Role of diagnostic hysterolaparoscopy in infertile women with normal hysterosalpingography

Abstract

Infertility is defined as one year of frequent unprotected intercourse during which pregnancy has not occurred. Causes of infertility in the female partner include disorders of ovulation, tubal disease, and uterine or cervical factors. Endometriosis also has been implicated as an independent cause of infertility. Owing to its non invasive nature and low cost, hysterosalpingography (HSG) is widely used as a first line approach to assess the patency of the fallopian tubes and uterine anomalies in the routine fertility workup. However, the inadequacy of HSG in determining the state of tubal patency emphasizes the need for laparoscopy. Diagnostic laparoscopy is the gold standard in diagnosing tubal pathology and other intra-abdominal causes of infertility. In the current study, 80 patients with primary infertility were selected and proved to be normal on physical examination and transvaginal ultrasound. All patients had essentially normal hysterosalpingogram, denoting bilateral tubal patency and an apparently normal uterine cavity. Diagnostic hysterolaparoscopy was performed to provide direct visualization of the uterine and peritoneal cavities. Hysteroscopy detected abnormalities in 55% of the studied group and likewise, laparoscopy revealed a 51.3% rate of abnormalities. Collectively, only 25% of the studied population had