Evaluation of Tubal Factor in Two Methods of Hysterosalpingography and Laparoscopy in Infertile Women (original) (raw)
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Journal of Evidence Based Medicine and Healthcare
BACKGROUND Approximately 15% of couple are affected by infertility. Tubal factor is one of the most frequent causes of infertility in women. As tubo-peritoneal factor is accountable for 30-40% of female infertility, evaluation of tubal patency is the basic investigation for assessment of female infertility. Hysterosalpingogram (HSG) and laparoscopy are the two most commonly conducted tests to evaluate the tubal factor of female infertility. The aim of the study was to compare hysterosalpingogram with laparoscopy in the diagnosis of tubal factor of female infertility. METHODS This is an observational cross-sectional study conducted among 80 infertile women either primary or secondary in the Department of Gynaecology and Obstetrics, R.G. Kar Medical College, Kolkata, a tertiary care hospital in NorthEast , over a period of one and half years (January 2018 to July 2019). Primary infertility incidence was 56.3% and that of secondary infertility was 43.8%. More than half the subjects (66.3%) were between 26 to 35 years of age. Mean age of the study population was 27.43 ± 5.14 years. The mean period of infertility (Mean ± S.D.) of patients was 4.3375 ± 2.3164. Both procedures were done in the same patient. HSG was done in preovulatory phase. Laparoscopy was performed under general anaesthesia. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. RESULTS Association of spillage of dye in HSG vs. laparoscopy was statistically significant (p<0.0001). Association of tubal block in HSG vs. laparoscopy was also significant. Association of abnormal tubal architecture in HSG vs. abnormal tubal architecture in laparoscopy is statistically significant (p= 0.0111296452). Difference in uterine filling defect in HSG and fibroid in laparoscopy was statistically significant (p=0.0013005280). Laparoscopy shows presence of fibroid in more no. of cases. In diagnosis of peritubular adhesion and abnormal tubal architecture, laparoscopy was significantly better than HSG. CONCLUSIONS HSG and laparoscopy are the two classic methods for evaluation of tubal patency in infertile women and are complementary to each other. HSG is less invasive, less expensive, more informative with regard to tubal luminal architecture; whereas, laparoscopy is the gold standard for tubal assessment.
International Journal of Medical and Biomedical Studies
Objectives: Hysterosalpingography and laparoscopy both are the diagnostic methods for assessment of female infertility. The present study was to compare the evaluation of hysterosalpingography (HSG) versus laparoscopy in determination of tubal factors in female infertility. Methods: Detailed assessment, physical examination and clinical investigations were performed in all 100 infertile female with age 20 years to 40 years. All patients were advised to perform digital HSG. Patients with an abnormal HSG underwent laparoscopy without delay, whereas in patients with a normal HSG, laparoscopy was performed three months after HSG. HSG is best scheduled during the 2nd -5th day interval immediately following the end of menstruation, to minimize risk for infection, avoid interference from intrauterine blood and clot, and to prevent any possibility that the procedure might be performed after conception. Results: Data was analysed by using IBM SPSS version 23 software. All data was tabulate...
Diagnostic laparoscopy in the evaluation of tubal factor in cases of infertility
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. The aim of this study was to determine the role of laparoscopy in the evaluation of tubal factor in infertile women.Methods: Sixty women presenting with complaints of primary and secondary infertility were investigated for tubal disease by laparoscopy at at Smt. NHL Municipal Medical College, Ahmedabad during July 2011 to September 2013. Tubal patency was tested by chromopertubation using Methylene blue dye.Results: Thirty-five (58.3%) patients were in primary infertility group while 25 (41.7%) patients were in secondary infertility group. 80% women were in the age group of 21 to 30 years. In 49% of women, the duration of infertility was between 2 to 4 years whereas 17% cases had been...
Aim: The aim of this work is to evaluate different factors affecting tubal patency in both primary and secondary infertile women using laparoscopy. Patients and methods: This study included 130 women with a diagnosis of infertility secondary to tubal factor. The patients were selected from gynecology outpatient clinic or the family planning clinic, Zagazig University Maternity Hospital. All patients had blocked fallopian tubes on HSG. All patients were offered diagnostic/operative laparoscopy. Results: There was a statistical significance differences between laparoscope & HSG in diagnosis of proximal & distal occlusion, adhesion and hydrosalpnix in fallopian tubes. Conclusion: HSG should be considered first-choice imaging modality in the assessment of tubal patency. Laparoscopy with dye test is the procedure of choice in the patient with abnormal HSG for further confirmation and assessment.
South African Journal of Radiology, 2011
Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. Design: Descriptive retrospective study. Setting: A university hospital in the north of Jordan. Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD) age was 31.5 (5.91) years. Mean (SD) duration of infertility was 4 (3.44) years. Infertility was reported as primary and secondary by 119 (42.3 %) and 162 (57.6 %), respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographica...
Journal of Obstetrics and Gynaecology Research, 2004
Aim: To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility in developing countries.Methods: In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero‐tubal junction was attempted.Results: Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post‐traumatic and/or post‐phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than b...
