Pilot Study Accuracy of Hysterosalpingography vs. Laparoscopy & Dye Test

1. Pilot Study Accuracy of Hysterosalpingography vs. Laparoscopy & Dye Test Roshan Zeirideen Zaid & Sanjula Sharma North Middlesex University Hospital NHS Trust, NewhamUniversity Hospital, UK. Objectives Method Findings Eighteen patients were analyzed. Ten patients had bilateral tubal blockage and 8 of them had single tube blockage. Two patients had history of STI. On HSG one patient had hydrosalpinges, one had severe uterine synechiae and one had bi-cornuate uterus Retrospective analysis of patients undergoing laparoscopy for tubal blockage/pathology diagnosed on HSG. Eighteen patients(3.8%) were identified out of 480 new couples attending fertility clinic at Newham General Hospital over the period of 2 years. Information was retrieved from patient database on Electronic Patient Recording(EPR) and operative notes. All our patients were between the ages of 22-40 and BMI 25-35. We also collected data regarding the presence or absence of PID/STI and endometriosis, Tubal factor is an important criteria in the investigation of sub-fertile couples. Hysterosalpingography (HSG) is one of the frequently used tools to assess the tubes, apart from Laparoscopy and dye test and HyCoSy. HSG yields information regarding patency of tubes, uterine cavity, hydrosalpinges and possible information about peri-tubal adhesions. HSG is less invasive, fewer side effects and well tolerated by women. The objective of our study was to assess the accuracy of HSG as a test to assess tubal patency.WHO sponsored multicentered trial from 1986 suggested that 55% had similar results and 42% had false positive results. Another study done in Riyad (1996) showed overall agreement between the two methods was 62.5%. HSG Results In our study, incidence of true positive (patency of tubes on laparoscopy) was confirmed in 28%. In comparison of HSG with laparoscopy, HSG had a false positive(blockage)rate of 72%. False positive result was higher in bilateral tubal blockage. Statistical significance wasn’t determined since the sample size was relatively small. Conclusion It would appear that laparoscopy dye test has an edge over HSG, but hysterosalpingography is a very useful primary diagnostic tool. It has yielded conclusive results in 96.2% of the patients. It also has other advantages for E.g. cheaper, well tolerated, no anesthetic risks and surgery related risks. Laparoscopy should be used in a selective population where pelvic pathology is suspected or HSG findings are abnormal. Reliability of blockage of tubes on HSG is poor as illustrated by high false positive results in previous multicentred (42%) trials and our study (72% ). HSG is useful as a primary diagnostic tool for tubal patency. Laparoscopy and dye test appear to be a more optimal method in a selective group. HSG Normal Tubes Women have laparoscopy if HSG suggests tubal blockage or other associated symptoms suggesting endometriosis or PID. Laparoscopy is more invasive, has the risk of organ damage and exposure to anaesthesia. However it is considered as the gold standard test for tubal patency. Right Hydrosalpinges Right Tubal Blockage References (1) Comparative trial of tubal insufflation, hysterosalpingography, and laparoscopy with dye hydrotubation for assessment of tubal patency, WHO, FertilSteril, 1986 Dec; 46(46): 1101-7. (2) Accuracy of Hysterosalpingography and laparoscopic hydrotubation in diagnosis of tubal patency, Adelusi B, al-Nuaim, FertilSteril, 1995 May; 63(5): 1016-20. Laparoscopy Normal Tube HSG vs. Laparoscopy Comparative Analysis