Therapeutic efficacy of hysterosalpingography with special reference to application of hydrostatic pressure during the procedure.

BACKGROUND: In the majority of infertile females, cause lies within the fallopian tubes. The causes for tubal obstruction include tuabal endometriosis, chlamydial and tuberculous infections, salpingitis, due to previous tubal approach, previous tubal pregnancy, peritubal adhesions due to previous appendicectomy, ovarian, uterine or adnexal operations. Other less important but easily treatable significant causes include tubal obstruction due to debris, fine adhesions or even unexplained tubal spasm. The later group can be managed with selective fallopian tube catheterization. Proximal tubal obstruction is seen in 10-20% of HSG examinations. The purpose of this study was to treat the infertility due to proximal fallopian tube obstruction with application of hydrostatic pressure during hysterosalpingography (HSG) technique. METHODS: A study of consecutive hundred women of 18-30 years (mean age=24 years) who were clinically suspected of proximal fallopian tube obstruction (FTO) or unexplained infertility were included in this study. Women with other organic causes were excluded from the study. All the selected women underwent for HSG examination within 10 days of the menstrual cycle (3-4 days after the bath) by applying 10 days rule and with the application of hydrostatic pressure using water soluble contrast medium during the procedure. Women with successful opening of fallopian tubes (47%) after the application of hydrostatic pressure were followed for 3-6 months for the pregnancy. RESULTS: The fallopian tubes were patent in 57 (57%) women and appeared obstructed in 43 (43%) females (33 unilateral and 10 bilateral). With application of hydrostatic pressure during HSG technique, 25 (47%) fallopian tubes in 22 women reveal prompt opening while 28 tubes in 21 women remain blocked. The rate of successful conception was observed in 6 (24%) women within 3-6 months after the procedure. CONCLUSION: Application of hydrostatic pressure during the HSG examination offers a promising technique for the management of minimal proximal fallopian tube obstructions due to debris, fine adhesions and even in unexplained tubal spasm. Therefore, being minimally invasive and cost-effective, this technique may be adopted in all the suspected proximal fallopian tube obstruction or unexplained infertility, especially prior to selective fallopian tube catheterization (FTC), laparoscopy and laparotomy.