Hysterosalpingography to assess whether the fallopian tubes are
functioning?
In the 1940s hysterosalpingography (HSG) was introduced. A radio-opaque dye
was introduced through the cervix and an x-ray picture was taken to track the
dye through the uterus and Fallopian tubes (Figure
9.3).
Hysterosalpingography (HSG) is a radiological test to
investigate the shape of the uterine cavity and the shape and patency of the
fallopian tubes.
All currently available clinical techniques, that assess the fallopian
tubes including hysterosalpingograms, look to see if there are blocked fallopian
tubes. They do not assess an essential component of fallopian tube function,
namely if the tubes are capable of moving the egg towards and into the uterus.
Figure 9.3 A
hysterosalpingogram
Fertility and
Infertility for Dummies (For Dummies)
The procedure involves ionizating x-rays and should be done in the early
phase of the cycle; pregnancy should be excluded. It is useful to diagnose
uterine abnormalities. It has been claimed that pregnancy rates are increased in
a cycle when an HSG has been performed. Using catheters, an interventional
radiologist can open tubes that are proximally occluded.
The HSG is usually done with radiographic contrast medium (dye) injected into
the uterine cavity through cervix. If the fallopian tubes are open the contrast
medium will fill the tubes and spill out into the peritoneal cavity. It can be
determined whether the fallopian tubes are open or blocked and whether the
blockage is located at the junction of the tube and the uterus (proximal) or
whether it is at the end of the fallopian tube (distal).
One concern is that some patients whilst having a hysterosalpingogram, find
it painful.
In one study,0801
the efficacy of oral naproxen with intrauterine instillation of 1%
lignocaine was compared for pain relief. Methods: Intrauterine lignocaine was no
more effective than a single oral dose of 375 mg of naproxen 1 hour prior to HSG.
In a study of 104 infertile couples, the women had both hysterosalpingography and laparoscopy with dye insufflation. There was an overall agreement between the two techniques in 62.5% of cases. It was concluded that whenever the HSG demonstrated tubal patency with free flow of dye, laparoscopic may not be necessary. At one time it was argued that laparoscopy had the advantage as it would allow a diagnosis of minimal endometriosis. This no longer seems relevant as such findings are of no clinical relevance (Q9.11). Several experts have come to the conclusion that in the absence of clinical indicators of significant pelvic disease and a normal hysterosalpingogram there is little to be gained by submitting infertile women to laparoscopy.
Related Medical Abstracts - Click on the paper title:-
Making Babies the Hard Way: Living with Infertility and Treatment
Tubal Surgery for Tubal Factor
Infertility
The success rates following tubal surgery will depend on the severity of the disease. Careful pre-operative assessment, including semen analysis and often hysterosalpingography and laparoscopy, is required.
The commonest site of tubal damage is at the fimbrial end (opening near the ovaries –Figure 9.1), with birth rates after surgery in the order of 25 per cent. Surgery for proximal tubal occlusion (the blockage is close to the uterus) is more successful, with live birth rates of 50% and ectopic rates of 10%. Just over a half of intrauterine pregnancies following tubal surgery may occur more than one year after surgery. Reversal of sterilisation, with removal of clips and re-anastomosis (reconnection), carries a relatively high success rate of up to 80%.
Tubal microsurgery involves the use of magnification as well as the adoption of a set of techniques including the use of special instruments, minimal handling of the Fallopian tubes and fine non-reactive suture material. There have been no controlled trials to prove conclusively an advantage over conventional surgical techniques but several surgical teams have reported improved success rates. It is technically possible to transplant Fallopian tubes and large numbers of these organs would undoubtedly be donated by women undergoing sterilisation or hysterectomy
(hysterectomy). Research interest in this area seems to have diminished following the development of IVF (Q10.24).
IVF
Introducing IVF - In Vitro Fertilisation (USA Fertilization)
IVF literally means fertilisation outside
the body. IVF was initially developed for women who had severe tubal disease or who had their Fallopian tubes removed but this treatment has also proved successful for unexplained
infertility and male factor infertility.
IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. A typical IVF treatment cycle is outlined in (Figure 10.3). Originally, eggs were collected laparoscopically (laparoscopy) but we now collect the eggs by ultrasound guidance usually through the vagina.
Please see
or
Tubal Surgery and IVF Compared
Information about success rates is essential for couples to make informed decisions. In vitro fertilization (IVF) provides an alternative to tubal surgery. For mild tubal disease and previous sterilisation, tubal surgery is probably the treatment of first choice. With severe tubal disease, IVF carries the better success rate. For intermediate disease, the optimum method in terms of success is less certain. IVF is becoming increasingly successful (Figure 10.5) and appropriately more popular (Figure 10.6).
The merits of tubal surgery and assisted reproduction (Assisted Reproductive Technology ART) need careful comparison. In-vitro fertilisation is becoming more readily available with a corresponding reduction in the use of tubal surgery.
IVF is associated with a higher incidence of multiple pregnancy. Perinatal mortality rates following assisted conception procedures are treble that of spontaneous conception although most of the increase is related to multiple pregnancy. There is a five-fold increase in perinatal mortality (stillbirths and first week losses) with triplets compared with singletons. The predicted costs associated with delivery of each baby for a singleton pregnancy in the USA in 1991 was $9,845, for a twin pregnancy $18,974 and for triplets $36,588. Between 1986 and 1991, assisted reproduction techniques were found to be responsible for 35% of twins and 77% of higher order pregnancies.
In the NHS only about 25% of purchasing authorities are currently supporting IVF treatment and the number is falling. There can be little doubt, that from a purely economic point of view, a greater number of pregnancies could be achieved with a given amount of funding using low tech treatments. Many couples would prefer tubal surgery in the first instance and the opportunity to conceive naturally, only resorting to IVF if this fails.
Tubal Surgery for Tubal Factor Infertility
IVF and Tubal Surgery Compared
Infertility Support Groups
Members of a support group, provide each other with various types of help
for a particular shared difficulty. The support may take the form of
providing relevant information, relating personal experiences, listening to
others' experiences, providing sympathetic understanding and establishing
social networks. A support group may also provide ancillary support, such as
serving as a voice for the public or engaging in advocacy. Support groups
maintain interpersonal contact among their members in a variety of ways.
Support groups also maintain contact through printed newsletters, telephone
chains, internet forums, and mailing lists.
Support groups offer companionship and information for people coping
with diseases or disabilities. Support groups may not be appropriate for
everyone, and some find that a support group actually adds to their stress
rather than relieving it.
Do you have an unanswered women's health question?
Please let us have your general question on our
NEW FORUM
/ MESSAGE BOARDS facility and we will try
to answer it for you. I am sure that you will appreciate that we cannot offer advice on the management of an individual's specific problem.
