Application of transvaginal hydrolaparoscopy to tubal infertility:clinical analysis of 50 cases

【Objective】To confirm tubal patency in hysterosalpingography (HSG) by transvaginal hydrola- paroscopy (THL) and to evaluate THL in treating pelvic lesions. 【Methods】 One to four days after HSG, the tubal patency of fifty infertile women was verified by dye-test during THL and the pelvic lesions were treated at the same time from Jan. 2008 to Feb. 2009. After THL, hysteroscopy and dye-test using catheterization of the tubal ostium by hysteroscopy were performed immediately. 【Results】① Value of tubal patency: The ac- curacy of HSG was only 64.7% when the examination revealed blocked tubes. The sensitivity and specificity of HSG were respectively 80.5% and 69.5%. ② Therapy for pelvic lesions: of 41 blocked tubes in THL, 7 were hydrosalpinx due to distal obstruction. Of the remained 34 tubes, 18 (52.8%) were patent after the dye- test using catheterization of the tubal ostium by hysteroscopy. Mild pelvic adhesion was found in 15 cases, moderate adhesion in 2 and severe adhesion in 2. Of 15 cases with mild adhesion and 2 cases with moder- ate adhesion, adhesiolysis was finished successfully for filmy pelvic adhesion using 5Fr bipolar electrocoagulat- ing needle and 7Fr hook scissors, but the cohesive adhesion that occurred at 1 ovary entirely failed to be lyzed. For the two cases with severe adhesion, the adhesiolysis was not performed. In addition, endometriosis spots of 6 cases were treated by bipolar electrocoagulating needle. Two PCOS cases with clomiphene citrate- resistance successfully underwent ovarian drilling. ③ No perioperative complications occurred. ④ Three women were out of follow-up, and excluding 2 cases with severe adhesion 18 out of 45 cases (40%) became preg- nant during a follow-up of 6-19 months. 【Conclusions】 HSG is not very reliable in diagnosis of blocked tubes. Some simple operations could be performed easily under THL and THL could achieve better effect while it is combined with hysteroscopy.