Ultrasound womb fallopian tube radiography combined with laparoscopic examination in the diagnosis of female infertility: Ultrasound in the womb fallopian tube radiography inspection may result in false positive findings due to fallopian tube kinking or overlap interference. Ultrasound womb fallopian tube radiography shows 11 clinical cases of patency that correspond with laparoscopic findings, and possible reasons include: 1) fallopian tube spasm resistance induced by contrast agent stimulation; and 2) mild adhesions after the first examination that were resolved after lysis of adhesions. In this group, the ultrasound method detected uterine cavity masses in 9 cases, all confirmed by hysteroscopy. Additionally, hysteroscopy revealed 4 cases of endometrial neoplasms that were not detected by ultrasound, mainly due to minor new biological changes. This group also found several examples of endometrial atrophy and endometritis via hysteroscopy, as well as several cases where ultrasound detected uterine myomas and adenomyosis on the wall.
Although ultrasound womb fallopian tube radiography provides free diagnosis for interstitial tubal atresia and has a higher rate of agreement with hysteroscopy, it cannot distinguish between organic blockages and transient ones such as those caused by blood clots, mucus plugging, or tubal sphincter spasms, which can be well distinguished by hysteroscopy. Ultrasound womb fallopian tube radiography is a newly developed interventional ultrasound diagnostic technique that uses the characteristics of ultrasound contrast agents to observe the flow and distribution of contrast agents within the uterine cavity and fallopian tubes, understanding their morphology and determining whether the fallopian tubes are patent. Simultaneously, ultrasound examination can provide important information about the cervix, internal os of the uterus, uterine cavity, and oviduct length. It can also evaluate uterine malformations, submucous myomas, uterine polyps, and pelvic lesions through the uterine and ovarian sections, making it a cheap, reliable, safe, and painless method. However, ultrasound womb fallopian tube radiography has limitations, as the contrast agent's stimulation can cause tubal spasm leading to obstruction.
Laparoscopy plays a major role in diagnosing tubal and peritoneal factors causing infertility, with inflammation and endometriosis being the main factors. Laparoscopic tubal fluid can be used for direct observation of internal genital organs and tubal patency, understanding the range and degree of pelvic adhesions and endometriosis lesions, as well as obtaining biopsies to understand pathophysiology and ovarian function for a reliable diagnosis. However, laparoscopy cannot assess the uterine cavity and oviduct lumen in cases of fallopian tube obstruction, similar to ultrasound womb fallopian tube radiography. Laparoscopy has high operational requirements, high costs, and is invasive with certain risks.
Hysteroscopy is an endoscope used for screening and treatment within the womb. For patients with infertility, it allows direct and full visualization of the uterine cavity, enabling accurate diagnosis and precise positioning of most uterine cavity lesions. Hysteroscopy can also treat certain lesions, such as cervical or endometrial polyps, pedunculated submucous myomas, germ residue, and membranous intrauterine adhesions, achieving satisfactory results. In this group, 2 cases became pregnant within half a year after hysteroscopic treatment. However, hysteroscopy has limitations, only allowing a view of the tubal openings without assessing the unobstructed rate of the fallopian tubes. Compared with ultrasound, hysteroscopy evaluates uterine and cervical factors better than ultrasound womb fallopian tube radiography but cannot replace it. The two methods complement each other for a more perfect evaluation.