Bisogni Francesco, Galanti Francesco, Riccio Serena, Ghanitab Simona, Polletta Stefania, Annesi Valentina, Antonaci Domenico, Rago Andrea, Schiavi Michele Carlo, Spina Vincenzo, Rago Rocco
Reproductive Physiopathology and Andrology Unit Sandro Pertini Hospital, Rome, Italy.
Obstetrics and Gynecology Unit ASL Frosinone, Frosinone, Italy.
Case Rep Obstet Gynecol. 2024 Jun 11;2024:7774854. doi: 10.1155/2024/7774854. eCollection 2024.
Infertility is increasing worldwide, as well as in Italy, and fallopian tube pathology represents one of the most impacting causes of infertility for multiple women. Indeed, tubal patency assessment is a crucial step in medical evaluation for women attending an in vitro fertilization (IVF) center. Currently, different methods for tubal investigation are available, such as chromosalpingoscopy, hysterosalpingography (HSG), and hysterosalpingo-contrast sonography (HyCoSy). This diagnostic exam is performed by ultrasonography and an air-water-based contrast agent represented by air-water, or foam solution (HyFoSy). An additional side benefit of these assessment tests is a fertility-enhancing effect, thanks to a positive effect defined as "tubal flushing," which in current literature is more strongly associated with HyFoSy with respect to HyCoSy. In this report, we present a case of a 34-year-old woman presented to our attention at the Reproductive and Physiopathology Unit of Sandro Pertini Hospital, Rome, in 2023, with unexplained infertility for 3.1 years of free sexual intercourse with a partner who did not report sperm abnormalities. Subsequently, in this exam, the woman spontaneously conceived in the same menstrual cycle that the 4D-HyCoSy was performed, without any additional fertility enhancement interventions. In this case report, we also include an updating review of the current literature regarding the insurgence of spontaneous pregnancy after this technique in order to explore the physiopathological and etiopathogenetic mechanisms underlying the achievement of spontaneous pregnancy and to confront our case with other recent works published. According to our clinical experience and the current literature, 4D-HyCoSy is the easiest, safest, and cheapest diagnostic exam for investigating tubal patency, which can lead to medical success in some cases of "unexplained infertility" as the achievement of a spontaneous pregnancy.
不孕不育在全球范围内以及意大利都呈上升趋势,输卵管病变是导致众多女性不孕不育的最主要原因之一。事实上,输卵管通畅性评估是前往体外受精(IVF)中心就诊的女性进行医学评估的关键步骤。目前,有多种输卵管检查方法可供选择,如染色体输卵管镜检查、子宫输卵管造影(HSG)以及子宫输卵管造影超声检查(HyCoSy)。这种诊断检查通过超声检查以及以空气 - 水或泡沫溶液(HyFoSy)为代表的气水基造影剂来进行。这些评估测试的另一个附带好处是具有提高生育能力的效果,这得益于一种被定义为“输卵管冲洗”的积极作用,在当前文献中,相较于HyCoSy,这种作用与HyFoSy的关联更为紧密。在本报告中,我们呈现了一例34岁女性的病例,该女性于2023年在罗马桑德罗·佩尔蒂尼医院的生殖与病理生理学科室引起了我们的关注,她在与未报告精子异常的伴侣进行3.1年无保护性交后出现不明原因不孕。随后,在此次检查中,该女性在进行4D - HyCoSy检查的同一个月经周期内自然受孕,未采取任何额外的提高生育能力的干预措施。在本病例报告中,我们还纳入了对当前有关该技术后自然妊娠发生率的文献的更新综述,以探讨自然妊娠实现背后的生理病理和病因发病机制,并将我们的病例与其他近期发表的研究进行对比。根据我们的临床经验和当前文献,4D - HyCoSy是用于检查输卵管通畅性的最简单、最安全且最便宜的诊断检查,在某些“不明原因不孕”病例中,它可促成自然妊娠,从而取得医疗成功。