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Ziogas AC, Tsakos E, Tsagias N, Thanasas I, Liasidi PN, Xydias EM. Enhancing Fertility in the Same Cycle: A Case Report on Effects of Hysterosalpingo-Foam Sonography (HyFoSy) for a Couple With Mild Infertility. Cureus 2024; 16:e56495. [PMID: 38510519 PMCID: PMC10951675 DOI: 10.7759/cureus.56495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 03/22/2024] Open
Abstract
Fertility issues are becoming increasingly prevalent, leading many couples to seek fertility treatment at specialized centers. Infertility is a diverse clinical condition, with multiple potential etiologic factors and variable severity in its manifestation. Regardless of the underlying factors and severity, routine fertility assessment rarely differs between cases, with an essential step being fallopian tube patency assessment. Hysterosalpingo-foam sonography (HyFoSy) is the latest available diagnostic technique to assess this parameter, offering robust results, with reduced intra-procedural pain and equipment requirements, in the convenience of the office setting. However, apart from its diagnostic value, HyFoSy has also demonstrated a therapeutic tubal flushing effect, that may be the decisive factor for couples with mild infertility to spontaneously conceive. In this report, we present the case of a couple with mild infertility, who managed to spontaneously conceive after a HyFoSy examination, and in fact within the same cycle.
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Affiliation(s)
- Apostolos C Ziogas
- Department of Obstetrics and Gynecology, School of Health Sciences, University of Thessaly, Larissa, GRC
| | - Elias Tsakos
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
| | - Nikolaos Tsagias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | - Emmanouil M Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
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Raperport C, Desai J, Qureshi D, Rustin E, Balaji A, Chronopoulou E, Homburg R, Khan KS, Bhide P. The definition of unexplained infertility: A systematic review. BJOG 2023. [PMID: 37957032 DOI: 10.1111/1471-0528.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/21/2023] [Accepted: 10/15/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There is no consensus on tests required to either diagnose unexplained infertility or use for research inclusion criteria. This leads to heterogeneity and bias affecting meta-analysis and best practice advice. OBJECTIVES This systematic review analyses the variability of inclusion criteria applied to couples with unexplained infertility. We propose standardised criteria for use both in future research studies and clinical diagnosis. SEARCH STRATEGY CINAHL and MEDLINE online databases were searched up to November 2022 for all published studies recruiting couples with unexplained infertility, available in full text in the English language. DATA COLLECTION AND ANALYSIS Data were collected in an Excel spreadsheet. Results were analysed per category and methodology or reference range. MAIN RESULTS Of 375 relevant studies, only 258 defined their inclusion criteria. The most commonly applied inclusion criteria were semen analysis, tubal patency and assessment of ovulation in 220 (85%), 232 (90%), 205 (79.5%) respectively. Only 87/220 (39.5%) studies reporting semen analysis used the World Health Organization (WHO) limits. Tubal patency was accepted if bilateral in 145/232 (62.5%) and if unilateral in 24/232 (10.3%). Ovulation was assessed using mid-luteal serum progesterone in 115/205 (56.1%) and by a history of regular cycles in 87/205 (42.4%). Other criteria, including uterine cavity assessment and hormone profile, were applied in less than 50% of included studies. CONCLUSIONS This review highlights the heterogeneity among studied populations with unexplained infertility. Development and application of internationally accepted criteria will improve the quality of research and future clinical care.
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Affiliation(s)
- Claudia Raperport
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Desai
- Queen Mary University of London Medical School, London, UK
| | | | | | - Aparna Balaji
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | | | - Roy Homburg
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool, UK
| | - Khalid Saeed Khan
- Department of Preventative Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain
- CIBER Epidemiology and Public Health, Madrid, Spain
| | - Priya Bhide
- Women's Health Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Lamari I, Xydias EM, Tsakos E, Thanasas I, Ziogas AC. Spontaneous Pregnancy in a Hysterosalpingo-Foam-Sonography (ΗyFoSy) Cycle: A Case Report and Review of the Available Literature. Cureus 2023; 15:e37640. [PMID: 37200641 PMCID: PMC10187797 DOI: 10.7759/cureus.37640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
Fallopian tube pathology is a very common cause of infertility for multiple couples worldwide. Tubal patency assessment is considered a crucial component of initial infertility evaluation with several evaluation tests available, such as hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), and hysterosalpingo-foam sonography (HyFoSy), the latest tubal patency assessment, utilizing ultrasonography and a foam-based contrast agent. An additional side-benefit of these assessment tests is a fertility-enhancing effect, best studied with the application of HSG. In this report, we present a case of a 28-year-old woman with unexplained infertility who spontaneously conceived in the same menstrual cycle that the HyFoSy exam with ExEm® foam (ExEm Foam Inc., Nashville, Tennessee, United States) was performed, without any additional fertility enhancement interventions.
