Phillips Catherine H, Benson Carol B, Ginsburg Elizabeth S, Frates Mary C
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.
Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.
Fertil Res Pract. 2015 Dec 23;1:20. doi: 10.1186/s40738-015-0012-3. eCollection 2015.
The causes of female infertility are multifactorial and necessitate comprehensive evaluation including physical examination, hormonal testing, and imaging. Given the associated psychological and financial stress that imaging can cause, infertility patients benefit from a structured and streamlined evaluation. The goal of such a work up is to evaluate the uterus, endometrium, and fallopian tubes for anomalies or abnormalities potentially preventing normal conception. To date, the standard method for assessing these structures typically involves some combination of transvaginal sonography (TVS), hysterosalpingography (HSG), and hysteroscopy (HSC). The goal of this review is to compare the diagnostic accuracy of TVS, HSG, and HSC for diagnosing abnormalities in infertility patients to determine if all studies are necessary for pre-treatment evaluation.
We identified infertility patients prior to initiation of assisted reproductive technology who had baseline TVS, HSG, and HSC within 180 days of each other. From medical record review, we compared frequencies of each finding between modalities. Of the 1274 patients who received a baseline TVS over 2 years, 327 had TVS and HSG within 180 days and 55 patients had TVS, HSG and HSC. Of the 327, TVS detected fibroids more often than HSG (74 vs. 5, < .0001), and adenomyosis more often than HSG (7 vs. 2, = .02). HSG detected tubal obstruction more often than TVS (56 vs. 8, = .002). Four (1.2 %) patients had endometrial polyps on both HSG and TVS. In the 55 patients with HSG, TVS, and HSC, HSC identified endometrial polyps more often than TVS (10 vs. 1, = .0001) and HSG (10 vs. 2, = .0007). TVS detected more fibroids than HSC (17 vs. 5, < .0001). Tubal obstruction was identified more often by HSG than HSC (19 vs. 5, < .0001).
TVS is superior for evaluation of myometrial pathology. HSG is superior for evaluation of tubal pathologies. Endometrial pathologies are best identified with HSC.
女性不孕症的病因是多因素的，需要进行包括体格检查、激素检测和影像学检查在内的综合评估。考虑到影像学检查可能带来的心理和经济压力，不孕症患者可从结构化、简化的评估中获益。此类检查的目的是评估子宫、子宫内膜和输卵管是否存在可能妨碍正常受孕的异常情况。迄今为止，评估这些结构的标准方法通常包括经阴道超声检查（TVS）、子宫输卵管造影（HSG）和宫腔镜检查（HSC）的某种组合。本综述的目的是比较TVS、HSG和HSC在诊断不孕症患者异常情况方面的诊断准确性，以确定预处理评估是否需要所有这些检查。
我们确定了在开始辅助生殖技术之前，在180天内进行了基线TVS、HSG和HSC检查的不孕症患者。通过病历回顾，我们比较了不同检查方式下各项检查结果的出现频率。在两年内接受基线TVS检查的1274例患者中，327例在180天内同时进行了TVS和HSG检查，55例同时进行了TVS、HSG和HSC检查。在327例患者中，TVS检测出肌瘤的频率高于HSG（74例对5例，<0.0001），检测出子宫腺肌病的频率也高于HSG（7例对2例，=0.02）。HSG检测出输卵管阻塞的频率高于TVS（56例对8例，=0.002）。4例（1.2%）患者在HSG和TVS检查中均发现有子宫内膜息肉。在55例同时进行了HSG、TVS和HSC检查的患者中，HSC发现子宫内膜息肉的频率高于TVS（10例对1例，=0.0001）和HSG（10例对2例，=0.0007）。TVS检测出的肌瘤比HSC多（17例对5例，<0.0001）。HSG发现输卵管阻塞的频率高于HSC（19例对5例，<0.0001）。
TVS在评估子宫肌层病变方面更具优势。HSG在评估输卵管病变方面更具优势。子宫内膜病变最好通过HSC来识别。
