Prognostic capacity of transvaginal hydrolaparoscopy to predict spontaneous pregnancy

BACKGROUND: In 1998, transvaginal hydrolaparoscopy (THL) was introduced as a new outpatient procedure for exploration of tubo-ovarian structures and tubal patency in subfertile patients. At present, there are no large studies that relate the findings at THL to fertility outcome. METHODS: Consecutive patients undergoing THL for subfertility between 2000 and 2004 were included in this prospective cohort study. Follow-up ended when ongoing pregnancy or tubal surgery occurred or at the day of last contact. Kaplan-Meier curves for the occurrence of intrauterine pregnancy (IUP) (spontaneous or after intrauterine insemination) were constructed for a normal THL, a THL with a one-sided tubal pathology and a THL with a two-sided tubal pathology. Fecundity rate ratios (FRRs) were calculated to express the association between THL findings and the occurrence of IUP. Patients rated their pain experiences and acceptability on a visual analogue scale (VAS). RESULTS: We included 272 women. In 96% (261) of the patients, access to the pouch of Douglas was achieved. Complications occurred in 2% of the procedures. In 203 (78%) patients, both tubo-ovarian structures could be visualized and tubal patency was shown. One-sided tubal occlusion was found in 10%, whereas two-sided tubal occlusion was seen in 4% of the patients. Adhesions and/or endometriosis were observed in 8% of the patients. The FRRs for one-sided tubal pathology, two-sided tubal pathology and adhesions/endometriosis were 0.59, 0 and 0.80, respectively. The VAS scores showed pain to be limited and the procedure to be acceptable. CONCLUSION: THL is a feasible technique. Its capacity to predict spontaneous ongoing pregnancy is comparable to that of laparoscopy.