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Affiliation(s)
- Ioanna Lamari
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GRC
| | - Emmanouil M Xydias
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GRC
- Research Department, EmbryoClinic IVF, Thessaloniki, GRC
| | - Elias Tsakos
- Research Department, EmbryoClinic IVF, Thessaloniki, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Apostolos C Ziogas
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GRC
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Boned-López J, Alcázar JL, Errasti T, Ruiz-Zambrana A, Rodriguez I, Pascual MA, Guerriero S. Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 304:1389-1398. [PMID: 34417840 DOI: 10.1007/s00404-021-06188-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. DESIGN Systematic review and meta-analysis. PATIENTS Women undergoing HyCoSy due to infertility. INTERVENTIONS Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. MAIN OUTCOME MEASURES Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. RESULTS Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. CONCLUSIONS HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.
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Affiliation(s)
- Jordi Boned-López
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain.
| | - Tania Errasti
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Alvaro Ruiz-Zambrana
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Ignacio Rodriguez
- Epidemiology and Statistics Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - María Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
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Welie NV, Ludwin A, Martins WP, Mijatovic V, Dreyer K. Tubal Flushing Treatment for Unexplained Infertility. Semin Reprod Med 2020; 38:74-86. [PMID: 33339062 DOI: 10.1055/s-0040-1721720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tubal patency testing was initially introduced as a diagnostic test. However, it has been observed that some tubal patency tests also have a therapeutic effect. This therapeutic effect can be influenced by the contrast medium used during tubal flushing. In this review, we discuss current evidence associated with different methods for tubal flushing and their potential impact on reproductive outcomes in women with unexplained infertility. Furthermore, we discuss their diagnostic accuracy, safety, and cost-effectiveness.
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Affiliation(s)
- Nienke van Welie
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin and Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed, Private Hospital and Clinic, Krakow, Poland
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Reproductive Medicine, SEMEAR fertilidade, Ribeirao Preto/SP, Brazil
| | - Velja Mijatovic
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dreyer
- Department of Reproductive Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Waheed KB, Albassam MA, AlShamrani AAG, Aloumi SA, Amin MS, Rashid L, AlGodayan SM, Ahmad SFB. Hysterosalpingographic findings in primary and secondary infertility patients. Saudi Med J 2019; 40:1067-1071. [PMID: 31588489 PMCID: PMC6887874 DOI: 10.15537/smj.2019.10.24538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To highlight and compare spectrum of hysterosalpingography (HSG) findings in primary and secondary infertility patients. Methods: This retrospective record-based cross-sectional study was performed in the Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia between August 2016 and 2018. All patients (N=303) who underwent successful HSGs were included, and grouped under primary and secondary infertility cases. Patients with failed, limited or incomplete studies were excluded. Imaging findings were documented as N (Normal) or Ab (Abnormal). Abnormal HSG findings were further categorized as: C=congenital malformation, I=infection or inflammation, S=surgery, T=tumor or tear. Abnormal findings were confirmed on further imaging or intervention. Chi-square test was used to determine any association of HSG findings with type of infertility, and p-value less than 0.05 was considered significant. Results: Of the 303 patients, 166 patients (54.8%) had primary infertility while the rest had secondary infertility. Abnormal studies were found in less than one-third of patients (n=93, 30.7%). Primary infertility patients exhibited more congenital (C) malformations, while surgery (S) was seen more in secondary infertility patients (p=0.01). Conclusion: Congenital malformations are commonly found abnormalities on HSGs in primary infertility patients, while surgery related findings are seen in secondary infertility cases.
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Affiliation(s)
- Khawaja B Waheed
- Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia. E-mail.
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