The usefulness of transvaginal hydrolaparoscopy in infertile women with abnormal hysterosalpingogram results but with no obvious pelvic pathology

Rui Yang, Yang R, Ma C, Caihong Ma, Qiao J, Jie Qiao, T. C. Li, Tin Chiu Li, Yan Yang, Yang Y, Xinna Chen, Chen X, Yang S, Shuo Yang, Ping Liu, Liu P
European journal of obstetrics, gynecology, and reproductive biology · 2010 · vol. 155(1) , pp. 41–43 · doi:10.1016/j.ejogrb.2010.10.023 · PMID:21111527 · W2006586938
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This study assessed the diagnostic value of transvaginal hydrolaparoscopy in infertile women whose hysterosalpingogram revealed abnormalities but showed no signs of pelvic disease.

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Abstract

ObjectiveTo evaluate the value of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram results but with no history of previous pelvic surgery and with normal gynecological examination and vaginal sonography.Study designThis is a retrospective study. From January 2008 to October 2009, 51 infertile women were planned to undergo standard laparoscopy because of abnormal HSG. None of the patients had any history of previous pelvic surgery and all had normal findings on gynecological examination and vaginal sonography. These women underwent THL.ResultsAmong the 51 cases, successful access to the pouch of Douglas was achieved in 49. There were two failures due to obesity, and the operation was converted to standard laparoscopy. No complication was observed in this study period. In 26 patients (53.1%) the THL procedure showed normal pelvic organs. Four patients were lost to follow-up. Of the remaining 22 cases, four became pregnant (4/22, 18.2%) through intercourse or intrauterine insemination (IUI). There were some morphologic abnormalities seen in the remaining 23 patients such as adhesions, endometriosis and hydrosalpinx. Six cases with mild adhesions and endometriosis were treated with THL alone, and four (4/6, 66.7%) became pregnant with or without IUI. Among the 19 who underwent standard laparoscopy, three were lost to follow-up. In the other 16 cases, natural pregnancy occurred in six (6/16, 37.5%) patients with or without IUI.ConclusionsFor women with abnormal HSG results but with no obvious pelvic pathology, THL should be recommended and about 50% could avoid an unnecessary laparoscopy. Adhesiolysis and coagulation of endometriotic lesions under THL in mild adhesion and endometriosis cases could lead to encouraging results.

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Condition tags

endometriosis

MeSH descriptors

Hysterosalpingography Infertility, Female Laparoscopy Sodium Chloride Ablation Techniques Diagnosis, Differential Douglas' Pouch Douglas' Pouch Endometriosis Endometriosis Endometriosis Fallopian Tube Diseases Fallopian Tube Diseases Female Gynecological Examination Humans Hysterosalpingography Infertility, Female Infertility, Female Infertility, Female

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