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

Abstract

Patients with both unilateral tubal occlusion and bilateral tubal occlusion on HSG should be reevaluated with LS to determine the appropriate management strategy.

Diagnostic Efficiency and Reproducibility of Hysterosalpingography

“…We found 93% accuracy of HSG in tubal pathology diagnosis, similar results were reported by previous studies [16,17]. Lavy, et al [18] concluded that in 95% of patients with normal HSG or suspicious unilateral obstructed tube, laparoscopy is not indicated, and patient management will not be altered.…”

The validity of HSG in infertility work up

“…Based on our study and results of previous literature [6,20,21,30,31], we can conclude that HSG is a valuable imaging modality for evaluating the genital tract of an infertile female; invasive procedures like laparoscopy and hysteroscopy are not indicated in patients with normal HSG findings and patients may be managed conservatively. Patients who had a pelvic disease or showing tubal obstruction on HSG needs further evaluation by laparoscopy.…”

“…The reported accuracy differed between studies concerning tubal obstruction (level and side of obstruction) [19][20][21][22]. It was more accurate in distal than proximal Fig.…”

“…Waheed S et al [6] reported that HSG is significantly superior in predicting tubal patency (68% of patients had bilateral tubal patency on HSG, compared to 28% on laparoscopy). B. Berker et al [21] recommended laparoscopy in patients with tubal obstruction (unilateral or bilateral) on HSG; they reported a change in the management plan from artificial reproductive technologies (ART) to intrauterine insemination in 12 patients with bilateral tubal obstruction on HSG but confirmed tubal patency by laparoscopy. Recently, fertiloscopy was analyzed as a procedure of choice for tubal status evaluation [23], but further studies are needed to assess the accuracy of this procedure.…”

Tubal Geçi̇rgenli̇k Değerlendi̇ri̇lmesi̇nde Hi̇sterosalpi̇ngografi̇ Mi̇? Laparoskopi̇ Mi̇? : İnferti̇l Olgularin Retrospekti̇f Anali̇zi̇

“…Özellikle olumsuz sonuçlarda HSG'nin geçerliliği yüksektir. IVF ile doğrudan devam etmek yerine L/S yapmak hamilelik süresini geciktirebilse de, HSG'de bilateral tubal oklüzyonlu hastaların önemli bir kısmı L/S sonrası yönetim planı değişikliği nedeniyle IUI'ye yönlendirilebilir (11). Aynı şekilde diğer bir çalışmada da HSG bulguları, özellikle bilateral proksimal tubal oklüzyon için pozitif prediktif değer göstermekle birlikte, HSG'nin tubal açıklığı doğru bir şekilde tanımlamak için sınırlı bir değeri olduğu görülmüştür.…”