Abstract

Objective:The aim of the present study was to evaluate the pregnancy rates of intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH) in patients with one-sided tubal occlusion on hysterosalpingography (HSG).Materials and Methods:Patients who underwent COH/IUI were enrolled into this retrospective cohort study. The patients with one-sided tubal occlusion diagnosed under HSG who met the inclusion criteria were accepted into the study group. The control group consisted of patients with unexplained infertility. The outcomes of COH/IUI were compared between the study and control groups.Results:Ninety-seven patients in the study group (n=44) and control group (n=53) who underwent COH/IUI treatment were included into study. The biochemical, clinical, and ongoing pregnancy rates were similar between patients with unilateral occlusion diagnosed under HSG and those with unexplained infertility. The spontaneous pregnancy rate within one year was higher in patients with normal HSG than in patients with unilateral tubal occlusion, but the difference did not show statistical significance.Conclusion:Infertile patients with one-sided tubal occlusion in HSG can be managed as with patients with unexplained infertility and normal HSG findings. In addition, COH/IUI may be considered as the first-line treatment option in the management of these patients.

The effect of unilateral tubal block diagnosed by hysterosalpingogram on clinical pregnancy rate in intrauterine insemination cycles: systematic review and meta‐analysis

“…Following the removal of duplicates, 148 remained and each title and abstract was reviewed by two reviewers. Subsequently, 73 full texts were selected for full review and an additional 63 were excluded, leaving ten studies for quantitative analysis . Reasons for exclusion included case reports, non‐English articles, systematic reviews, and studies that failed to screen and exclude cases of male/female infertility, studies that did not specify the diagnostic method of diagnosing women with tubal block, and studies that did not report pregnancy outcomes.…”

“…Indeed, multiple studies have suggested that instances of proximal tubal occlusion may in fact represent false‐positive results caused by tubal spasm or the ‘steal effect’, and that HSG is better at diagnosing true distal occlusion compared with proximal occlusion . In fact, Dessole et al noted that 60% of cases of proximal tubal occlusion will actually show bilateral tubal patency on repeat HSG . Despite its limited sensitivity compared with alternative diagnostic methods such as sono‐HSG, HSG remains the most widely accepted first‐line test to assess tubal patency owing to its low cost, minimal invasiveness, and high specificity, particularly among patients with no known risk factors for peritoneal disease …”

High dose letrozole in infertile women with unilateral tubal block: a preliminary report

“…There is no universal agreement on management of such women. Management options include expectant management [4][5][6], surgical management and correction, and controlled ovarian stimulation (COS) combined with IUI or IVF/ICSI [5,6]. A recent systematic review and meta-analysis showed that patients with proximal tubal block have similar pregnancy rates after COH-IUI when compared with those with bilateral patent tubes and unexplained infertility [6].…”