Clinical value of real time three-dimensional hysterosalpingo-contrast sonography for analysis of factors leading to female infertility

doi:10.3877/cma.j.issn.1673-5250.2019.06.017

Objective

To investigate the effects of real-time three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) for analysis of factors leading to female infertility.

Methods

A total of 249 female infertility patients who received real-time 3D-HyCoSy examination in Department of Ultrasound, Yan′an University Affiliated Hospital from August 2016 to November 2018 were selected as research subjects. Among them, 121 cases were primary infertility females and 128 cases were secondary infertility females, and they were enrolled into primary group (n=121) and secondary group (n=128), respectively. Twenty-two female infertility patients (2 cases with a history of unilateral salpingectomy due to ectopic pregnancy, with a total of 40 fallopian tubes) underwent X-ray hysterosalpingography (HSG) examination within 1 month after real-time 3D-HyCoSy. Results of real-time 3D-HyCoSy of all subjects were retrospectively analyzed. Incidences of factors leading to female infertility, such as the constituent ratio of fallopian tube patency, incidences of uterine cavity, pelvic cavity and ovarian lesions in two groups were compared by chi-square test. The overall coincidence rate and Kappa value of real-time 3D-HyCoSy and HSG in evaluation of fallopian tube patency in female infertility patients were calculated. The procedures in this study were in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. There were no statistical differences between two groups in the age, body mass index (BMI), menstrual cycle and duration of infertility (P>0.05).

Results

①Incidence of uterine cavity lesions in secondary group was 30.5% (39/128), which was statistically higher than that in primary group 16.5% (20/121), and the difference was statistically significant (χ²=6.685, P=0.010). There were no statistical differences between two groups in constituent ratio of unobstructed, partially passable and obstructed fallopian tubes, and incidences of pelvic cavity and ovarian lesions (P>0.05). ②The overall coincidence rate of real-time 3D-HyCoSy and HSG in evaluation of fallopian tube patency in female infertility patients was 87.5% (35/40), and the Kappa value was 0.695 (Z=5.308, P<0.001), the consistency of these two methods was high.

Conclusions

Real-time 3D-HyCoSy has certain clinical values for analysis of factors leading to female infertility between primary and secondary infertility, and it is helpful for clinical evaluation of factors leading to female infertility. Due to the relatively small sample size included in this study, the clinical values of real-time 3D-HyCoSy for analysis of factors leading to female infertility remain to be confirmed by large-sample and multi-center clinical studies.

Key words: Hysterosalpingography, Infertility, primary, Secondary, Fallopian tubes, Fallopian tube patency, Imaging, three-dimensional, Ovarian diseases, Female

表1 2组不孕症患者一般临床资料比较(±s)

组别	例数	年龄(岁)	BMI(kg/m²)	月经周期(d)	不孕年限(年)
原发组	121	27.0±3.3	20.6±2.8	28.3±3.2	2.0±0.1
继发组	128	28.1±5.0	21.5±3.6	30.4±2.1	2.1±1.0
t值	?	0.260	1.782	1.230	0.311
P值	?	0.772	0.185	0.131	0.578

表1 2组不孕症患者一般临床资料比较(±s)

组别	例数	年龄(岁)	BMI(kg/m²)	月经周期(d)	不孕年限(年)
原发组	121	27.0±3.3	20.6±2.8	28.3±3.2	2.0±0.1
继发组	128	28.1±5.0	21.5±3.6	30.4±2.1	2.1±1.0
t值	?	0.260	1.782	1.230	0.311
P值	?	0.772	0.185	0.131	0.578

表2 实时3D-HyCoSy对2组不孕症患者不孕因素分析结果比较

组别	例数	输卵管通畅性^a[条数(%)]			子宫腔病变[例数(%)]
组别	例数	输卵管通畅	输卵管通而不畅	输卵管阻塞	子宫内膜息肉样病变	宫腔黏连	合计
原发组	121	137(57.1)	81(33.7)	22(9.2)	2(1.6)	18(14.9)	20(16.5)
继发组	128	126(50.4)	89(35.6)	35(14.0)	7(5.5)	32(25.0)	39(30.5)
χ²值	?	3.599			—	—	6.685
P值	?	0.165			—	—	0.010
组别	例数	盆腔病变[例数(%)]	卵巢病变[例数(%)]
组别	例数	盆腔病变[例数(%)]	卵巢囊肿	卵巢多囊样改变	合计
原发组	121	4(3.3)	15(12.4)	7(5.8)	22(18.2)
继发组	128	0(0)	10(7.8)	14(10.9)	24(18.7)
χ²值	?	2.463 ^b	—	—	0.013
P值	?	0.117	—	—	0.909

表2 实时3D-HyCoSy对2组不孕症患者不孕因素分析结果比较

组别	例数	输卵管通畅性^a[条数(%)]			子宫腔病变[例数(%)]
组别	例数	输卵管通畅	输卵管通而不畅	输卵管阻塞	子宫内膜息肉样病变	宫腔黏连	合计
原发组	121	137(57.1)	81(33.7)	22(9.2)	2(1.6)	18(14.9)	20(16.5)
继发组	128	126(50.4)	89(35.6)	35(14.0)	7(5.5)	32(25.0)	39(30.5)
χ²值	?	3.599			—	—	6.685
P值	?	0.165			—	—	0.010
组别	例数	盆腔病变[例数(%)]	卵巢病变[例数(%)]
组别	例数	盆腔病变[例数(%)]	卵巢囊肿	卵巢多囊样改变	合计
原发组	121	4(3.3)	15(12.4)	7(5.8)	22(18.2)
继发组	128	0(0)	10(7.8)	14(10.9)	24(18.7)
χ²值	?	2.463 ^b	—	—	0.013
P值	?	0.117	—	—	0.909

表3 实时3D-HyCoSy与HSG检查对22例不孕症患者(40条输卵管)的输卵管通畅性判断结果比较(条)

实时3D-HyCoSy	HSG		合计
实时3D-HyCoSy	输卵管不通畅	输卵管通畅	合计
输卵管不通畅	26	3	29
输卵管通畅	2	9	11
合计	28	12	40

表3 实时3D-HyCoSy与HSG检查对22例不孕症患者(40条输卵管)的输卵管通畅性判断结果比较(条)

实时3D-HyCoSy	HSG		合计
实时3D-HyCoSy	输卵管不通畅	输卵管通畅	合计
输卵管不通畅	26	3	29
输卵管通畅	2	9	11
合计	28	12	40

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