Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography

Abstract

Background: Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients' clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy.

Methods: This was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization (WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy.

Result(s): One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy.

Conclusion(s): This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8-9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .

Keywords: Hysterosalpingo contrast; Infertility; Sonography; Spontaneous conception; Tubal patency.

Fig. 1

The flowchart of the study

Fig. 2

Different types of fallopian tubes on 4D-HyCoSy. a. The tubes were patent, and the passage of the tube was soft and naturally. b. The left tube was poor patency, and the entire fallopian tube was stiff, angled, circuitous and directed upward. c. Both fallopian tubes were obstructed, we could not see the entire passage of the tubes or the spillage at the fimbria of the tube

Fig. 3

Total cumulative conception rate in different fallopian tubes patency. The conception rate was highest in type VI (62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%) (P < 0.01)

Fig. 4

The comparison of conception rate among groups with different types of fallopian tubes. *: p<0.05; **: p<0.01; ***: p<0.001

Fig. 5

Total cumulative conception rate in different sterility duration. The 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%)