Transvaginal MHAW-ultrasonography: new opportunities for assessment of fallopian tubes functionality
The relation between various ultrasonographic phenotypes of funnel of fallopian tubes and minimal endometriosis, STDs, and pelvic surgery in ninety-six women among the couples with unexplained infertility were studied. The comparison group was consisted of 31 women among the couples with male factor of infertility. The investigation of hard-to-see subtle pelvic subjects by the non-contrast transvaginal ultrasound technique of mobile hydro-acoustic window (TVS+MHAW) was performed in all patients. Various segments of fallopian tubes were identified in 32 (33.3 %) of 96 women of study group and 12 (38.7 %) women of comparison group. The four main phenotypic subgroups of uterine tubes funnel were characterized: finger-like, mastoid-like, fimbriated and combined phenotypes. These phenotypes were found in 19 (59.4 %), 7 (21.9 %), 4 (12.5 %) and 2 (6.3 %) cases in the study group, versus 58.3 %, 8.3 %, 16.7 %, 16.7 % in the comparison group, respectively. The association of mastoid-like phenotypes with the STDs (85.7 %), minimal endometriosis (85.7 %) and pelvic surgery (71.4 %) was more often observed in the study group than comparison group. For the first time two sonographic types of uterine tubes fimbriae - the primary, and those normally fringing them in great number as prolifered mucosa - the small ones or secondary were classified. Non-invasive TVS+MHAW technique allows to perform systematic evaluation of the function of distal segments of uterine tubes as well as makes the optimal choice between laparoscopy and intrauterine insemination for the management in couples with unexplained infertility.