Izhar, R., Husain, S., Tahir, M. A., & Husain, S. (2020). Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography. Journal of ultrasonography, 20(81), e116-e121. https://doi.org/10.15557/JoU.2020.0019
Izhar R, Husain S, Tahir MA, Husain S. Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography. Journal of ultrasonography. 2020;20(81):e116-e121. doi:10.15557/JoU.2020.0019
Izhar, R., et al. "Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography." Journal of ultrasonography, vol. 20, no. 81, 2020, pp. e116-e121.
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RRM Academy Synopsis
Women with cervical stenosis who chose dilation conceived more often
About 7 out of 10 women who chose dilation for cervical stenosis conceived, in a prospective one-year study of 117 women with unexplained infertility. Fewer than 2 out of 10 women who declined dilation conceived. Women who chose dilation also conceived sooner.
Key Findings
Among 1097 women with unexplained infertility who had saline infusion sonography, 117 (10.7%) had cervical stenosis, suspected when a Foley catheter could not be passed into the cervical canal.
Clinical pregnancy, meaning a fetal heartbeat on transvaginal scan, occurred in 62 women (70.45%) who had dilation and 5 women (18.5%) who declined it (p <0.001).
Mean time to conception was 8.10 ± 3.43 months with dilation and 11.39 ± 1.97 months without it (p <0.001). Survival analysis also favored dilation (log rank, p <0.001).
A history of endometriosis (p <0.001), prior surgery, polyps and pelvic inflammatory disease was significantly associated with cervical stenosis.
All dilations were done under ultrasound guidance with no false passages. The authors report that women conceived spontaneously, with no intrauterine insemination or IVF needed.
Interpretation
The authors describe a prospective case control study. Women with cervical stenosis who agreed to dilation were the cases, and those who declined were the controls. Stenosis turned up in 10.7% of women labeled as having unexplained infertility. The authors argue these women may not have had unexplained infertility to begin with, since dilation removes a cervical hindrance to sperm. Participants were women aged 20 to 39 years with no conception despite 24 months of regular unprotected intercourse. Exclusions included male factor, ovulatory disorders, a history of cervical cancer, and a congenital cervical abnormality. Follow-up lasted 12 months. The authors note that the single-center design means results in other groups need checking.
RRM Context
Restorative reproductive medicine reads unexplained infertility as undiagnosed infertility and looks for causes before treating. The authors stress a full assessment of the couple before that label is used, since standard fertility tests skip the uterine cavity. They call cervical stenosis a condition that can be easily treated. In their study, women conceived on their own after dilation, with no insemination or IVF needed.
Our editorial summary of this paper, not the article's abstract.
Abstract
Aim
To assess the effect of ultrasound-guided cervical dilation on clinical pregnancy rates in women with cervical stenosis.
Methods
A prospective case control study was conducted in women with unexplained infertility. These women underwent saline infusion sonography and were suspected of having cervical stenosis if a 7 French Foley's catheter could not be introduced into the cervical canal. Women with suspected stenosis who agreed to undergo ultrasound guided dilation were included as cases. Those with suspected stenosis who refused dilation were used as controls. Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heart beat present on transvaginal scan during the follow up period.
Results
During the study period, 1097 women who underwent SIS were included. A total of 117 (10.7%) patients had cervical stenosis. No statistically significant difference was there in both groups in terms of mean age (p = 0.617), mean body mass index (p = 0.598), duration of infertility (p = 0.588) and type of infertility (p = 0.167). However, both groups were significantly different in terms of history for risk factors i.e. endometriosis (p <0.001), prior surgery (p <0.001), polyps (p = 0.004) and pelvic inflammatory disease (p = 0.001). Eighty-nine women agreed to have dilation and were used as cases and 28 women refused and were used as controls. Of the cases, 70.45% conceived as compared to 18.5% of controls. The mean time to conception in months was also significantly lower in cases (8.10 ± 3.43 vs. 11.39 ± 1.97, p <0.001).
Conclusions
Our study shows that ultrasound-guided cervical dilation in women with cervical stenosis can lead to improved conception rates.
Aim
To assess the effect of ultrasound-guided cervical dilation on clinical pregnancy rates in women with cervical stenosis.
Methods
A prospective case control study was conducted in women with unexplained infertility. These women underwent saline infusion sonography and were suspected of having cervical stenosis if a 7 French Foley’s catheter could not be introduced into the cervical canal. Women with suspected stenosis who agreed to undergo ultrasound guided dilation were included as cases. Those with suspected stenosis who refused dilation were used as controls. Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heart beat present on transvaginal scan during the follow up period.
Results
During the study period, 1097 women who underwent SIS were included. A total of 117 (10.7%) patients had cervical stenosis. No statistically significant difference was there in both groups in terms of mean age (p = 0.617), mean body mass index (p = 0.598), duration of infertility (p = 0.588) and type of infertility (p = 0.167). However, both groups were significantly different in terms of history for risk factors i.e. endometriosis (p <0.001), prior surgery (p <0.001), polyps (p = 0.004) and pelvic inflammatory disease (p = 0.001). Eighty-nine women agreed to have dilation and were used as cases and 28 women refused and were used as controls. Of the cases, 70.45% conceived as compared to 18.5% of controls. The mean time to conception in months was also significantly lower in cases (8.10 ± 3.43 vs. 11.39 ± 1.97, p <0.001).
Conclusions
Our study shows that ultrasound-guided cervical dilation in women with cervical stenosis can lead to improved conception rates.
