| Background Fallopian tubal sterility is one of the main cause of female infertility,therefore,an accurate evaluation of tubal patency is a fundamental step during clinical management for infertile women.Recently,hysterosalpingography(HSG)and four-dimensional hysterosalpingo-contrast sonography(4D-HyCoSy)are the most common imaging methods to evaluate tube patency.Several reports have shown an increase in conception rate after HSG during the past sixty years.This may be related to the following factors:mechanical flushing of debris or mucus plugs in the fallopian tubes,enhanced ciliary activity and some immune mechanisms.Since 4D-HyCoSy has the advantages of accuracy,noninvasiveness and without radiation.There is no need for routine contraception for 3 months after the examination,and sexual intercourse is permitted without vaginal bleeding and other discomfort one week after 4D-HyCoSy.Therefore,Evaluation of the conception outcome in infertile women after 4D-HyCoSy has more practical clinical significance.Our clinical follow-up data and previous studies showed that some infertile women can succeed in spontaneous conception after 4D-HyCoSy.Thus,expectant treatment is recommended to reduce overtreatment,clinical risks and save medical resources due to the therapeutic effects of 4D-HyCoSy.At present,it is still unclear how to make choice of later treatment options according to the basic clinical characteristics of infertile women and the evaluation results of 4D-HyCoSy on tubal patency,whether it is expected therapy or clinical interventions,and the length of expected treatment after 4D-HyCoSy.Previous studies have shown that the mean conception time point in infertile women after 4D-HyCoSy is 5.3 months.Fallopian tube patency was significant related to conception rate.However,it is relatively simple and does not indicate the length of expected treatment after 4D HyCoSy.Purpose The study aimed to analyze the relationship between the spontaneous conception outcome and age,duration of infertility,infertility type,history of abortion,history of pelvic inflammatory disease,previous pelvic surgery,history of intrauterine surgery,multiparas,fibromyoma,lesion of uterine cavity,polycystic ovary and tubal patency after 4D-HyCoSy,to provide reference on ways to manage the patient after 4D-HyCoSy,as well as carry out further clinical interventions.Materials and methods In order to determine the spontaneous conception of infertile women after 4D-HyCoSy,it was necessary to select patients conformed to two major criteria:1.the patient's husband showed no evident cause for infertility.2.No clinical interventions were given after 4D-HyCoSy.To conform to these criteria,A total of 498 women with normal semen of their husband were performed 4D-HyCoSy between December 2014 and October 2017.the exclusion criteria were as follows:women did not conceive without contraception less than a years(35 patients),hydrosalpinx by ultrasound examination(29 patients),hysteroscopy and laparoscopic surgery(103 patients)or ART(4 patients).within a.year after 4D-HyCoSy.The outcome was spontaneous conception,defined as a woman succeeded in conception by sexual intercourse and a sonographically fetal sac was visible in her uterine cavity,all patients were devided into two groups based on the following results:conception group and non-conception group.According to the bilateral tube patency,patients were divided into six categories:type ?,defined as bilateral fallopian tubes obstruction;type ?,defined as one obstructed fallopian tube with poor patency in the other;type ?,defined as one obstructed fallopian tube with patent in the other;type ?,defined as bilateral fallopian tube poor patency;type V,defined as one fallopian tube poor patency with patent in the other;type VI,defined as bilateral fallopian tubes patent.We analyzed the correlation between spontaneous conception outcome of infertile women after 4D-HyCoSy and their underlying clinical conditions as weill as tubal patency.Results1.Basic characteristics of patientEach case was followed up for a year.A total of 44 patients were lost follow-up,and 283 patients were finally included in our study.The age of the participants ranged from 20 to 46 years,with an average age of(30.4 ± 5.4)years.The duration of infertility ranged from 1 to 10 years,with a mean of(2.0 ± 1.7)years.2.Spontaneous conception outcomeOn follow-up for 1 year after 4D-HyCoSy,116 infertile women succeeded in spontaneous conception.The cumulative conception rate was 40.9%and the mean conception time was(8.8 ± 0.3)months.The conception rate of 1-3 months,1-6 months,1-9months and 1-12 months was 21.5%,30.4%,38.2%,40.9%,respectively,and the conception rates of 1-3 months,4-6 months,7-9 months and 10-12 months accounted for 52.6%,20.7%,19.8%and 6.9%of the total conception rates,respectively.3.The relation of fallopian tube patency and spontaneous conceptionWithin a year after 4D-HyCoSy,the spontaneous conception rate was highest in type ?,reaching 62.5%,followed by type ?(46.2%),type ?(44.4%),type ?(39.4%),type ?(33.9%)and type ?(14.8%)(P<0.01).Further comparison between the two groups(Due to the small number of type ?,no statistical analysis was currently performed).showed the conception rate of type ? had significantly exceeded that of type ? and type ?.There was no significant difference in conception rate between type ? and type V.Meanwhile,The conception rate of type ?,type ? and type ? was significantly higher than that of type ?.Cox regression analysis showed fallopian tube patency was significantly associated with spontaneous conception,and the conception rate of infertile women with type ?and type ? increased significantly after 4D-HyCoSy.The mean conception time was(5.0 ± 2.1)months in type ?,(8.6 ± 0.5)months in type ? and(9.0 ± 0.5)months in type ?,respectively.4.The relation of duration of infertility and spontaneous conceptionThe conception rate was highest in duration of infertility less than 2 years(52.5%),followed by duration of infertility ranging 2 to 3 years(29.4%)and the duration of infertility more than or equal to 3 years(22.8%)(P<0.05).Cox regression analysis showed that duration of infertility was significantly associated with spontaneous conception.The conception rate of infertile women with duration of infertility less than 2 years increased significantly after 4D-HyCoSy.The mean conception time was(8.2±0.4)months in patients with duration of infertility less than 2 years.5.The relation of disease of the uterine cavity to spontaneous conceptionAfter 4D-HyCoSy,the conception rate in those with lesion of uterine cavity(endometrial polyp or adhesion of uterine cavity)was significantly lower than those without(27.7%VS.43.6%,P<0.05)6.The relation of other factors and spontaneous conceptionThe age,type of infertility,multiparas,history of pelvic surgery,history of pelvic inflammation,history of abortion,history of uterine cavity operation,uterine fibromyomata and polycystic ovary were unrelated to spotaneous conception outcome after 4D-HyCoSy(P>0.05).Conclusion ?This study showed that the conception rate in infertile women within six months after 4D-HyCoSy was 30.4%,which was higher than the spontaneous conception rate in infertile women without performed 4D-HyCoSy reported by other studies.It showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy.?Infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible and based on the 4D-HyCoSy results they could choose the appropriate clinical intervention.?According to the results,expectant treatment of about 8-9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed bilateral fallopian tubes poor patent or at least one fallopian tube patent ?Alternatively,an immediate clinical intervention is recommended for those with one obstructed fallopian tube with poor patency in the other(type ?)or bilateral obstructed tubes((type ?)). |
PDF Full Text Request