Comprehensive Approach to Female Fertility: Indian Scenario

Abstract

ABSTRACT:The female factors responsible for infertility are ovulation disorders (25%), tubal disease (15%-35%) and endometriosis (10%) and the male factors contribute to infertility in approximately 25% of cases. Causes are unknown in a further 15% to 25% of the remaining cases. 1,2 Laparoscopic chromo perturbation (LCP) is one of the investigations available to evaluate various tubal factors responsible for female infertility. Hysterosalpingography (HSG) is useful in assessing the tubal pathology. Both these modalities are effective and have their own benefits and limitations. Hysterosalpingo-contrast sonography (HyCoSy) is an effective alternative imaging modality providing a comprehensive approach to the investigations for female fertility. HyCoSy is performed as an out-patient procedure and is devoid of radiation exposure, anaphylaxis and anaesthesia. It provides information regarding uterine cavity, uterine abnormalities, tubal patency, ovaries and the pelvic cavity. In this paper, we have evaluated the efficacy of HyCoSy in comparison to laparoscopic dye perturbation, which is a gold standard in fertility workup. This prospective study has been taken up to establish this non-invasive, readily available, inexpensive, out-patient HyCoSy investigation to replace the invasive, sparsely available, expensive, operative LCP. This comprehensive approach is extremely essential in the management of infertile women in India. KEYWORDS: Hysterosalpingo contrast sonography (HyCoSy), laparoscopic chromo perturbation (LCP), female fertility, Contrast enhanced ultrasonography (CEUS). INTRODUCTION:Epidemiological studies indicate that 8 to 20% of couples in the reproductive age group are infertile Main causes of infertility are male factor, ovulatory and tubal disorders. The tubal disorder accounts to 35% of infertile women and is the most frequent female factor. Hysterosalpingography (HSG) and laparoscopy and dye test have been used to assess tubal function.Hysterosalpingo contrast sonography (HyCoSy) is an effective alternate imaging technique. HyCoSy is done by instilling ultrasound contrast media into the uterine cavity, using an8F Foley's catheter inserted in the uterine cavity through the cervical os .Real time imaging of tubes is done by trans-vaginal ultrasoundThe main purpose of this study is to establish HyCoSy as an effective method on its own, in evaluation of female fertility, which gives us comprehensive information regarding various female factors that are essential in evaluating women with infertility in Indian Scenario. The technique provides clinically valuable information regarding tubal patency, ovarian and uterine abnormalities. 3