A comparison of hysterosalpingography and laparoscopy in the evaluation of tubal factors in female infertility
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This observational study compared hysterosalpingography and diagnostic laparoscopy with chromopertubation in 125 infertile women to evaluate tubal patency. The results demonstrated a significant agreement between the two methods, identifying bilateral tubal block as the most common abnormality. The authors concluded that while hysterosalpingography effectively assesses tubal and intra-uterine factors, laparoscopy provides complementary value by simultaneously detecting and treating non-tubal issues such as pelvic adhesions. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.
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Abstract
Background: WHO defines infertility as “failure to conceive after having regular, unprotected intercourse for one year. Factors responsible - male factors (20-30%), female factors (40-55%), combined male and female factors (10-40%) and unexplained infertility (10-20%). Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. The aim of this study was to compare findings of HSG and diagnostic laparoscopy with chromopertubation for tubal patency in infertile women.Methods: An observational study, done on a total of 125 females suffering from primary and secondary infertility who underwent HSG and then 97 patients who gave consent, underwent diagnostic laparoscopy with chromopertubation. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.Results: Primary infertility cases were more than secondary infertility cases. Mean age of patients was found to be 28.92±5.33 years. Most common tubal abnormality found on hysterosalpingography and chromopertubation was bilateral tubal block. Inter rater kappa agreement used and significant agreement found between hysterosalpingography and chromopertubation with kappa value of 0.612.Conclusions: From this study authors conclude that HSG and laparoscopy with chromopertubation are complimentary to each other. Laparoscopy helps in identification of tubal and non-tubal factors like intra-abdominal and pelvic adhesions, endometriosis etc. and simultaneously they can be treated while HSG helps in evaluation of tubal factors as well as of intra-uterine factors like synechiae, polyps etc.
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Background
WHO defines infertility as “failure to conceive after having regular, unprotected intercourse for one year. Factors responsible - male factors (20-30%), female factors (40-55%), combined male and female factors (10-40%) and unexplained infertility (10-20%). Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. The aim of this study was to compare findings of HSG and diagnostic laparoscopy with chromopertubation for tubal patency in infertile women.
Methods
An observational study, done on a total of 125 females suffering from primary and secondary infertility who underwent HSG and then 97 patients who gave consent, underwent diagnostic laparoscopy with chromopertubation. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.
Results
Primary infertility cases were more than secondary infertility cases. Mean age of patients was found to be 28.92±5.33 years. Most common tubal abnormality found on hysterosalpingography and chromopertubation was bilateral tubal block. Inter rater kappa agreement used and significant agreement found between hysterosalpingography and chromopertubation with kappa value of 0.612.
Conclusions
From this study authors conclude that HSG and laparoscopy with chromopertubation are complimentary to each other. Laparoscopy helps in identification of tubal and non-tubal factors like intra-abdominal and pelvic adhesions, endometriosis etc. and simultaneously they can be treated while HSG helps in evaluation of tubal factors as well as of intra-uterine factors like synechiae, polyps etc.
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References
World Health Organization. Sexual and reproductive health: Infertility definitions and terminology. Available at: https://www.who.int/reproductivehealth/topics/infertility/en/. Accessed on 22nd March 2020.
Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AM. WHO manual for the standardized investigation and diagnosis of the infertile male. Cambridge University Press; 2000.
Hodin S. The burden of infertility: global prevalence and women’s voices from around the World. Maternal Health Task Force. 2017
Dutta DC. Text Book of Gynecology, 6th edition, New Central Book Agency pvt Ltd. Chapter 10; 136-137. Available at: http://bvhmch.in/wp-content/uploads/2018/03/Gynaecology-DC-Dutta.pdf. Accessed on 2nd March 2020.
Anuradha J, Kumari KA, Sujatha A. Comparative study of tubal patency by hysterosalpingography, transvaginal sonosalpingography and laparoscopy. IAIM. 2016;3(9):126-33.
Saini VK, Patel SC, Kawad K. Role of diagnostic laparoscopy in infertility-study of 50 cases. Int J Sci Res. 2013;2(7):290.
Adamson PC, Krupp K, Freeman AH, Klausner JD, Reingold AL, Madhivanan P. Prevalence and correlates of primary infertility among young women in Mysore, India. The Indian J Med Res. 2011;134(4):440.
Ibinaiye PO, Lawan RO, Avidime S. Comparative evaluation of pattern of abnormalities in hysterosalpingography, diagnostic laparoscopy and hysteroscopy among women with infertility in Zaria, Nigeria. Int J Med Med Sci. 2015;7(2):26-35.
Foroozanfard F, Sadat Z. Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women. Nurs Midwifery Stud. 2013;2(2):188.
Oguntoyinbo AE. Department of radiology, faculty of clinical sciences college of health sciences, University of Ilorin, Ilorin, Nigeria, 2018. Available at: https://pdfs.semanticscholar.org/3c30/d440d75bee 9714fe34e99fc35354c56ed9ab.pdf. Accessed on 21st March 2020.
Geetha D, Thilagavathy D. Comparative evaluation of tubal patency by sterosalphingography and laparoscopic chromopertubation. J Den Med Sci. 2016;15(08):53-7.
Sachdeva PK, Kaur N. Role of hysterosalpingography and diagnostic laparoscopy in infertility. Int J Reprod Contracept Obstet Gynecol. 2016;5(11):3744.
Sakar MN, Gul T, Atay AE, Celik Y. Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women. Saudi Med J. 2008;29(9):1315-8.
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