Comparison of hysterosalpingography and laparoscopy in evaluation of female infertility

Abstract

Background and Objectives: Laparoscopic surgery (LS) is the most important diagnostic technique for the detection of causes of infertility; however, this method is accompanied by some setbacks. Given the noninvasive nature and cost-effectiveness of hysterosalpingography (HSG), it is widely used as the first-line approach for the evaluation of the patency of the fallopian tubes and uterine anomalies in female infertility. Herein, we aimed to compare the diagnostic values of HSG with LS in the assessment of patency of the fallopian tubes and peritoneal disease in infertile women.Materials and Methods: This prospective, cross-sectional study was performed on 115 infertile women admitted to the Department of Obstetrics and Gynecology in Fatemiyeh Teaching Hospital, Hamedan, Iran, during March 2011- September 2012. Tubal patency, peritubal adhesion, uterine anomalies, and tubo-ovarian abscess (TOA) findings in HSG were compared with laparoscopic findings. Data was analyzed using McNemar's test and Cohen's Kappa. Results: The sensitivity, specificity, and accuracy of HSG for the detection of unilateral and bilateral tubal occlusion were 75%, 91.2%, 89.5%, 75%, 97.2%, and 96.6%, respectively. Furthermore, false-positive and false-negative rates of HSG for the detection of unilateral and bilateral tubal occlusion were 8.7% and 25%, respectively. The accuracy of HSG in detecting uterine anomalies and hydrosalpinx were 93.3% and 93.9%, respectively. Peritubal adhesion and TOA were detected in 61% of the cases with normal HSG. In addition, of the nine cases of bilateral tubal occlusion detected by HSG, six cases were confirmed to have bilateral occlusion using laparoscopy. The comparison between HSG and LS techniques showed a significant difference in diagnosis of distal fallopian tube occlusion (P=0.021) and unilateral fallopian tube occlusion (P<0.001) among infertile women. The comparison between HSG and LS techniques demonstrated a significant difference in diagnosis of TOA (P<0.001) and peritubal adhesion (P=0.033).Conclusion: It seems that the findings of HSG regarding occlusion, hydrosalpinx, and uterine anomalies are reliable. However, due to its low sensitivity in detecting peritubal adhesion, performing LS before initiation of treatment in these patients is necessary to rule out adhesion and to confirm tubal patency.