Fertility & Reproduction, 2020
Background: Tubal evaluation is an integral part of the evaluation of female infertility. Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes, which has been used as a first-line test for tubal assessment since 1920s. Laparoscopy is considered to be the gold standard for the diagnosis and management of tubo-peritoneal pathology. The objective of this study is to evaluate and compare the diagnostic value of both HSG and laparoscopy for assessment of tubal occlusion. Methods: This is a prospective cross-sectional study. Laparoscopic chromopertubation was conducted on 125 consecutive infertile women who attended the “Infertility Management Center” from October 2018 to September 2019. All patients had HSG performed in the radiology department of different hospitals. Laparoscopic findings were used as a reference standard to analyze the findings of HSG for tubal occlusion. Data were analyzed by SPSS software (version 16). Results: Normal HSG findi...
Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility
Open Journal of Obstetrics and Gynecology, 2020
Context and Objectives: Tubal factor infertility accounts for a large portion of female factor infertility. Tubal disease is responsible for 25%-35% of female infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Various modalities for investigating tubal factor infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy), hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter being the gold standard. The aim of this study was to determine the role of diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of three hundred and ninety-one (391) records of all diagnostic laparoscopy procedures performed because of infertility in the endoscopic gynecology unit of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who underwent diagnostic laparoscopy to assess tubal factor infertility in the Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was tested by laparoscopy and chromopertubation using methylene blue dye. The clinical characteristics of these women (age, parity, type of infertility), the intra-operative findings and complications were evaluated. Data on age, parity, type of infertility and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and laparoscopic findings were missing were excluded from the study.
International Journal of Medicine and Medical Sciences, 2015
Laparoscopy and hysteroscopy procedures commenced recently in our center and no study has been done on them yet. Also, there is paucity of information in our environment on comparison of laparoscopy/hysteroscopy findings with hysterosalpingography (HSG) amongst infertile women. The purpose of this study was to evaluate pattern of the abnormalities detected on HSG in infertile women and to compare them with laparoscopy and hysteroscopy findings. A prospective study of 220 consecutive patients who had HSG between December, 2011 and May, 2013, at Department of Radiology, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria was conducted. Clinical notes and radiological findings were analyzed for demographic data, uterine status, tubal and pelvic abnormalities. Findings were correlated with those of laparoscopy and hysteroscopy. Data was analyzed using EPI Info version 3.3.2 for windows. Of the 72 women with tubal occlusion on HSG, 46 (63.89%) women had laparoscopy with dye test. HSG demonstrated unilateral tubal occlusion in 35 (76.09%) women and bilateral tubal occlusion in 11 (23.91%) women. The laparoscopy with dye test also demonstrated unilateral tubal occlusion in 34 (73.91%) women and bilateral tubal occlusion in 10 (21.74) women. The difference in the findings of both tests on tubal patency was not statistically significant (p>0.05). All the 26 women with uterine adhesion on HSG had diagnostic hysteroscopy which confirmed all the cases. There was no difference in the findings of both tests (p>0.05). Both HSG and diagnostic laparoscopy are effective in evaluating tubal patency with no significant difference in accuracy. Also both HSG and hysteroscopy are effective in evaluating intrauterine adhesions with no difference in accuracy.
Uterine and tubal abnormalities in infertile Saudi Arabian women: A teaching hospital experience
Saudi Journal of Medicine and Medical Sciences, 2016
Background and Objective: Hysterosalpingography (HSG) is commonly used in the evaluation of the subfertile and infertile women. This study was undertaken to assimilate the findings observed during HSG in Saudi Arabian infertile patients and to find the most common pathology identified by the HSG. Patients and Methods: A retrospective analysis was conducted of subfertile and infertile patients who had undergone HSG between June 2007 and May 2012. Patients' demographic data were collected from the medical records of the King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The data included age, years of marriage, menstrual history either regular or irregular, primary/secondary infertility, hormonal profile, previous infection or pelvic surgery, and diagnostic laparoscopy. Radiographic reports of HSG were collected from the IPAC system and analyzed for fimbrial findings, tubal patency, and cervical and uterine cavitary pathology. The data were entered in the database and analyzed using a t-test to compare means between the age, type of infertility, different pathologies and for all the parameters assessed. All tests were performed using Statistical Package for the Social Sciences, version 14.0, Chicago, Illinois, USA. A P < 0.05 was considered statistically significant with a confidence interval of 95%. Results: Data from the medical records of 117 patients with an average age of 32.59 ± 5.48 years were analyzed. Of this total, 48 (41%) had been diagnosed as having primary infertility. In 95 (81.2%) patients, there was an abnormality in the fallopian tubes and in 27 (23%) patients, there was an abnormality in the uterus. Patients with primary infertility were significantly younger (29.7 ± 5.6 vs. 34.58 ± 4.75; P < 0.001), and tubal and uterine pathology was more common (P < 0.08 and 0.01). Conclusions: Our review indicates that the most common pathology found through HSG in women presenting with infertility is tubal blockage.