Main »
Infertility
» Diagnosis of infertility - hysterosalpingography
15:06
Diagnosis of infertility - hysterosalpingography
Hysterosalpingography
Objective information about the state of the uterus and fallopian tubes may be obtained by X-ray studies of the uterus and tubes - study, known as hysterosalpingography (HSG).
Features of this procedure will be described below, but here, just shows what it looks like the uterus and tubes on radiographs in healthy women and in various cases of infertility. a) A normal X-ray picture of the uterus and tubes. b) The two pipes are impassable in the interstitial compartments. c) The right tube is impassable in the istmicheskom department, the left - in the ampullar. d) The right tube is absent, the left impassable - saktosalpinks (trumpet as a "bag")
Immediately prior to hysterosalpingography should verify with the help of vaginal smears in the absence of inflammation in the genital tract. Failure to do so may lead to an exacerbation of the inflammatory process after snapshot and dramatically worsen the condition of pipes. If the swabs dysfunctional, it is necessary to carry out treatment before the study and achieve normalization of their reception, of course, under the supervision of a physician.
It is important to reliably protect against pregnancy when the doctor insists on conducting research in the second half of the menstrual cycle. There are many cases where in spite of the long-term (6-8 years or more) history of infertility, it is a cycle, when performed hysterosalpingography, the woman finds herself pregnant. As a result, much desired pregnancy or broken on their own or had to interrupt it for medical reasons. And for the couple and the doctor is a strong psychological trauma, as often think that maybe it was the only chance.
The same warning applies to hydro-test or pnevmopertubatsii that sometimes try to replace hysterosalpingography should be noted that these procedures are much less informative than X-rays, since they allow to establish only the fact of cross-country or obstruction of the fallopian tubes (or pipes), but does not allow us to estimate state of the endometrium and particularly anatomy of the uterus and tubes.
In order to avoid erroneous interpretation of hysterosalpingography associated with spastic reduction of tubes in response to the introduction of contrast medium, which creates a false impression of their obstruction, preferably 30-40 minutes before the shot (or pilot gidrotubatsii) Take 2 tablets shpy or baralgina. In cases where prior intrauterine intervention is complicated by the emergence or exacerbation of the inflammatory process, the next shot, or his substitute procedure must be performed on the background of anti-inflammatory treatment, a doctor appointed by the (few days before the day of the study and a few days after the shot), and only if the normal pattern vaginal smears.
How often must be repeated shots of the uterus and tubes? Basically, after every serious exacerbation of inflammation and the intrauterine intervention (eg, diagnostic curettage, abortion, etc.) in the case on previous radiographs, one or both tubes were completely or partially passable, and after the course treatment aimed at restoring tubal patency.
However, in practice, repetition and painful unsound research is not acceptable, so repeat hysterosalpingography is sometimes replaced by gidrotubatsiyami trial or recommend the diagnostic laparoscopy for a final decision on the future tactics of treatment, if the spouses are strongly tuned to a natural conception.
X-rays provide a good overview on the state of the uterus and tubes, but do not allow us to estimate the severity of adhesions, leading to their obstruction, or to establish the presence of adhesions around the ovaries, endometriosis, etc. In addition, if the X-ray tube is clearly visible obstruction, and pregnancy, despite treatment, does not occur, repeat hysterosalpingography completely devoid of meaning.
