Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology?

Yuval Lavy, Lavy Y, Ahinoam Lev-Sagie, Ahinoam Lev‐Sagie, Hananel Holtzer, Holtzer H, Ariel Revel, Hurwitz A, Arye Hurwitz
European journal of obstetrics, gynecology, and reproductive biology · 2004 · vol. 114(1) , pp. 64–68 · doi:10.1016/j.ejogrb.2003.09.035 · PMID:15099873 · W2011153882
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This paper evaluates whether laparoscopy is a necessary part of infertility assessments for women with normal hysterosalpingograms or suspected unilateral distal tubal issues.

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Abstract

OBJECTIVE: To assess the diagnostic benefit of laparoscopy in infertile women with normal hysterosalpingography (HSG) or suspected unilateral pathology on HSG. STUDY DESIGN: Charts of infertile women that underwent complete infertility evaluation between 1996 and 1998 were retrospectively reviewed. Eighty-six patients in whom both HSG and laparoscopy were performed were included in the study. HSG results were compared with laparoscopic findings and the suggested treatment based on HSG results was compared with the treatment plan based on laparoscopic findings. RESULTS: Among 63 patients with a normal HSG or suspected unilateral tubal pathology, who were assigned to ovulation induction and intrauterine insemination (IUI), 60 patients were found to have laparoscopic findings that did not necessitate any change in the original treatment plan. In three patients (4.8%), abnormalities discovered at laparoscopy were of such an extent that a change in the original treatment regimen and referral to in vitro fertilization (IVF) was needed. Among 23 patients with suspected bilateral tubal occlusion on HSG, 16 patients (69.6%) were found to have an abnormal laparoscopy with bilateral tubal adhesions, 6 patients (26%) had unilateral tubal adhesions, and 1 patient (4.3%) had pelvic adhesions with no obstruction. These latter findings led to changes in the original treatment plan of these seven patients from IVF to ovulation induction and IUI. CONCLUSIONS: Laparoscopy may be omitted in women with normal HSG or suspected unilateral distal tubal pathology on HSG, since it was not shown to change the original treatment plan indicated by HSG in 95% of the patients. However, laparoscopy should be recommended in cases with suspected bilateral tubal occlusion on HSG, since it altered the original treatment plan in 30% of the patients from IVF to induction of ovulation with IUI. The reassuring results found in the present study may be related to the low prevalence of pelvic inflammatory diseases and endometriosis in our population.

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Condition tags

infertility

MeSH descriptors

Fallopian Tube Diseases Infertility, Female Laparoscopy Adult Adult Diagnostic Tests, Routine Diagnostic Tests, Routine Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Female Female Humans Humans Hysterosalpingography Hysterosalpingography Infertility, Female Infertility, Female

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