Title: Comparison of Laparoscopy and Hysterosalpingography in Diagnosis of Tubal Occlusion
Authors: Dr Nikita Gandotra, Dr Abhinav Sharma, Dr Syed Masuma Rizvi
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.46
BACKROUND: Infertility has always been one of the most elusive symptom complexes that perplex the best gynecologists. ‘ OBJECTIVES: To compare hysterosalpingography and laparoscopy in the diagnosis of tubal occlusion in infertile patients. METHODS: 30 Patients of infertility were evaluated prospectively in the Department Of Gynaecology and Obstetrics in Government Lalla Ded Hospital, Srinagar from April 2014to October 2014. The findings of HSG and laparoscopy were compared. RESULTS: The sensitivity of HSG was 90.91% and specificity was 77.78 % with positive predictive value of 83.33% and negative predictive value of 87.50%, when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. CONCLUSION: HSG demonstrates high sensitivity in our study. So it should be used as the initial investigation for identifying tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy. KEYWORDS: Laparoscopy, Hysterosalpingography, Infertility 1. Jose Miller AB, Boyden JW, FreyK.A. Infertility. Am Fam Physician 2007; 75:849-56. 2. World Health Organization .Manual for the standardized investigation and diagnosis of infertile couple. Cambridge, UK: Cambridge University Press, 2000. 3. Cheong YC, Li TC.Evidence based management of tubal disease and infertility Current Obstetrics and Gynaecology 2005; 15(5):306-13. 4. Balasch J. Investigation of infertile couple: investigation of infertile couple in the era of assisted reproductive technology. A time for reappraisal Hum Reprod 2000; 15:2251-57. 5. Laufer N, Simon A,. Unexplained infertility: a reappraisal. Ass Reprod Rev 1993; 3:26-36. 6. Fertility Committee of RCOG Gynecological Laparoscopy .The report of the world party of the confidential enquiry into gynecological laparoscopy 1992; 126. 7. Looking back, looking forward: a profile of sexual health in India. New Delhi: Population Council; 2004.Population Council. Infertility; p 67-72. 8. Jonathan S Berek. Bereks and Novaks Gynaecology-15thedition.chapter 32 Page 1157. 9. Mehmat N Sakar ,Tulip Gul, Yousuf Celik. Comparison of hysterosalpingog-raphy and laparoscopy in evaluation of infertile women p10- Saudi Medical Journal 2008 -vol 29(9): 1315-131. 10. Birolt Durukhan, Gokhan Goynumer, Gamze Yetim, Isin Karaaslan, Lale Wetherilt, Oznur Gokcen, ,–Hysterosalpingography, Laparoscopy or both in the diagnosis of tubal disease in infertility-World Journal of Laparoscopic Surgery ,May-August 2008, 1(2): 23-26. 11. Hompes P G, and Lambalk C B ,Tanahatoe S J. Investigation of the infertile couple: Should diagnostic laparoscopy be performed in infertility work up programme in patients undergoing IUI? Hum reprod 2003 Jan; 18(1):8-11. 12. Corson S L, Cheng A, Gutmann J N. Laparoscopy in normal infertile patient: A question revisited. J Am Assoc gynaecol laparoscopy 2000; T: 317-24. 13. Adoni A, Laufer N , Lavy Y ,Glastein I Z, Hurwitz A, Sleeper L A, , Simon A, ,Palti Z , Observer variability in diagnosis and management of hysterosalpingography. 14. Sharma R; Sharma V. The infertile woman: a study of 120 cases. J Indian Med Assoc, 1991; 89(2); 31-32. 15. Bossuyt PM , Mol BW ,Swart P, Redekop WK , van Beurden , van der Veen F ,. The accuracy of hysterosalpingography in diagnosis of tubal pathology: a meta analysis .Fertil Steril 1995; 64:486-91.Abstract
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