Page 20 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):23-26
Hysterosalpingography, Laparoscopy or Both in the Diagnosis of Tubal Disease in Infertility
Hysterosalpingography, Laparoscopy or Both in

the Diagnosis of Tubal Disease in Infertility

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1 Gokhan Goynumer, Gamze Yetim, Oznur Gokcen, Isin Karaaslan, Lale Wetherilt, Birol Durukan
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Goztepe Education and Research Hospital, Istanbul, Turkey

Abstract Since morphological abnormalities of the Fallopian tubes
Objectives: To evaluate and compare the diagnostic value of can be visualized directly under laparoscopy, it is generally
hysterosalpingography (HSG) with laparoscopy in the assessment of accepted as the gold standard in diagnosing tubal pathology
fallopian tube patency in infertile women.
and other intra-abdominal causes of infertility. Diagnostic
Design: A comparative prospective cross-sectional study. laparoscopy has become the standard procedure in the infertility
Setting: Department of Obstetrics and Gynaecology in Goztepe work up in many clinics as the final test to be performed before
Education and Research Hospital, Istanbul, Turkey. the couple is referred to infertility treatment. This diagnostic
scenario concerns couples eligible for intrauterine insemination
Materials and Method: Laparoscopy was performed in 100 infertile (IUI), i.e. unexplained infertility, male subfertility and cervical
patients with either unexplained infertility or tubal factors indicated
by hysterosalpingography. Regarding laparoscopy as the reference hostility. Laparoscopy is not usually performed in patients who
standard, tubal patency findings in histerosalpingography were are already planned for assisted reproductive technology. In
compared with laparoscopic findings. such patients, assessment of the tubes and other intra-abdominal
pathologies is of less concern except in the presence of
Results: The sensitivity, specificity, positive predictive value, negative 5
predictive value of HSG in detecting tubal patency were 0.80, 0.75, hydrosalphinges which can be diagnosed by ultrasonography.
0.91 ( 95 % CI 0.82-0.96), and 0.55 ( 95 % CI 0.38-0.70), respectively. Meta-analyses of 20 studies on basic infertility investigations
The false- negative and false-positive rates of HSG in detecting tubal carried out in 4000 infertile women were reviewed to determine
patency were 15 % and 6 %, respectively. Adnexial adhesions, ovarian the accuracy of hysterosalpingography (HSG) in the
cysts and pelvic endometriosis were detected in 27% of cases with demonstration of tubal patency, with the idea that tubal
normal HSG’s. Of the twelve cases of bilaterally occluded tubes obstruction is a reliable finding of HSG that does not have to be
detected by HSG, only 3 (25%) were confirmed to have bilateral confirmed by laparoscopy; however, normal hysterosalpingo-
occlusion during laparoscopy.
graphic findings are not sufficient enough to exclude tubal
Conclusion: Because HSG has a limited value for accurately identifying pathologies with peritoneal factors. Nevertheless, Fatum et al
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tubal patency, laparoscopy is necessary to rule out the existence of stated that couples with unexplained infertility should be treated
peritubal adhesions and mild and moderate endometriosis.
with IUI without preceding diagnostic laparoscopy, and if
unsuccessful, they should be referred directly to IVF. 7
INTRODUCTION
The relative merits of HSG and laparoscopy in the screening
Hysterosalpingography (HSG), laparoscopy or both can be for tubal pathologies have been a matter of discussion for more
applied to demonstrate tubal patency. Owing to its noninvasive than 30 years. We designed a study to compare the diagnostic
nature and low cost, hysterosalpingography (HSG) is widely value of hysterosalpingography (HSG) with laparoscopy in the
used as a first-line approach to assess the patency of the assessment of fallopian tube patency in infertile women.
Fallopian tubes and uterine anomalies in the routine fertility
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workup. However, even when tubal patency is demonstrated Materials and Methods
by HSG, laparoscopy has been suggested as a mandatory step
to rule out the existence of peritubal adhesions as well as Hundred patients admitted to the Infertility Department of
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endometriosis and peritubal adhesions. Some authors have Goztepe Education and Research Hospital between March 2008
suggested laparoscopy after hysterosalpingography for pelvic and July 2008 were included in this cross-sectional study. The
pathologies which could be missed with HSG. 3,4 informed consents of all the patients were obtained and the

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