Screening strategies for tubal factor subfertility

Abstract

CAT is proposed as first screening test for tubal factor subfertility. In CAT-negative women, HSG may be performed because of its high specificity and fertility-enhancing effect. In CAT-positive women, hs-CRP seems promising, whereas HSG has no additional value. The position and timing of laparoscopy deserves critical reappraisal.

Spectrum of hysterosalpingographic findings among women presenting with infertility in Abuja, Nigeria’s capital

“…5 Even though laparoscopy is considered as the reference standard in infertility workup, HSG can be performed first and the use of laparoscopy should be limited to cases suspected for etiologies other than intra tubal, such as endometriosis and peritubal adhesions. 6 The high specificity of hysterosalpingography makes it very helpful for ruling out tubal disease, even where endoscopic evaluation is available. 6,7 HSG is less invasive and enhances fertility in select situations.…”

“…6 The high specificity of hysterosalpingography makes it very helpful for ruling out tubal disease, even where endoscopic evaluation is available. 6,7 HSG is less invasive and enhances fertility in select situations. 7,8 Endometrial Contour abnormalities and filling defects in HSG can be a pointer to congenital abnormalities, uterine fibroids, polyps and intrauterine adhesions.…”

Tubal Damage, Infertility and Tubal Ectopic Pregnancy: Chlamydia trachomatis and Other Microbial Aetiologies

“…These authors conclude that their study shows that a longer duration of the asymptomatic period results in a more pronounced impact of a screening programme (Althaus et al, 2010). The incidence of PID in untreated women infected with C. trachomatis has been reviewed and widely discussed in the literature in terms of (1) its cost-effectiveness as a screening program and (2) as a predictor of tubal damage in infertile patients (Aghaizu et al, 2008;Althaus et al, 2010;Bakken & Ghaderi 2009;den Hartog et al, 2008;Dietrich et al, 2010;Kalwij et al, 2010;Land et al, 2010;Low et al, 2009;Low & Hocking 2010;Oakeshott et al, 2010;Risser & Risser 2007;Simms & Horner 2008). In a comprehensive study that evaluated all available original research and assessed the incidence of PID following C. trachomatis infection, it was concluded that no study could adequately answer the question and that many studies either had inaccuracies, validition problems or only indirect evidence to support their reported incidences (Risser and Risser, 2007).…”

“…It has been noted that screening for serological markers of persistence (including C-reactive protein) seems useful for identifying infected women at highest risk of tubal pathology. It has been proposed that three screening strategies would be useful for identifying tubal factor sub-fertility in women infected in the genital tract with C. trachomatis: (1) C. trachomatis IgG antibody testing, (2) high sensitivity CRP testing and (3) hysterosalpingography (den Hartog, 2008). A recent mathematical modelling study has analysed previously published data on the persistence of asymptomatic C. trachomatis infection in women, and has estimated the mean duration of the asymptomatic period to be longer (433 days) than previously anticipated.…”

Hysteroscopy in Assisted Reproductive Technology Programs

“…По данным европейского консорциума по IVF -мониторингу (EIM) при европей-ском сообществе репродукции человека и эмбриологии (ESHRE), частота наступления беременности в программе ЭКО в среднем составляет 28,4%. Повышение частоты на-ступления беременности является чрезвычайно важной проблемой в этой области медицины [20,21,28,31].…”