Mindy S Christianson1, Richard S Legro2, Susan Jin3, Esther Eisenberg4, Michael P Diamond5, Karl R Hansen6, Wendy Vitek7, Aaron K Styer8, Peter Casson9, Christos Coutifaris10, Gregory M Christman11, Ruben Alvero12, Elizabeth E Puscheck13, Alicia Y Christy4, Fangbai Sun3, Heping Zhang3, Alex J Polotsky14, Nanette Santoro14. 1. Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mchris21@jhmi.edu. 2. Department of Ob/Gyn, Penn State College of Medicine, Hershey, PA, USA. 3. Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA. 4. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA. 5. Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA. 6. Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. 7. Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA. 8. Department of Obstetrics, Gynecologyn, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. 9. Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT, USA. 10. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA. 11. Department of Obstetrics and Gynecology, Shands Hospital, University of Florida, Gainesville, FL, USA. 12. Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA. 13. Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA. 14. Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA.
Abstract
PURPOSE: To compare saline infusion sonohysterography (SIS) versus hysterosalpingogram (HSG) for confirmation of tubal patency. METHODS: Secondary analysis of a randomized controlled trial, Pregnancy in Polycystic Ovary Syndrome II (PPCOS II). Seven hundred fifty infertile women (18-40 years old) with polycystic ovary syndrome (PCOS) were randomized to up to 5 cycles of letrozole or clomiphene citrate. Prior to enrollment, tubal patency was determined by HSG, the presence of free fluid in the pelvis on SIS, laparoscopy, or recent intrauterine pregnancy. Logistic regression was conducted in patients who ovulated with clinical pregnancy as the outcome and HSG or SIS as the key independent variable. RESULTS: Among women who ovulated, 414 (66.9%) had tubal patency confirmed by SIS and 187 (30.2%) had at least one tube patent on HSG. Multivariable analysis indicated that choice of HSG versus SIS did not have a significant relationship on likelihood of clinical pregnancy, after adjustment for treatment arm, BMI, duration of infertility, smoking, and education (OR 1.14, 95% CI 0.77, 1.67, P = 0.52). Ectopic pregnancy occurred more often in women who had tubal patency confirmed by HSG compared to SIS (2.8% versus 0.6%, P = 0.02). CONCLUSIONS: In this large cohort of women with PCOS, there was no significant difference in clinical pregnancy rate between women who had tubal patency confirmed by HSG versus SIS. SIS is an acceptable imaging modality for assessment of tubal patency in this population.
RCT Entities:
PURPOSE: To compare saline infusion sonohysterography (SIS) versus hysterosalpingogram (HSG) for confirmation of tubal patency. METHODS: Secondary analysis of a randomized controlled trial, Pregnancy in Polycystic Ovary Syndrome II (PPCOS II). Seven hundred fifty infertile women (18-40 years old) with polycystic ovary syndrome (PCOS) were randomized to up to 5 cycles of letrozole or clomiphene citrate. Prior to enrollment, tubal patency was determined by HSG, the presence of free fluid in the pelvis on SIS, laparoscopy, or recent intrauterine pregnancy. Logistic regression was conducted in patients who ovulated with clinical pregnancy as the outcome and HSG or SIS as the key independent variable. RESULTS: Among women who ovulated, 414 (66.9%) had tubal patency confirmed by SIS and 187 (30.2%) had at least one tube patent on HSG. Multivariable analysis indicated that choice of HSG versus SIS did not have a significant relationship on likelihood of clinical pregnancy, after adjustment for treatment arm, BMI, duration of infertility, smoking, and education (OR 1.14, 95% CI 0.77, 1.67, P = 0.52). Ectopic pregnancy occurred more often in women who had tubal patency confirmed by HSG compared to SIS (2.8% versus 0.6%, P = 0.02). CONCLUSIONS: In this large cohort of women with PCOS, there was no significant difference in clinical pregnancy rate between women who had tubal patency confirmed by HSG versus SIS. SIS is an acceptable imaging modality for assessment of tubal patency in this population.
Authors: S Tanawattanacharoen; S Suwajanakorn; B Uerpairojkit; W Boonkasemsanti; P Virutamasen Journal: J Obstet Gynaecol Res Date: 2000-02 Impact factor: 1.730
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