Intérêt de la fertiloscopie dans la prise en charge de l’infertilité : étude rétrospective, à propos de 262 cas

Abstract

ObjectivesTo evaluate fertiloscopy's results and to redefine its place in the management of female infertility. Patients and methodsRetrospective study including 262 cases of fertiloscopy and 260 patients with primary or secondary idiopathic infertility. Analysis of infertility assessment's findings (hysterosalpingography), perioperative data (operating technique, laparoscopic conversion, failures and complications). Comparison of hysterosalpingography's findings and peroperative data; comparison of fertiloscopy and laparoscopy's findings. ResultsAccess to peritoneal cavity was possible for 248 fertiloscopies (95%), and pelvic exploration was considered as complete for 226 cases (86%). Laparoscopic conversion was necessary in 54 cases (21%) and indicated by surgical pathology in more of one third of the cases (n=20). Our failure rate was only 5,3% (n=14), partially thanks to posterior colpotomie (70% of failures avoided). We deplored 8 complications (3.05%) which were not severe (no bowel injury), among which half were linked with the hysteroscopy (uterus perforation). In the cases of laparoscopic conversion, laparoscopic findings confirmed per-fertiloscopic data, considering adhesions and tubal patency. Hysterosalpingography had poor sensibility and positive predictive value. Discussion and conclusionFertiloscopy is a safe, reproducible and not much invasive procedure. It can be substituted to laparoscopy in infertility assessment when there is no obvious surgical indication. Moreover, it could be considered as a first line way of investigation in female infertility management, instead of hysterosalpingography which has poor sensibility and positive predictive value.