Female Infertility Clinical Trial
Official title:
Magnetic Resonance Imaging Hysterosalpingography Versus Radiographic Hysterosalpingography in Female Infertility
The main objective of this study is to compare the data of Hystérosalpingo-MRI with intra cavitary injection of diluted gadolinium salts with the classic hysterography, which allows to realize at once with no irradiating examination, a complete assessment of the female infertility.
Infertility is a disease which affects around 15% of couples (one union of seven) and has
been increasing for 10 years. Therefore, and due to the development of methods of medically
assisted procreation, demand for infertility evaluation is steadily increasing.
The infertility evaluation always begins with an accurate history, coupled with a physical
examination of both partners. Indeed, infertility of a couple is due to the female partner in
about two thirds of cases, the male partner in the remaining third of cases. In women, the
main observed causes are ovulatory function disorders (10 to 20%), tubal causes by proximal
or distal occlusion (10%), uterine causes involving intra-uterine synechiae, leiomyomas,
adenomyosis, mucosal polyps (5 %), inadequate cervical mucus or cervical stenosis , and
peritoneal causes such as endometriosis and post-infectious or post-surgical peritubo-ovarian
adhesions (20 %).
Medical imaging is one of the key methods to identify the different etiologies in men as in
women. It will serve to clarify the etiology in question and assess the likelihood of
subsequent pregnancy. The initial imaging assessment for infertility in any woman includes an
endovaginal ultrasound examination and a hysterosalpingography (HSG) . The use of MRI is
considered as a second line in the absence of definitive diagnosis or to establish a
definitive diagnosis before considering a targeted therapy. Indeed the performance of MRI for
the diagnosis of pelvic endometriosis or fibroids mapping are well established.
HSG is the imaging technique of choice to evaluate the morphology of the uterine cavity and
tubal patency. But it has several important limitations. Firstly it is an imaging method that
uses x-rays and therefore delivers irradiation to the gynecological organs. Moreover, it does
not allow a precise exploration of the entire abdomen and pelvis: therefore, the physician
cannot have a complete assessment of the etiologies of infertility with HSG. Finally, it has
a very good specificity but a relatively low sensitivity.
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