Title: Comparison of Hysterosalpingography and Laparoscopy in Evaluation of Tubal Factor as a Cause of Female Infertility
Authors: Shivi Jain, Shuchi Jain, R.C. Shukla, Madhu Jain
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.138
Abstract
Introduction: Tubal factor contributes to 60% of female infertility in Indian women (Chaudhari AD et al., 2017). Hysterosalpingography (HSG) and laparoscopy are commonly used for assessment of tubal patency. The objective of the study was to assess the diagnostic accuracy of HSG and compare it with laparoscopy, taking latter as the gold standard in evaluation of tubal patency.
Material & Method: 50 infertile patients (20-40 years), referred from department of Obstetrics & Gynaecology, IMS, BHU were subjected to HSG on day 6-9 of menstrual cycle and tubal findings were classified into patent and blocked tubes (unilateral and bilateral). All patients then underwent diagnostic laparoscopy with chromopertubation to assess tubal patency and look for any associated findings like adhesions, tuberculosis, endometriosis, etc.
Result: 34/50 patients had primary infertility (68%) and 16/50 had secondary form (32%). Laparoscopy showed patent tubes in 23 (46%), unilateral tubal block in 10 (20%) and bilateral tubal block in 17 (34%) compared to 20 (40%), 8 (16%) and 22 (44%), respectively on HSG. HSG showed sensitivity: 92.59% (95% CI: 75.71%-99.09%), specificity: 78.26% (95% CI 56.30%-92.54%), positive predictive value: 83.33% (95% CI: 69.57%-91.62%), negative predictive value: 90.00% (95% CI: 69.98%- 97.20%) and diagnostic accuracy: 86.00% (95% CI: 73.26%-94.18%). Additional laparoscopic findings were also detected in patients with tubal block (n=27); pelvic adhesions-13 (48.1%), endometriosis-6 (22.2%) & tuberculosis-8 (29.7%) and also in those with patent tubes (n=23); pelvic adhesions-1 (4.4%) & endometriosis-2 (8.7%).
Conclusion: HSG should be used as initial test for assessing tubal patency due to its high sensitivity. Laparoscopy being invasive, should be used either in those cases who have normal HSG but fail to conceive or in those who have blocked tubes, to not only confirm the HSG findings but also to diagnose etiological factors so that decision can be taken for tubal microsurgery/in-vitro fertilization.
Keywords: Tubal factor, Female infertility, HSG, Laparoscopy.
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