KUMJ | VOL. 13 | NO. 4 | ISSUE 52 | OCT-DEC, 2015
Comparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility
Nigam A, Saxena P, Mishra A
Abstract: Background
Hysterosalpingography (HSG) is a useful screening test for the evaluation of female
infertility. Laparoscopy has proven role in routine infertility work up but role of
hysteroscopy in an infertile patient with normal HSG for additional information is a
subject of debate. Hysteroscopy permits direct visualization of the cervical canal and
the uterine cavity and thereby helping in the evaluation of shape, and cavitary lesion.
Objective
To detect uterine abnormalities in infertile women by various approaches i.e. HSG and
hysteroscopy and evaluating the role of combining hysteroscopy with laparoscopy
for the evaluation of tubo-uterine factor for primary infertility.
Method
One twenty eight infertile women were evaluated and HSG was performed as a basic
test for evaluation of tubes and uterine cavity. Women were subjected to combined
laparoscopic and hysteroscopic examination on evidence of HSG abnormalities. In
absence of any HSG abnormality, women were subjected to ovulation induction
for three to six months and if they did not conceive during this period they were
undertaken for combined laparo-hysteroscopic evaluation.
Result
The positive predictive value of HSG for detecting the intrauterine abnormalities was
70% among 126 patients where the hysteroscopy could be performed successfully.
The diagnostic accuracy of HSG for intrauterine abnormalities revealed false negative
rate of 12.96%. The most frequent pathologies encountered by laparoscopy were
tubal and/or peritoneal and were found in 68% (87/128) of women. Total 64.06%
infertile women had some abnormality on laparoscopy. This detection rate has been
increased from 64.06% to 71.86% on including the concomitant hysteroscopy.
Conclusion
HSG is a good diagnostic modality to detect uterine as well as tubal abnormalities
in infertile patient. HSG and hysteroscopy are complementary to each other and
whenever the patient is undertaken for diagnostic laparoscopy for the infertility,
hysteroscopy should be combined to improve the detection rate of abnormalities
especially in communities where there is enormous risk of pelvic infection.
Keyword : Hysterosalpingography, hysteroscopy, infertility, laparoscopy
