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Clinical and Experimental Medical Journal
Authors:
István Szabó
,
Zoltán Langmár
,
Zoltán Fontányi
,
Gábor Sobel
,
Gádám Galamb
,
Dóra Zergényi-Molnár
, and
Attila Pajor

Abstract

Tubal infertility, in particular proximal tubal occlusion (PTO) (15–25%), is gaining increasing attention. In the case of bilateral tubal occlusion, in vitro fertilization (IVF) is indicated since the expected pregnancy rate (EPR) is the same as can result from macrosurgical methods. The pregnancy rate after microsurgical procedures can go up to 60–70%. Despite the fact that better and encouraging results are being obtained by sophisticated assisted reproduction techniques, IVF procedures that are performed unnecessarily or not indicated objectively can result in serious consequences. Therefore, there is no question that refining the procedures used for evaluating the fallopian tubes is extremely important in order to reduce the physical and psychological burden on the patients, as well as from the viewpoint of cost effectiveness. We recommend a diagnostic method to ensure tubal patency in one session. The procedure is easy to perform and, according to our experience, the examination is highly accurate.

Restricted access
Clinical and Experimental Medical Journal
Authors:
István Szabó
,
Zoltán Langmár
,
Gábor Sobel
,
Zoltán Fontányi
,
Péter Sziller
,
Máté Hazay
,
Ferenc Paulin
, and
Attila Pajor

Abstract

Introduction

With the introduction of falloposcopy, an in vivo image of the inner surface of the Fallopian tubes has become available. The tubal factor in subfertile couples also provides specific, clinically relevant, and valuable prognostic information by clearly demonstrating the presence or absence of even minor anatomical abnormalities. We introduced falloposcopy to our clinical practice at the end of 1999.

Objective

To perform tuboscopy in the evaluation of infertility.

Patients and methods

The examination was performed under general anesthesia, using the transcervical (via hysteroscopy) “guide wire” catheterization system and a 0.5-mm falloposcope with 3000 pixels, under laparoscopic control. We attempted this examination in 22 cases.

Results

Differences were found in the falloposcopic image and in the previous finding of hysterosalpingography. We succeeded in cannulating the Fallopian tube even in cases with intramural occlusion showed by hysterosalpingography. In our series, fever was not observed and only one perforation occurred. Submucosal interstitial edema was observed in one of the Fallopian tubes. The mean operational time including the cervical dilatation, hysteroscopic procedure, and laparoscopic CO2 insufflation was 50 min.

Conclusions

After the first introduction of falloposcopy in Hungary, we need to find its place in evaluating infertility and to discuss its indication. Furthermore, the technical difficulties should also be taken into consideration. We recommend incorporating the falloposcopic examination into the screening of infertility.

Restricted access
Orvosi Hetilap
Authors:
István Szabó
,
Zoltán Langmár
,
Zoltán Fontányi
,
Gábor Sobel
,
Máté Hazay
,
Ádám Galamb
,
Dóra Zergényi-Molnár
,
Péter Sziller
, and
Attila Pajor

A petevezető-eredetű meddőség, amelynek oka 15–25%-ban a kürt proximalis szakaszának elzáródása, egyre nagyobb figyelmet kap a reprodukciós szakemberek részéről. A kétoldali tubaocclusio szervezeten kívüli megtermékenyítés javallatát képezi, mivel a terhességi arány a makrosebészeti eljárás eredményességével csaknem azonos. Azzal együtt, hogy az asszisztált reprodukciós eljárások alkalmazásával egyre jelentősebb eredményeket érnek el, a nem kellően megalapozott javallattal indított in vitro fertilizációs kezelések felesleges terhet jelentenek mind a páciensek, mind a társadalombiztosító számára. Egyértelmű tehát, hogy a petevezető átjárhatóságának vizsgálatára irányuló eljárások folyamatos tökéletesítése rendkívül fontos mind a páciensek kisebb megterhelése, mind a finanszírozói oldal szempontjából. Közleményünkben ajánlunk egy lehetséges kivizsgálási protokollt, amely egy ülésben végezhető el, valamint felhívjuk a figyelmet egy általunk kifejlesztett, egyszerűen kivitelezhető, ám véleményünk szerint igen fontos vizsgálati technikára, amely diagnosztikus hiszteroszkópia útján alkalmazható, lehetővé téve a kürtök szelektív vizsgálatát.

Open access