Hysterosalpingography in the treatment of infertility

CILJ ISTRAŽIVANJA: pokazati uspješnost HSG-a u neplodnih žena podvrgnutih ovom zahvatu te ispitati postoje li razlike kod neplodnih žena u kojih je došlo do trudnoće nakon HSG-a s obzirom na dob, vrstu steriliteta (primarni i sekundarni), trajanje steriliteta te vremenski učinak terapijskog djelovanja HSG-a. MATERIJALI I METODE: Ovo retrospektivno istraživanje provedeno je u Klinici za ženske bolesti i porode KBC Split od 06. prosinca 2011. do 25. veljače 2016. Podatci o prohodnosti jajovoda, trudnoći nakon zahvata, dobi žene, duljini trajanja neplodnosti i tipu steriliteta pred zahvat prikupljeni su telefonskim putem od 165 neplodnih žena u dobi od 23 do 48 godina te su obrađeni u statističkom paketu IBM SPSS 21.0.0. Kriteriji uključenja bili su uredan spermiogram partnera, hormonski status i ovulacijski ciklus. Kriteriji isključenja su bili loš nalaz spermiograma, bolesti štitnjače, Cushing, hiperprolaktinemija, povišeni androgeni–tumori, dob preko 40 godina te loši testovi rezerve jajnika. REZULTATI: Analizom prohodnosti jajovoda dobiveni su podatci da od 165 pacijentica, 72,7% je imalo prohodne, a 27,3% neprohodne jajovode. Analizom steriliteta utvrđeno je da od 45 pacijentica s neprohodnim jajovodima, 55,6% ih je bilo s primarnim, a 44,4% sa sekundarnim sterilitetom. Od 120 pacijentica s prohodnim jajovodima, 48 (40%) je postiglo trudnoću. Od toga je 31,7% unutar godinu dana, a 8,3% nakon više od godinu dana od HSG-a. Od ukupno 45 pacijentica s neprohodnim jajovodima, 14 pacijentica (31,1%) su ostvarile trudnoću, od toga 17,8% unutar 6 mjeseci, a 13,3% nakon više od 6 mjeseci. Od ukupno 62 pacijentice koje su ostvarile trudnoću, 74,2% ih je bilo mlađe od 35 godina, a 25,8% starije od 35 godina, 54,8% je bilo neplodno do dvije godine, 35,5% 2 do 5 godina, 8,1% 5 do 10 godina, a 1,6% više od 10 godina. ZAKLJUČAK: Histerosalpingografija nije samo dijagnostička, već i terapijska metoda i najveći učinak ima u perioidu od 6 mjeseci nakon zahvata. Ako je nalaz HSG-a uredan, laparoskopija se ne smije raditi barem 6 mjeseci od pretrage, ako je neuredan, laparoskopija se preporučuje odmah. Odgođeno rađanje je važan čimbenik nemogućnosti začeča. Žene sa neprohodnim jajovodima najčešće su primarnog steriliteta, što ukazuje na brigu o reprodukcijskom zdravlju. Što je žena mlađa i trajanje neplodnosti do liječenja kraće, postoji veća mogućnost da će doći do trudnoće.RESEARCH OBJECTIVE: prove the success of HSG in the treatment of infertile women undergoing this procedure and whether there are differences in infertile women who experienced pregnancy after HSG in terms of age, type of infertility (primary and secondary), duration of infertility and the time of hysterosalpingography's therapeutic effect. MATERIAL AND METHODS: This retrospective study took place at the Department of Gynecology and Obstetrics in KBC Split from 06. December 2011. to 25. February 2016. The data of tubal passability, pregnancy after the procedure, women age, duration of infertility and type of infertility before the procedure were collected by phone from 165 infertile women between 23-48 years old and processed in a statistical package IBM SPSS 21.0.0. Inclusion criteria was partners normal spermiogram and womens normal hormonal and ovulatory cycle. Exclusion criteria was an abnormal spermiogram, thyroid disease, Cushing, hyperprolactinemia, increased androgens-tumors, age over 40 and bad tests of ovarian reserve. RESULTS: The analysis of tubal passability obtained data of 165 patients. 72,7% had passable and 27,3% impassable fallopian tubes. The analysis of sterility found that of 45 patients with impassable fallopian tubes, 55,6% were with primary and 44,4% with secondary infertility. From 120 patients with passable fallopian tubes, 48 (40%) of them achieved pregnancy. 31,7% of them within a year and 8,3% after more than a year of the HSG test. Of the total 45 patients with impassable fallopian tubes, there were 14 (31,1%) patients who achieved pregnancy. 17,8% of them within 6 months and 13,3% after more than 6 months. From the total of 62 patients who achieved a pregnancy, 74,2% were younger than 35 and 25,8% were older than 35; 54,8% were infertile up to two years, 35,5% 2-5 years, 8,1% 5-10 years and 1,6% over 10 years. CONCLUSION: Hysterosalpinography not only has diagnostic value, but also a potential therapeutic effect six months after the HSG test. If HSG shows passable tubes, laparoscopy should not be done for at least six months after the test, if it shows impassable tubes, laparoscopy is recommended immediately. Delayed childbirth is an important factor in reproductive failure. Women with impassable fallopian tubes usually have primary sterility, which indicates that the care of reproductive health is well. Younger women with shorter duration of infertility benefit more from hysterosalpingography