In-office transvaginal hydrolaparoscopy: a step-by-step, intraoperative pain evaluation

Giampaolino, Pierluigi; Pellicano, Massimiliano; Tommaselli, Giovanni A.; Bifulco, Giuseppe; Simioli, S.; Nappi, Carmine; Carlo, Costantino Di

doi:10.1007/s00404-015-3750-x

Cited by 3 publications

(1 citation statement)

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“…Comparing HSG to THL, THL is superior in diagnosing endometriosis and peritubal adhesions , whereas HSG gives more information about the uterine cavity. THL performed under local anesthesia is well-tolerated by the patient (Giampaolino et al 2015) and in two RCT's, THL patients were found to have lower pain scores than those undergoing HSG The most important aspect of tubal testing however, is its prognostic capacity: it has to distinguish between women who can conceive a natural pregnancy and women who have a strongly reduced chance to conceive, and therefore may need IVF or tubal surgery. Studies on the prognostic capacity of HSG showed that women with unilateral tubal patency compared to women with bilateral patent tubes had only a mild reduction in the chance of a natural conceived pregnancy, whereas women with bilateral tubal occlusion had a significantly reduced chance of a naturally conceived pregnancy (Verhoeve et al 2011.…”

Section: Introductionmentioning

confidence: 99%

Transvaginal hydrolaparoscopy

Kessel

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Transvaginal hydrolaparoscopy is performed to investigate tubal pathology in subfertile women. We studied the findings at THL and subsequent pregnancy rates in a retrospective multicenter cohort study. Between 2000 and 2011 1,033 subfertile women participated in our study. Primary outcome measure was intra-uterine pregnancy, either after natural conception or after treatment with intra-uterine insemination or ovulation induction. We calculated cumulative intra-uterine pregnancy rates using Kaplan-Meier analysis and fecundity rate ratios (FRR). THL showed bilateral patent tubes in 83%, one-sided tubal occlusion in 12.4% and bilateral tubal occlusion in 4.6% of women. Cumulative intrauterine pregnancy rates after 36 months were 52% for women with bilateral patent tubes, 44% for one-sided tubal occlusion (FRR 1.04 (95% CI 0.78-1.39) and 7% for bilateral tubal occlusion (FRR 0.13 (95% CI 0.04-0.43). Endometriosis was diagnosed in 6.4%, adhesions in 9.1%, while 3.9% of women had both. Corresponding FRRs were 0.73 (95% CI 0.49-1.09), 0.68 (95% CI 0.46-1.02), and 0.42 (95% CI 0.20-0.84). In conclusion, women with bilateral tubal occlusion or the combination of endometriosis and adhesions found at THL have significantly reduced chances of natural conception.

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Section: Introductionmentioning

confidence: 99%