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Aim: The purpose is to investigate pain perception during transvaginal four‐dimensional hysterosalpingo‐contrast sonography (TV 4D‐HyCoSy) and factors influencing pain severity. Methods: This was a retrospective study included 340 women who underwent TV 4D‐HyCoSy examination from January 2016 to October 2017. The factors were recorded, including age, childbearing history, infertility type, history of pelvic inflammation, pelvic surgery, history of uterine manipulation, history of ectopic pregnancy, atropine delivery mode, uterine position, uterine malformation, uterine lesion, fibroid, intrauterine adhesion, polycystic ovary, endometrial implantation cyst, dysmenorrhea score, the degree of patency of fallopian tube and contrast agents dosage. Pain was evaluated during and after TV 4D‐HyCoSy. The time point of peak pain was evaluated and the influencing factors of moderate/severe pain were analyzed. Results: The highest pain occurred at contrast instillation. The independent influencing factors of moderate/severe pain were age (P = 0.021), dysmenorrhea score (P = 0.003) and tubal patency (P < 0.001). Further analysis showed that age affected the pain score when TV 4D‐HyCoSy started and the peak pain occurred. Dysmenorrhea score and tubal patency affect the pain score at most time points. Conclusion: Age, dysmenorrhea score and tubal patency are factors influencing the severity of pain during TV 4D‐HyCoSy. [ABSTRACT FROM AUTHOR]

Good evidence that oil‐soluble contrast media (OSCM) enhances pregnancy rates when used to assess fallopian tube patency by hysterosalpingogram has prompted rapid clinical uptake by some fertility doctors and imaging specialists in Australia and New Zealand. The ACCEPT group met in July 2019 to develop a consensus document outlining the indications for and safe use of OSCM, to inform and guide clinicians interested in offering procedures using this media to couples with infertility. [ABSTRACT FROM AUTHOR]

Background: Fallopian tube occlusion is a common cause of infertility, but the effect of unilateral tubal block (UTB) on pregnancy rates (PR) after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) remains controversial.Objective: To evaluate PR after COH-IUI among infertile women with proximal and distal UTB diagnosed by hysterosalpingogram (HSG), compared against women with bilateral patent tubes experiencing unexplained infertility.Search Strategy: We searched EMBASE, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to 14 January 2018.Selection Criteria: Studies that report PR/cycle or cumulative PR among women with UTB and controls were included.Data Collection and Analysis: Two authors independently selected and extracted study characteristics and data. Methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.Main Results: Among 2965 patients and 5749 IUI cycles across ten studies, no significant difference in PR/cycle (odds ratio, OR = 0.88; 95% confidence interval, 95% CI = 0.69-1.12) and cumulative PR (OR = 0.80, 95% CI = 0.62-1.04) was observed. Patients with proximal UTB demonstrated similar PR/cycle (OR = 1.06, 95% CI = 0.68-1.66) and cumulative PR (OR = 1.10, 95% CI = 0.75-1.62), compared with controls, whereas patients with distal UTB had significantly lower cumulative PR (OR = 0.49, 95% CI = 0.25-0.97, P = 0.04). Patients with proximal block also demonstrated significantly improved cumulative PR, compared with patients with distal block (OR=2.41, 95% CI = 1.37-4.25, P = 0.002).Conclusion: Infertile patients with proximal UTB diagnosed by HSG can expect similar pregnancy rates after COH-IUI, compared with those with bilateral tubal patency and unexplained infertility, whereas patients with distal UTB have lower odds of pregnancy. These differences may reflect inherent diagnostic limitations of HSG or differences in underlying pathologies.Tweetable Abstract: Meta-analysis evaluates pregnancy outcomes after COH-IUI in women with unilateral tubal block diagnosed by HSG. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of Chlamydia trachomatis infection among Nigerian women undergoing hysterosalpingography (HSG) and to identify any correlation between chlamydial antibody levels and a diagnosis of tubal disease.Methods: A prospective cross-sectional study was conducted from January 1 to June 30, 2013, among women scheduled to undergo HSG in the radiology department of Lagos University Teaching Hospital, Nigeria. Endocervical swabs and serum samples were collected to assess the levels of chlamydial antigen and antibody, respectively.Results: Among 150 participants, 83 (55.3%) had bilateral tubal patency and 67 (44.7%) had tubal disease. Overall, 53 (35.3%) women had positive test results for chlamydial antibodies; however, none of the participants tested positive for chlamydial antigen. Women with tubal disease were more likely to test positive for chlamydial antibodies (n=44 [65.7%]) than were those whose test results were negative (n=9 [10.8%]; P<0.001). The sensitivity and specificity of chlamydial antibody testing to predict tubal disease diagnosed by HSG were 66% and 89%, respectively.Conclusion: The presence of chlamydial antibodies was quantitatively related to the likelihood of HSG-diagnosed tubal disease. [ABSTRACT FROM AUTHOR]

