Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?

Abstract

Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy.
 Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility.
 Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed.
 Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction.
 Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.
 Keywords: Infertility; hysterosalpingography; laparoscopy; tubal factor.

Correlation between hysterosalpingography diagnosis and final hysterolaparoscopy with dye-test diagnosis in women with utero-tubal infertility: A cross-sectional study of the implication for which test should be the first-line investigation

“…The accuracy is, however, poor when compared to HLD. The findings by Gündüz et al 20 revealed a lower specificity, sensitivity, PPV and NPV for HSG at 64.6%, 81.3%, 56.4% and 86% in the determination of tubal obstruction. When an analysis of the overall accuracy of HSG in detecting tubal blockade was performed, this gave a poor result (<90%); thus, HSG may not be the best of the tools in detecting tubal patency/blockade.…”

“…Although the routine administration of naproxen, diclofenac and hyoscine during HSG was an attempt to mitigate this effect, some existing studies have cast doubt on its efficacy. 25 , 26 Studies by Gündüz et al 20 and Varlas et al 24 did not, however, consider the diagnostic accuracy of HSG and HLD.…”

“…‘WHO defines primary infertility as the failure to conceive after 1 year of sexual intercourse without contraception and secondary infertility as the failure to conceive after the previous pregnancy’. 19 , 20 Patients with positive pregnancy test (defined at qualitative or quantitative beta human chorionic gonadotropin (hCG) testing during the research period), women with acute pelvic infection (defined as sexually active women who had lower abdominal pain, and vaginal discharge with demonstrable adnexal tenderness ± positive cervical excitation tenderness during her last clinic visit) or participants undergoing active treatment for sexually transmitted infection (STI) or PID (defined as sexually active women who had vaginal discharge ± lower abdominal pain with demonstrable adnexal tenderness and positive cervical excitation tenderness ± visible vulvo-vaginal lesion during her last clinic visit that are undergoing treatment for their disease), and those with known allergy to contrast/dye (women who demonstrated flare, wheal, urticaria rash, itch or other known allergic symptoms following the use of similar dyes or contrast in the past) and women who are unwilling to do both HSG and HLD procedure were excluded (refusal to do both HSG and HLD tests).…”

Intrauterine adhesions, peritubal adhesions and tubal occlusion on hysterosalpingography

“…6,[8][9][10] Though some authors use tubal obstruction and tubal occlusion interchangeably, others use the term 'obstruction' to imply a temporary process which can be reversible (like spasm and mucus plugging), and 'occlusion' to imply a permanent organic damage as seen in peritubal adhesions (typified by hydrosalpinges and perifimbrial adhesions), intrauterine adhesions and tubal scarring secondary to infections. 6,[8][9]11 The proximal, mid or distal portions of the tube may be involved in tubal lesion and this may be unilateral or bilateral. 6,9 Secondary infertility is the inability to conceive after an earlier pregnancy which may or may not have led to term delivery of live baby.…”

Non communicable diseases persist despite being overshadowed by Covid-19 globally

“…40 We also have papers on married women procuring abortions 41 , fetal ear length 42 , infertility 43 , and paternity in motherless children. 44 These are followed by papers on birth length 45 , neonatal asphyxia 46 , and neonatal mortality 47 , and factors associated with underweight in Ethiopia. 48 Then we have a cocktail of papers on anti-inflammatory potential of Eucalyptus 49 , herbal medicine use in Ethiopia 50 , and traditional bone-setting in Tanzania 51 .…”