The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility

Abstract

Background: More than 50 million women suffer from infertility worldwide, among whom 30% have associated fallopian tube pathology. Fortunately, the diagnostic accuracy of tubal patency has been enhanced with the consistent development of ultrasound imaging technology, especially the invention of transvaginal 4-dimensional hysterosalpingo-contrast sonography (TV 4D HyCoSy). However, detailed imaging data for evaluating the tubal condition for spontaneous conception and assessing the necessity of assisted reproductive technology (ART) have yet to be amassed.Methods: Patients with tubal factor infertility (TFI) who received TV 4D HyCoSy were recruited for this study. They were divided into two groups according to the method of conception: the natural pregnancy group (patients who naturally conceived within 3 months after TV 4D HyCoSy) and the assisted reproduction group (patients who failed to conceive naturally within the 3 months but successfully conceived through ART). Logistic regression analysis was performed to examine the data obtained from participants' medical history and TV 4D HyCoSy investigation.Results: Of the initial 1,433 women, 348 were excluded due to exclusion criteria or lack of follow-up. A total of 1,085 TFI patients were finally included, with individuals in the natural pregnancy group accounting for 27.74% (n=301), and those in the ART group accounting for 37.33% (n=405). The age was younger and the duration of infertility was shorter in the group of women who conceive spontaneously after TV 4D HyCoSy (P<0.05). In terms of imaging data, their endometrial thickness was thinner, right fallopian tube wall was more intact, morphology of the right fallopian tube was smoother, and their ovarian motility (bilateral), fallopian tube visualization (bilateral) and overflow condition of the contrast agent from the fimbriae of fallopian tube (bilateral) were better. In addition, the resistance of the contrast agent injection was less likely to be persistent, reflux was less likely to happen and 0/1 dispersion of the contrast agent around the ovary (bilateral) were more likely to be annular (P<0.05). Conclusions:The imaging data gathered from TV 4D HyCoSy in TFI patients were comprehensive, which suggested that TV 4D HyCoSy could have potential to be used to assess the necessity of post-HyCoSy ART intervention in patients with TFI. This could be of benefit in reducing the incidence of overtreatment and potential complications of ART.

Comparison of Effectiveness as well as Advantages and Disadvantages of Different Dimensions of Hysterosalpingo-Contrast Sonography for Diagnosis of Lesions Associated with Female Infertility

“…Endometrial thickness, fallopian tube wall, ovarian motility, etc. can be clearly observed, which has important research significance for evaluating female infertility [ 12 ]. Since HyCoSy is noninvasive, has no allergy and anesthesia risks, is radiation-free, and allows conception within a short period of time after the test, if its role in infertility evaluation can be confirmed, it will be an important enhancement for the future treatment of infertility.…”

Contrast Agent Reflux in Transvaginal 4-D Hysterosalpingo-Contrast Sonography

“…34 If the endometrium is thin, the epithelial cells, interstitial structure, and neovascularization of the functional layer have not been completely repaired, or the basal layer is damaged, it is easy to cause the contrast medium to flow back into the myometrium or parauterine venous plexus, therefore affecting the observation of normal angiographic images. 35,36 There are some shortcomings in this study that are worth considering. First of all, the sample size of this study is small, and there may be insufficient effects to detect the group differences.…”

“…The large time span and individual differences led to great differences in intimal thickness 34 . If the endometrium is thin, the epithelial cells, interstitial structure, and neovascularization of the functional layer have not been completely repaired, or the basal layer is damaged, it is easy to cause the contrast medium to flow back into the myometrium or para-uterine venous plexus, therefore affecting the observation of normal angiographic images 35,36 …”

A Review of Tubal Factors Affecting Fertility and its Management

“…It can also be used at the same time. It increases the incidence of secondary infertility in pregnant women [ 14 ]. When hydrosalpinx under hysteroscopy indicates tubal obstruction, the guide wire can be directly recanalized and monitored laparoscopically, and has a good therapeutic effect on the proximal fallopian tube lesions [ 15 ].…”

“…[ 19 ]. HyCoSy is advantageous because patients show better pain tolerance; it avoids the use of contrast agents containing iodine and prevents the use of ionizing radiation [ 14 ].…”