Role of Ovarian Artery to Uterine Artery Anastomosis in Uterine Artery Embolisation: A Retrospective Study

Introduction: Uterine Artery Embolisation (UAE) is now extensively recognised as a treatment for uterine fibroids, uterine artery pseudoaneurysms, and Uterine Arterio-Venous Malformations. The occurrence of collateral circulation from the ovarian artery to the uterine artery is one of the reasons for the failure of the process. The occurrence of ovarian failure and premature menopause after the UAE is high in patients with Utero-ovarian Artery (UOA) anastomosis. Aim: To classify UOA as per Razavi MK et al., angiographic classification and to determine the presence of such anastomosis in UAE procedure failure cases. Materials and Methods: A retrospective study was done for a period of two years from November 2017 to October 2019. UAE was performed with Poly Vinyl Alcohol (PVA) microparticles (300 to 500 μm in size) followed by capping with a gelatin sponge in all 25 cases and coils were used in three cases. The presence or absence of UOA and four different types as per Razavi MK et al., angiographic classification were noted. Results: Among 25 cases who underwent UAE, 14 had UOA. The majority (six cases) were type Ib, five cases were type Ia, two cases were type II and one case was type III. The bilateral anastomosis was noted in one case with type Ia and Ib on either side. Eight cases with UOA had successful embolisation. The UAE was successful in 16 cases, and failed in nine cases. Among various causes for failure, six out of nine were due to UOA. Among six failure cases of UOA, two cases were Type Ia, two cases were Type Ib, one case was Type II and one case was Type III anastomosis. Conclusion: UOA is one of the major risk factors in the procedural failures of the UAE. Identification avoids non target ovarian embolisation

Conventional and magnetic resonance hysterosalpingography in assessing tubal patency—A comparative study

Context: Tubal factors, one of the leading causes of female infertility, have been conventionally evaluated by hysterosalpingography (HSG). The role of magnetic resonance imaging (MRI) in assessing female infertility is gaining importance because of its inherent efficiency in detecting structural abnormalities. Magnetic resonance hysterosalpingography (MR HSG) is less invasive and avoids exposure of ovaries to ionizing radiation. Its utility is extrapolated to visualize fallopian tubes. Aims: To assess the diagnostic accuracies of dynamic MR HSG and conventional HSG (cHSG) in identifying tubal patency in women with infertility using diagnostic laparoscopy (DL) as gold standard. Materials and Methods: A prospective study of 40 patients was conducted over a period of 6 months. The patients were subjected to MR HSG followed by cHSG during the preovulatory period. If tubes were blocked, the patients were subjected to DL in the next menstrual cycle. If the tubes were patent and there was failure of conception, they were subjected to DL in the interval of 3 months. Results: Twenty-four patients had bilateral tubal spill which was confirmed using cHSG and DL. One patient had discordant MR HSG and cHSG results and six patients had discordant MR HSG and DL results. No statistical difference was observed between MR HSG and cHSG. Conclusion: Pelvic MRI is an inevitable tool in infertility evaluation. MR HSG can be used in addition as it avoids exposure of the reproductive organs to radiation and has the same efficacy as cHSG