The Significance of Laparoscopy in Determining the Optimal Management Plan for Infertile Patients with Suspected Tubal Pathology Revealed by Hysterosalpingography

Abstract

The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of infertility. Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance. The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the impact on fertility. Bilateral tubal pathology affects the prospect of spontaneous fertility, whereas unilateral tubal pathology affects the prospect of spontaneous fertility less severely (Nordenskjold et al. 1983;Mol et al. 1999). The pregnancy rates after adhesiolysis for peritubal adhesions were 75% in mild adhesions and 33% in severe adhesions (Carey et al. 1987). The intrauterine pregnancy rate after salpingostomy for hydrosalpinx was 0~44% (Taylor et al. 2001). In cases that include over half normal tubal mucosa without adhesions, size of hydrosalpinx < 1 cm, and thin thickness of the fallopian tubal wall, salpingostomy will allow postoperative spontaneous pregnancy (Vasquez et al. 1995). Salpingectomy should be recommended if the fallopian tube has severely damaged mucosa (Strandell et al. 2000). In this manner, determination of the management plan is associated with the degree of tubal pathology.Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions (Helmerhorst et al. 1995;Mol et al. 2001). A meta-analysi...

Laparoscopic Findings of Different Factors Affecting Tubal Patency in Infertile Women at Zagazig University Hospital.

“…These findings concur with those by Tsuji et al, (12) who found that HSG had a high specificity of diagnosing proximal tubal occlusion or hydrosalpinx and lower sensitivity in cases with peritubal adhesions. The data showed that laparoscopy is a superior technique as far as detection of hydrosalphinx is concerned.…”

“…This concurs with the findings by Tsuji et al, (12) who conducted a study to find out the impact of patient characteristics such as female age, duration of sub-fertility, and a clinical history without risk factors for tubal pathology. From their study, they estimated that the pooled sensitivity and specificity of HSG were 85% and 87% respectively for any tubal pathology.…”

“…The sensitivity of HSG in diagnosing adhesions in the fallopian tube was estimated to be 17.9% and specificity of 85.7%.These researcher's conclusion was that although HSG is of limited use for detecting tubal patency because of its low sensitivity; its high specificity makes it a useful test for ruling in tubal obstruction. Laparoscopy confirmed bilateral tubal patency in 16 cases (17.8%) in whom HSG had diagnosed tubal occlusion (12) .…”

“…Tsuji et al, (12) found a higher incidence of endometriosis in patients with unexplained infertility.…”

Laparoscopic evaluation of tubal factor in cases of infertility

“…Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. 6 Laparoscopy and chromopertubation is widely considered the gold standard test for investigating tubal patency. Additionally, it allows assessment for peritubal disease, adhesions and endometriosis.…”