Page 21 - WALS Journal

Gokhan Goynumer et al
study was approved by the Human Research Review Committee. Results
Patients with subfertility complaints lasting less than a year, Hundred cases with unexplained infertility or infertility due to
women older than 40 years at the time of their first visit, tubal factors were included in this study. Mean female age of
anovulation despite clomiphene citrate or bromocriptine use, the study was 31.1 ± 5.5 (range 20-40). 69 Patients had primary
partners with abnormal semen analyses according to the WHO and 31 had secondary infertility. The average infertility duration
criteria, previous histories of oophorectomy, salpingectomy or of patients with primary infertility was 2.6 years. The average
pelvic inflammatory disease and surgical or medical treatment duration of patients with secondary infertility was 4.3 years. 63
for endometriosis were excluded from the study. The past of the laparoscopic procedures conducted were diagnostic, while
medical histories, semen analyses, day 3 hormone levels and 37 were operative. Table 1 shows tubal status detected at HSG
investigations for ovulation were obtained from all the study as compared to tubal status detected at laparoscopy. The
participants and a physical examination was carried out. sensitivity and specificity of HSG were 0.80 and 0.75,
Hysterosalpigography and laparoscopy was performed for the respectively, with a positive predictive value of 0.91 ( 95 % CI
assessment of tubal patency in all the participants except for 0.82-0.96) and a negative predictive value of 0.55 ( 95 % CI 0.38-
those with recent HSGs performed within the last two years, in 0.70), when tubal pathology was defined as any form of tubal
whom only laparoscopy was performed and the available HSG occlusion detected at laparoscopy be it one-sided or two-sided.
was evaluated. All hysterosalpingographies were performed in The false- negative and false-positive rates of HSG in detecting
the outpatient clinic of the department of radiology, between tubal patency were 15 % and 6 %, respectively. The likelihood
the 7th to the 10th day of the menstrual period. A water soluble ratio of HSG for a positive test result was 3.21 and the likelihood
contrast medium was used. Photographs were taken at the ratio for a negative test result was 0.26 (Table 1).
instant when the uterine cavity and tubes were filled with opaque In laparoscopy, 21 patients were found to have
material and when an overflow was seen at both sides of the intraabdominal adhesions disturbing the tuboovarian anatomy.
tubes or when maximal filling of the tubes was observed 8 patients were diagnosed with stage 1 or 2 endometriosis.
without any overflow. After 30 minutes, a late film was made Ovarian cysts were detected in three patients and hydrosalpinx
to detect contrast depots. HSG findings were classified as detected in 5 patients. Laparoscopic surgery was performed in
having no tubal occlusions, one-sided tubal occlusion or two– cases with intraabdominal pathologic findings. A summary of
sided tubal occlusions (partial or total occlusion). Additional tubal patency findings in HSG and laparoscopy can be found in
abnormalities of the uterine cavity were recorded as well. The Table 2.
laparoscopic examination was performed under general
anesthesia, in the follicular phase of the menstrual cycle. After TABLE 1: Comparison of tubal status between HSG and
making a pneumoperitoneum, a thorough inspection of the laparoscopy
pelvis, internal genitalia, and liver region was performed, Laparoscopy
followed by testing for Fallopian tube patency using HSG No occlusion One-sided Two-sided Total
Methylene Blue. A dilute solution of Methylene Blue was occlusion occlusion
injected through the cervix via a Rubin cannula. The presence
5
of adhesions, structural abnormalities of the uterus, No occlusion 61 11 1 1 67
9
One-sided occlusion
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endometriosis and Fallopian tube occlusion were sought for. Two-sided occlusion 6 3 3 12
Tubal occlusions detected with laparoscopy were classified Total 76 19 5 100
as no tubal occlusions, one-sided tubal occlusion or two–
sided tubal occlusion. During laparoscopy, therapeutic Disease defined as any abnormality: sensitivity 0.80, specificity 0.75
reproductive surgery such as coagulation of grade I or II TABLE 2: Detection of tubal status at HSG and laparoscopy
endometriosis, adhesiolysis or cystectomy were performed
when required. Tubal status at HSG and laparoscopy
n
Statistics HSG patent, Laparoscopy patent 61
HSG one-sided occluded, Laparoscopy patent 9
Tubal occlusions detected at HSG were compared with HSG two-sided occluded, Laparoscopy patent 6
occlusions detected at laparoscopy. Tubal pathology was HSG patent, Laparoscopy one-sided occluded 5
defined as any form of tubal occlusion, be it one-sided or two- HSG one-sided occluded, Laparoscopy one-sided occluded 11
sided . Sensitivity, specificity, positive predictive value, negative HSG two-sided occluded, Laparoscopy one-sided occluded 3
predictive value and likelihood ratio of HSG in the diagnosis of HSG patent, Laparoscopy two-sided occluded 1 1
HSG one-sided occluded, Laparoscopy two-sided occluded
tubal occlusions were calculated, regarding laparoscopy as HSG two-sided occluded, Laparoscopy two-sided occluded 3
the reference standard. Confidence intervals (95% CI) were
reported. Total 100
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