The Comparison of Hysterosalpingography and Laparoscopy in Predicting Fertility

Abstract

Objective of the study was to compare the prognostic significance of Hysterosalpingography (HSG) and laparoscopy for fertility outcome.

Materials and Method: Study was conducted in Radiology Departments of Sir Ganga Ram Hospital, Lahore and Lahore General Hospital, Lahore from June to November 2005. Hysterosalpingography was performed on 100 patients being investigated for infertility. Later all study patients were investigated with Laparoscopy.  Findings of both these investigations were compared for their ability to demonstrate anatomy and pathology of fallopian tubes, uterine cavity, intrapelvic peritoneal adhesions, and intraperitoneal contrast/ dye spill.

Results: On HSG 68% patients showed bilateral intraperitoneal contrast spill demonstrating patency of both fallopian tubes, 22% showed unilateral spill and 10% showed no spill. On laparoscopy, 28% patients showed bilateral intrapelvic spill of dye, 18% showed unilateral spill, while 55% patients showed no intrapelvic spill of dye. Difference in determination of tubal patency was significant (p < 0.001) between both these methods. There was no significant difference between two techniques in demonstrating hydrosalpinx and uterine cavity. On HSG 24% patients showed bilateral peritoneal adhesions, 28% showed unilateral while 50% patients were without such adhesions. Using laparoscopy, the number of patients with bilateral adhesions was 39%, while 16%patients had unilateral and 4% were without peritoneal adhesions. Results with two techniques differed significantly (p<0.05).

Conclusion Hystero-salpingography was found to be significantly more accurate in showing patency of fallopian tubes and thus predicting future prognosis in patients being managed for infertility. It is less invasive as compared to laparoscopy and is reliable and almost equally useful method for evaluating internal architecture of female reproductive tract. Utilizing HSG it may be possible to minimize the use of invasive procedures like laparoscopy and hysteroscopy. Laparoscopy was found to be more useful than HSG in demonstrating pelvic adhesions.

Key Words Hysterosalpingography (HSG), Laparoscopy, Hysteroscopy, Infertility, Peritoneal adhesions, Tubal patency, Hydrosalpinx.