Influencing factors for contrast agent reflux in four-dimensional hysterosalpingo-contrast sonography: a logistic regression analysis

Abstract

Objective To investigate the influencing factors of contract agent reflux during four-dimensional hysterosalpingo-contrast sonography. Methods A total of 235 infertility women (aged from 22 to 47 years, with an infertility duration of 1 to 13 years) who undertook four-dimensional hysterosalpingo-contrast sonography in the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2017 to December 2018 were enrolled in this study. Retrospective analyses were conducted on the 101 patients who experienced reflux of contract agent during the examination. Ultrasonograms of their reflux were observed, and reasons for that were probed from the following 15 aspects: age, infertility time, tube patency, pain level, uterine position, endometrial thickness, menstruation examination time, infertility type, abortion history, uterine malformation, ectopic pregnancy history, gynecological inflammation, uterine space-occupying lesions, pelvic surgery history, and intrauterine adhesion. Results The incidence of contrast reflux was 42.9% in this cohort. Univariate analyses showed that endometrial thickness, history of abortion, menstruation examination time, intrauterine adhesion, type of infertility and tubal patency were associated with occurrence of contract reflux (P < 0.05). Multivariate logistic regression analyses indicated that endometrial thickness, menstruation examination time, type of infertility and tube patency were closely related with the reflux (P=0.036, 0.045, 0.025, 0.004), and endometrial thickness and menstruation examination time were negatively correlated with the reflux (B=-0.834, -0.802), while type of infertility and obstruction of fallopian tubes were positively correlated (B=1.122, 0.898). Conclusion Endometrial thickness < 6 mm, examination 3 to 4 d after menstruation, secondary infertility and tubal occlusion are the main causes of contrast reflux. Therefore, it is advisable to have the examination when the endometrial thickness is ≥6 mm and the menstruation is over for 5 to 7 d. Meanwhile, endometrial damage should be avoided and uterine cavity pressure be reduced as much as possible, which may be beneficial to keep incidence of reflux low.

Keywords

• four-dimensional hysterosalpingo-contrast sonography
• reflux
• contrast agent
• infertility