Abstract
Background: An accurate diagnosis of tubal occlusion is a crucial part of infertility management of women for which Hysterosalpingography is an integral part for this purpose. Objective: The study is designed to find out tubal occlusion by hysterosalpingography (HSG) and comparing the findings with diagnostic laparoscopy with chromopertubation (laparoscopy) by determining validity and agreement of findings in the study group. Materials and Methods: In this observational study, one hundred and ninety-seven women with infertility were recruited from an infertility clinic of a tertiary care hospital ofWest Bengal, in between April 2018 and March 2020, i.e. 24 months’ period. Women, who were exposed to both of the investigations i.e. HSG and laparoscopy tests, were our study subjects. HSG findings were compared with the findings of laparoscopy to detect tubal occlusion by analyzing sensitivity, specificity, positive predictive value, negative predictive value and kappa. Results: We found mean age of women with primary infertility (66%) was 27.23 years and with secondary infertility (34%) was 32.02 years. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HSG in comparison to laparoscopy to detect tubal occlusion were 80.85%, 74%, 49.35%, 92.5% and 75.63% respectively. Findings showed statistically significant (p Conclusion: This study provides strong supportive evidence to utilise HSG as a screening test for diagnosing tubal occlusion in infertility work up with high accuracy, especially in low resourceful area of rural India. Keywords: Infertility, Hysterosalpingography, Laparoscopy, Chromopertubation.
Highlights
Infertility is a disease of couples due to failure to achieve clinical pregnancy even after 12 months of regular unprotected intercourse. 1 It may be primary or secondary
Women with normal hormone profile i.e. thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) and normal semen analysis of husband were included as a study subject
We considered two outcomes by hysterosalpingography and by laparoscopy, i.e. unilateral and bilateral occlusion of tube as a single group of tubal occlusion is considered as positive findings and patency found in both the is tube considered as negative finding
Summary
Infertility is a disease of couples due to failure to achieve clinical pregnancy even after 12 months of regular unprotected intercourse. 1 It may be primary or secondary. 2,6 Hysterosalpingography (HSG) was used as a screening test to detect infertility from tubal occlusion. Women, who were exposed to both of the investigations i.e. HSG and laparoscopy tests, were our study subjects. HSG findings were compared with the findings of laparoscopy to detect tubal occlusion by analyzing sensitivity, specificity, positive predictive value, negative predictive value and kappa. Results: We found mean age of women with primary infertility (66%) was 27.23 years and with secondary infertility (34%) was 32.02 years. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HSG in comparison to laparoscopy to detect tubal occlusion were 80.85%, 74%, 49.35%, 92.5% and 75.63% respectively. Conclusion: This study provides strong supportive evidence to utilise HSG as a screening test for diagnosing tubal occlusion in infertility work up with high accuracy, especially in low resourceful area of rural India
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