Department of Obstetrics and Gynaecology, BP Koirala Institute of Health Science, Dharan, Nepal.
Kathmandu Univ Med J (KUMJ). 2007 Oct-Dec;5(4):456-60.
Subfertility is the inability of a couple to conceive even after one year of regular unprotected coitus. The desire of woman for children is great, sometimes greater than self-interest in beauty and figure and may be stronger than the claims of a career. Considering the social stigma attached to subfertility, a sympathetic and a carefully balanced therapeutic approach to their problem is required.
The present work has been undertaken with a view to asses the role of HSG in the evaluation of subfertility.
For the present study, a total of 105 infertile patients were selected from the outpatient department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Darbhanga. Only those cases were selected where the couples were in the fertile age group of and were living together for two or more years. The patients were advised to take 600 mg ibuprofen, an hour before the procedure to ease the cramps. A catheter was inserted through the cervical canal, and radio-opaque dye (urograffin 76%) was passed through it. A radiograph was taken after injection of two ml. of medium to ensure that there was no filling defect in the uterine cavity which, otherwise, would be concealed by overdistending the uterus. Further injection outlined the Cornua, isthmus and ampullary portions of the tube and evaluated the degree of spillage.
Of the total number of cases, abnormal HSG findings were seen in 55 patients. Majority of the patients were between 26-30 years age group with 6-10 years duration of subfertility. The tubes were occluded in 34.28% of cases in the ratio of 1:8, proximal occlusion being the commonest. 5.71% showed hydrosalpinx. Beaded & wiry appearances of tubes were seen in 2.85% of cases. Amongst the uterine anomalies, which accounted for 20% of cases, only five patients had acquired abnormality. In the congenital group maximum number of patients had hypoplastic uterus (52.38%) followed by bicornuate uterus. Unicornuate and arcuate uterus accounted for 9.52% each. Intravasation of contrast occurred in two patients.
Hysterosalpingography plays an important role in the initial diagnostic assessment of female subfertility. Other than being diagnostic, it can prove to be therapeutic also. An accurate interpretation of the hysterosalpingogram is necessary for the initial subfertility workup. Knowledge of these entities is important to avoid the practice of unnecessary and sometimes more aggressive procedures.
不孕症是指一对夫妇即使经过一年规律的无保护性交仍无法受孕。女性对孩子的渴望非常强烈，有时甚至超过了对美丽和身材的自身关注，可能比职业追求更强烈。考虑到与不孕症相关的社会耻辱感，需要对他们的问题采取一种富有同情心且精心平衡的治疗方法。
开展本研究旨在评估子宫输卵管造影（HSG）在不孕症评估中的作用。
在本研究中，从达班加医学院和医院妇产科门诊选取了总共105例不孕患者。仅选取那些夫妇处于生育年龄组且共同生活两年或更长时间的病例。建议患者在检查前一小时服用600毫克布洛芬以缓解痉挛。通过宫颈管插入一根导管，然后注入不透X线的染料（泛影葡胺76%）。注入两毫升造影剂后拍摄X线片，以确保宫腔内没有充盈缺损，否则过度充盈子宫会掩盖这种缺损。进一步注入造影剂可勾勒出输卵管的角部、峡部和壶腹部，并评估造影剂的溢出程度。
在所有病例中，55例患者的子宫输卵管造影结果异常。大多数患者年龄在26 - 30岁组，不孕症病程为6 - 10年。34.28%的病例输卵管堵塞，比例为1:8，近端堵塞最为常见。5.71%的病例显示输卵管积水。2.85%的病例可见输卵管呈串珠状和线状外观。在占病例20%的子宫异常中，只有5例患者有后天性异常。在先天性组中，最多的患者有子宫发育不全（52.38%），其次是双角子宫。单角子宫和弓形子宫各占9.52%。两名患者出现造影剂血管内渗漏。
子宫输卵管造影在女性不孕症的初始诊断评估中起着重要作用。除了具有诊断作用外，它也可能具有治疗作用。对子宫输卵管造影进行准确解读对于不孕症的初始检查至关重要。了解这些情况对于避免进行不必要的、有时甚至更激进的检查非常重要。
