Comparison of Hysterosalpingography and Laparoscopy in Diagnosis of Tubal Occlusion.

ABSTRACT

Background: Infertility is one of the most common conditions confronting Gynecologists and tubal factor is one of the most common causes of infertility. Hysterosalpingography and laparoscopy are used as methods for diagnosis of tubal patency in infertility. HSG is an OPD procedure and, for many years has been used as an invaluable procedure for diagnosis of tubal patency and intrauterine pathology in infertility. Laparoscopy is an invasive procedure and is used for evaluation of tuboperitoneal factors. Aims and objectives: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology in infertility in comparison to laparoscopy Methods: 60 patients of infertility were evaluated in the department of Gynecology and obstetrics, Government Lalla Ded Hospital ,Srinagar from April 2013 to August 2014. A prospective cross sectional study was performed. HSG was performed in the pre-ovulatory phase .Laparoscopy was performed under general anesthesia at least three months after HSG in the premenstrual phase. Diagnostic laparoscopy was considered as the reference standard in detecting tubal blockade and findings of hysterosalpingography were compared with laparoscopy. Results: All the patients in the study group were complaining of infertility. The total number of patients in this study was 60 in which 41 were in primary infertility group and 19 were in secondary infertility group. The age of patients was between 21 and 39 years. The average duration of primary infertility was 4.08 years and secondary infertility was 5.15 years. The sensitivity of HSG was 90.91% (95%CI 76.43-96.86) and specificity was 77.78% (95%CI 59.24-89.39) with positive predictive value of 83.33% (95%CI 68.11-92.13) and negative predictive value of 87.50% (95%CI 69.0- 95.66),when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. The further advantage of laparoscopy is the possibility of visualization of some other pelvic abnormalities which may be the cause of infertility. In our study, in patients with tubal block, adnexal adhesions were found in 15 (45%), endometriosis in 8(25%) and suspected intratubal block in 10(30%). Conclusion: HSG is the first step diagnostic test for assessment of fallopian tubes. Although laparoscopy is more invasive than HSG, laparoscopy with chromotubation is the gold standard for diagnosis of tubal block, and for identifying periadnexal adhesions and endometriosis and thus to guide appropriate therapy.