Abstract
Objective: To assess predictive factors for spontaneous pregnancy after Saline Infusion Salpingography (SIS).
Methods: A retrospective study was carried out from January 2017 to December 2020 at the Reproductive Medicine Unit of a University Hospital in Portugal. A total of 468 patients were eligible for the study and divided into two groups: spontaneous pregnancy after SIS (n=75) and non pregnant after SIS (n=373).
Results: The median age of the group of women who became pregnant was 34.0 years versus 35.0 years in those who did not become pregnant (p=0.013). In the non-pregnant group, 32% were overweight versus 20.6% in the pregnant group (p=0.030). The mean time of infertility was 2.7 ± 2.1 years for those who did not become pregnant versus 1.9 ± 0.9 for those who did (p<0.0001). The median anti-Mullerian hormone was 1.8 ng/mL in the non-pregnant group versus 2.4 ng/mL in the pregnant group (p=0.002), and antral follicle count was 10 in the non-pregnant group versus 12 in the pregnant group (p=0.03). The median age of the partner was 36 versus 35 years in the non-pregnant versus the pregnant group (p=0.019). The pregnancy rate was 16% and significantly higher in the first 30 days after SIS (33.3%) (p<0.0001). Conclusions: The present study provides evidence of the positive impact of SIS on spontaneous pregnancy, especially within the first 30 days after SIS, and suggests considering expectant management in younger patients with a shorter duration of infertility, a higher functional ovarian reserve and a normal weight.
References
Zegers-Hochschild F, Adamson GD, Dyer S, et al. The international glossary on infertility and fertility care, 2017. Hum Reprod. 2017;32(9):1786-1801.
Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. The international committee for monitoring assisted reproductive technology (ICMART) and the world health organization (WHO) revised glossary on ART terminology, 2009. Hum Reprod. 2009;24(11):2683-2687.
Zhang Y, Wang Q, Gao C-y, et al. Evaluation of the safety and effectiveness of tubal inflammatory drugs in patients with incomplete tubal obstruction after four-dimensional hysterosalpingo-contrast-sonography examination. BMC Pregnancy and Childbirth. 2022;22(1):395.
Giugliano E, Cagnazzo E, Bazzan E, Patella A, Marci R. Hysterosalpingo-contrast sonography: is possible to quantify the therapeutic effect of a diagnostic test? Clin Exp Reprod Med. 2012;39(4):161-165.
Liu Y, Zhang N, He Y, et al. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography. BMC Pregnancy and Childbirth. 2020;20(1):638.
Chen F, Quan J, Huang P, You X. Hysterosalpingo-contrast Sonography with four-dimensional technique for screening fallopian tubal patency: Let’s make an exploration. J Minim Invasive Gynecol. 2017;24(3):407-414.
Rezk M, Shawky M. The safety and acceptability of saline infusion sonography versus hysterosalpingography for evaluation of tubal patency in infertile women. Mid East Fertil Soc J. 2015;20(2):108-113.
Christianson MS, Legro RS, Jin S, et al. Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome. J Assist Reprod Genet. 2018;35(12):2173-2180.
Robertshaw I, Martinez A, Batcheller A, DiPaola K, Sroga J, Lindheim S. Air bubble saline infused sonography (SIS) is equivalent to hysterosalpingogram (HSG) in assessment of tubal patency. Fertil Steril. 2014;102(3):e281-e2.
Zhang N, Liu Y, He Y, Shi J, Zhou M, Liu H. Transvaginal four‐dimensional hysterosalpingo‐contrast sonography: Pain perception and factors influencing pain severity. J Obstet Gynaecol Res. 2021;47(1):302-310.
Hamed HO, Shahin AY, Elsamman AM. Hysterosalpingo-contrast sonography versus radiographic hysterosalpingography in the evaluation of tubal patency. Int J Gynecol Obstet. 2009;105(3):215-217.
Exacoustos C, Zupi E, Carusotti C, Lanzi G, Marconi D, Arduini D. Hysterosalpingo-contrast sonography compared with hysterosalpingography and laparoscopic dye pertubation to evaluate tubal patency. J Am Assoc Gynecol Laparosc. 2003;10(3):367-372.
Chunyan G, Bin P, Ping Y, et al. Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography. Biomed Res Int. 2018;2018: 4901281.
Siam EM. Pregnancy outcome after hystero-salpingo-contrast-sonography (HyCoSy) versus hysterosalpingography (HSG) using different contrast media. Mid East Fertil Soc J. 2011;16(4):265-271.
Lindborg L, Thorburn J, Bergh C, Strandell A. Influence of HyCoSy on spontaneous pregnancy: a randomized controlled trial. Hum Reprod. 2009;24(5):1075-1079.
Ferreira A. How to perform Sonosalpingography? Visual Encyclopedia of Ultrasound in Obstetric and Gynecology: VISUOG; 2023. Available at: https://www.isuog.org/education/visuog/gynecology/ultrasound-guided-procedures/how-to-perform-sonosalpingography.html
Zain MM, Norman RJ. Impact of obesity on female fertility and fertility treatment. Women’s Health. 2008;4(2):183-194.
Gu P, Yang X, Zhao X, Xu D. The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility. Quant Imaging Med Surg. 2021;11(8):3698-3714.
Al-Omari MH, Obeidat N, Elheis M, Khasawneh RA, Gharaibeh MM. Factors affecting pregnancy rate following fallopian tube recanalization in women with proximal fallopian tube obstruction. J Clin Med. 2018;7(5):110.
Bisogni F, Galanti F, Riccio S, et al. 4D-HyCoSy performed in a reproductive center: retrospective analysis of pain perception, complications and spontaneous pregnancy rate after the technique. Eur Rev Med Pharmacol Sci. 2021;25(23):7468-7475.
Wahby O, Sobrero AJ, Epstein JA. Hysterosalpingography in relation to pregnancy and its outcome in infertile women. Fertil Steril. 1966;17(4):520-530.
Nugent D, Watson AJ, Killick SR, Balen AH, Rutherford AJ. A randomized controlled trial of tubal flushing with lipiodol for unexplained infertility. Fertil Steril. 2002;77(1):173-175.
Dreyer K, Van Rijswijk J, Mijatovic V, et al. Oil-based or water-based contrast for hysterosalpingography in infertile women. N Engl J Med. 2017;376(21):2043-2052.
Lo Monte G, Capobianco G, Piva I, Caserta D, Dessole S, Marci R. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point! Arch Gynecol Obstetrics. 2015;291(1):19-30.
Mohiyiddeen L, Hardiman A, Fitzgerald C, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2015(5): CD003718.
Li R, Qiu X, Chen XF, et al. Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility. Arch Gynecol Obstet. 2022;306(3):893-900.
Maheux-Lacroix S, Bergeron C, Moore L, et al. Hysterosalpingosonography is not as effective as hysterosalpingography to increase chances of pregnancy. J Obstet Gynaecol Canada. 2019;41(5):593-598.
Zhou L, Zhang X, Chen X, et al. Value of three‐dimensional hysterosalpingo‐contrast sonography with SonoVue in the assessment of tubal patency. Ultrasound Obstetrics Gynecol. 2012;40(1):93-98.
Magnus MC, Wilcox AJ, Morken N-H, Weinberg CR, Håberg SE. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019;364:l869.
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