Key content The pathogenesis of infertility is multi-factorial; investigative and treatment approaches should therefore be individualised., There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function., There is often a clear need for in vitro fertilisation (IVF) in the management of infertility., This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART)., Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans-vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency., To understand the role of Chlamydia trachomatis serology in tubal patency testing., To evaluate the role of tubal patency test in the hierarchy of investigations for infertility., To understand the role of tubal surgery in modern management of infertility., To understand the importance of medical history taking in infertility., Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception., Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF?, There may be psychosocial issues or anxiety so a multidisciplinary approach is important. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the hysterosalpingographic findings from infertile women who were subsequently diagnosed with genital tuberculosis. Methods: A retrospective study of 70 infertile women who underwent hysterosalpingography to investigate infertility and were subsequently diagnosed with genital tuberculosis. Results: The mean age of the women was 27.3 years and the mean duration of infertility was 6.1 years. A total of 57 (81.4%) women had primary infertility while 13 had secondary infertility. Diagnosis of genital tuberculosis was made by polymerase chain reaction (54.3%), tuberculous granuloma on biopsy (22.8%), acid-fast bacilli culture (2.8%), and at laparoscopy or hysteroscopy (20%). Hysterosalpingographic findings were a normal uterine cavity observed in 57.1% of women, an irregular cavity in 18.5%, a shrunken cavity in 2.8%, and an irregular filling defect in 18.5%. Synechiae were observed in 17.1% of women. Conclusion: Genital tuberculosis is a common cause of infertility in India, causing significant uterine and tubal pathologies. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic accuracy of hysterosalpingography and sonohysterosalpingography in detecting tubal and uterine abnormalities.Methods: In a prospective study for the evaluation of uterine and tubal pathologies, 186 patients with primary and secondary infertility rates (51.6% and 44%, respectively), as well as recurrent abortion rates (3.8%), underwent sonohysterosalpingography. The tubal pathologies, as well as intracavitary and/or structural uterine abnormalities, detected with this procedure were compared with preoperative hysterosalpingography and operative procedures.Results: With surgical findings as the gold standard, sonohysterosalpingography had a sensitivity of 78.2%, a specificity of 93.1%, a positive predictive value of 82.7%, and a negative predictive value of 91%. For total tubal and uterine pathologies, the findings for the same parameters using HSG were 76.3%, 81.8%, 90.9%, and 59.2%, respectively. Sonohysterosalpingography was more accurate than hysterosalpingography for detecting intrauterine adhesions and various forms of uterine anomalies.Conclusions: Sonohysterosalpingography is a safe, easy, accurate, and promising procedure for the detection of female upper genital tract pathologies, especially because it can differentiate specific uterine anomalies. [ABSTRACT FROM AUTHOR]

Background: To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo-ovarian structures in the management of patients with unexplained infertility.Methods: A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy. The remaining 106 patients had transvaginal laparoscopy performed under local anesthesia, with standard laparoscopy performed only on those with pathology, which required operative intervention. Information on pathology, complications, and successful access to the pouch of Douglas were recorded.Results: The successful rate of access was 93%. Pathology was found in 29 patients, of whom 15 required operative laparoscopy. Also, out of 19 patients with adhesions, 11 (58%) had normal dye test bilateral, and only two (11%) had bilateral occlusion of the tubes. No complications were observed.Conclusion: Transvaginal hydrolaparoscopy is a safe and well-tolerated method for investigating the tubo-ovarian structures in unexplained infertility. It is superior to hysterosalpingography for diagnosis of adhesions. [ABSTRACT FROM AUTHOR]

The article presents a comment to a systematic review and meta-analysis about unilateral tubal block at hysterosalpingogram (HSG). It discusses the results of the systematic review and meta-analysis which attempted to combine the current knowledge about unilateral tubal obstruction on HSG in patients undergoing intrauterine insemination (IUI) without prior surgical treatment for tubal block.

Objective: To compare the therapeutic effects of cannulation guided by ultrasound or tactile sensation in women with proximal tubal obstruction.Method: This prospective randomized study reports on outcomes for 50 women treated as outpatients, 25 by the ultrasound-guided method and 25 by the tactile sensation method.Results: Of the 50 fallopian tubes in each group, 42 tubes (84%) were successfully cannulated by the ultrasound-guided method and 32 (64%) by the tactile sensation method; and of the 50 patients, 8 (16%) conceived in the 6 months following cannulation. The difference in pregnancy rates between the 2 groups was not statistically significant.Conclusion: Whether guided by ultrasound or tactile sensation, cannulation can be offered as a first-line outpatient procedure to women with proximal tubal obstruction. [ABSTRACT FROM AUTHOR]