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Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome

  • Assisted Reproduction Technologies
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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.

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Funding

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Grants for PPCOS II: U10 HD27049, U10 HD38992, U10HD055925, U10 HD39005, U10 HD38998, U10 HD055936, U10 HD055942, U10 HD055944; and Clinical Research Scientist Program (CREST): R25HD075737.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Mindy S. Christianson

  2. Department of Ob/Gyn, Penn State College of Medicine, Hershey, PA, USA

    Richard S. Legro

  3. Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA

    Susan Jin, Fangbai Sun & Heping Zhang

  4. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Esther Eisenberg & Alicia Y. Christy

  5. Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA

    Michael P. Diamond

  6. Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Karl R. Hansen

  7. Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, NY, USA

    Wendy Vitek

  8. Department of Obstetrics, Gynecologyn, and Reproductive Biology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Aaron K. Styer

  9. Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT, USA

    Peter Casson

  10. Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA

    Christos Coutifaris

  11. Department of Obstetrics and Gynecology, Shands Hospital, University of Florida, Gainesville, FL, USA

    Gregory M. Christman

  12. Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Ruben Alvero

  13. Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA

    Elizabeth E. Puscheck

  14. Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA

    Alex J. Polotsky & Nanette Santoro

Authors
  1. Mindy S. Christianson
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  2. Richard S. Legro
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  3. Susan Jin
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  4. Esther Eisenberg
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  5. Michael P. Diamond
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  6. Karl R. Hansen
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  7. Wendy Vitek
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  8. Aaron K. Styer
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  9. Peter Casson
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  10. Christos Coutifaris
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  11. Gregory M. Christman
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  12. Ruben Alvero
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  13. Elizabeth E. Puscheck
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  14. Alicia Y. Christy
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  15. Fangbai Sun
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  16. Heping Zhang
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  17. Alex J. Polotsky
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  18. Nanette Santoro
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Corresponding author

Correspondence to Mindy S. Christianson.

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Christianson, M.S., Legro, R.S., Jin, S. et al. Comparison of sonohysterography to hysterosalpingogram for tubal patency assessment in a multicenter fertility treatment trial among women with polycystic ovary syndrome. J Assist Reprod Genet 35, 2173–2180 (2018). https://doi.org/10.1007/s10815-018-1306-2

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  • DOI: https://doi.org/10.1007/s10815-018-1306-2

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