Should Hysterosalpingography Routinely Or Selectively Performed As A First Step İn The Evaluation Of İnfertile Couples?

Öz

Aim: Routine hysterosalpingography HSG in the evaluation of infertile couples is still a subject of discussion. Whereas some of the professional organizations recommend performing HSG to all patients, other authors recommend performing it selectively. We aimed to assess whether risk factors in medical history might predict the presence of tubal disease on HSG.Material and methods: Five-hundred and fifty-three patients whom were assessed with HSG between January-2010 and December-2012 in Department of OBGYN, Hacettepe University were enrolled. Of them, images of 423 cases were sufficient for further evaluation. The pathologies those are observed with HSG were stratified according to the location as uterine, tubal, both tubal and uterine diseases. Meanwhile, all patients were questioned by telephone about Pelvic Inflammatory Disease PID symptoms and previous pelvic surgery.Results: Of 423 women, no pathology was noticed in 47.8% of them n= 202 . We were able reach 208 of 423 subjects by phone and 48 23.1% of them had a history of previous PID attack. Among patients having significant symptoms for PID, while 50.0% had normal HSG, 33.3% had tubal-only, 8.3% had uterine-only, and 8.3% had both tubal and uterine diseases on HSG. Patients without a history of PID, the respective figures for normal, uterine-only, tubal-only and both uterine and tubal diseases were 50.0%, 17.8%, 27.5% and 5.0% on HSG p > 0.05 for all comparisons . A presence of previous pelvic surgery was significantly more prevalent among the patients with abnormal HSG findings 42.3% vs. 28.8%, p=0.042 and it remained to be significant predictor for abnormal findings on HSG along with female age in the logistic regression analysis.Conclusion: Even among patients who do not have risk factors for tubal disease, considerable amount of tubal pathology is still determined via HSG. Since some attacks remain subclinical, the underestimation of the prevalence of PID might be responsible for that conclusion. Therefore, only screening for risk factors related with tubal disease might not be ideal before deciding to perform uterine-tubal imaging or not. Whereas increasing female age and presence of previous pelvic surgery might be independent predictors for abnormal HSG findings.

Anahtar Kelimeler

• Tubal patency,PID,HSG,pelvic surgery,routinely

İnfertil Çiftin İlk Basamak Değerlendirmesinde Histerosalpingografi Rutin Herkese Mi Veya Seçilmiş Hastalara Mı Yapılmalı?

Öz

Amaç: İnfertil çiftin değerlendirilmesinde rutin histerosalpingografi HSG yeri hala tartışma konusudur. Bazı dernekler bültenlerinde HSG’nin tüm hastalara rutin olarak yapılmasını önerirken buna karşın bazı yazarlarda seçilmiş hastalarda uygulanmasını önermektedir. Biz çalışmamızda kadının medikal öyküsündeki risk faktörlerinin HSG’de tubal patoloji varlığını öngörebilip öngöremeyeceğini araştırmayı amaçladık.Gereç ve Yöntemler: Çalışmaya Ocak 2010 – Aralık 2012 tarihleri arasında Hacettepe Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalında HSG çekilen 553 kadın dahil edildi. Bu HSG’lerin 423 tanesi ileri değerlendirme için uygun yeterlilikte bulundu. HSG’deki patolojiler yerine göre tubal, uterine ve hem tubal hem uterin patoloji şeklinde gruplandırıldı. Aynı zamanda çalışmaya dahil edilen bu hastalar telefon ile aranarak pelvik inflamatuar hastalık PID ve geçirilmiş pelvik cerrahi yönünden sorgulandı.Bulgular: Değerlendirilen 423 kadın arasından %47.8’inde n=202 herhangi bir patolojiye rastlanılmadı. Telefon ile yapılan ankete 423 hastanın 208 tanesi katıldı ve bunların 48 %23.1 tanesinin hikayesinde geçirilmiş PID atağı saptandı. PID semptomları olan kadınların %50.0’sinin HSG’si normalken %33.3’ünün sadece tubal patoloji, %8.3’nün sadece uterin patolojisi ve %8.3’nün hem uterin hem tubal patolojisi vardı. PID semptomu olmayan hastalarda bu durum sırasıyla %50.0, 27.5%, %17.8 ve %5.0’idi ve tüm karşılaştırmalar istatistiksel olarak anlamsızdı. Diğer yandan anormal HSG’si olan kadınlar arasında geçirilmiş pelvik cerrahinin istatistiksel anlamlı olarak daha sık olduğu gözlendi ve lojistik regresyon analizinde de artan kadın yaşı ile birlikte geçirilmiş pelvik cerrahinin HSG’de anormal bulgular için bağımsız birer belirteç olduğu saptandı.Sonuç: Medikal hikayesinde tubal hastalık yönünden risk faktörü olmayan kadınlar arasında bile HSG’de hala hatırı sayılır derecede patolojiye rastlanılmaktadır. Bazı ataklar subklinik kalabileceğinden PID sıklığının azımsanması bu sonuçların nedeni olabilir. Bu nedenle uterin ve tubal görüntüleme yapılıp yapılmayacağına sadece tubal hastalık ile ilgili risk faktörleri varlığına göre karar vermek ideal olmayabilir. Buna karşın ilerleyen kadın yaşı ve geçirilmiş pelvik cerrahinin varlığı da anormal HSG bulguları yönünden bağımız belirteç olabilir.

Anahtar Kelimeler

• Tubal geçirgenlik,PID,HSG,pelvik cerrahi,rutin

Kaynakça

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