Is Diagnostic Curettage Harmful in Women with Unexplained Infertility?

The apparently simple procedure of diagnostic curettage is a mainstay in the armamentarium of many gynecologists in their investigation of infertility. The present study was designed to determine whether diagnostic curettage used in this way might carry any risk of causing tubal damage. One hundred and ninety-five women with otherwise unexplained primary infertility were studied by combined laparoscopy and hysteroscopy. One hundred and forty-two had not undergone diagnostic curettage (group A); 53 had undergone dilatation and curettage elsewhere, specifically as part of an infertility investigation (group B). The findings at laparoscopy with respect to the tubal and peritubal architecture were recorded on a standard protocol. A diagnosis of pelvic inflammatory disease was made if one or more of the following were observed: bilateral or unilateral peritubal and/or periovarian adhesions; bilateral or unilateral hydrosalpinx formation; bilateral tubal phimosis (defined as agglutination of the fimbria with delayed dye transit); bilateral failure of dye to pass the tubo-cornual junctions. Confirmation by hysterosal-pingography was obtained for the seven patients in whom the latter was detected. All procedures were successfully completed, and there were no complications. The findings at pelvic laparoscopy are shown in Table 1. The nature of the laparoscopically detected chronic pelvic inflammatory changes is shown in Table 2. The incidence of pelvic inflammatory changes was significantly greater in the curetted group (P 0.5).