Infertility work-up: To what degree does laparoscopy change the management strategy based on hysterosalpingography findings?

Abstract

The aim of this study was to assess the diagnostic accuracy of hysterosalpingography (HSG) on tubal patency (TP) and to determine whether performing laparoscopy (LS) can change the original management strategy based on HSG findings. Records of all infertile couples (n = 1298) treated at a university-based infertility clinic between January 2002 and June 2010 were reviewed. All patients who had both HSG and LS testing (n = 264) were included in the study. HSG was performed in an attempt to rule out tubal and/or uterine pathologies. All patients included in the study were evaluated with LS not more than 12 months after HSG. The validity of HSG screening for TP was calculated as 84.1%. The positive and negative predictive values of HSG were 54.6% and 98.3%, respectively. The sensitivity of HSG was higher in patients with distal tubal occlusion than in patients with proximal tubal occlusion (69.8% [44/63] vs 46.7% [28/60], respectively; P = 0.011). The rates of management plan change in patients with bilateral TP, unilateral tubal occlusion and bilateral tubal occlusion were 2.8%, 12.2% and 32.4%, respectively (P = 0.000). Patients with both unilateral tubal occlusion and bilateral tubal occlusion on HSG should be reevaluated with LS to determine the appropriate management strategy.