Comparison of Hysterosalpingography and Laparoscopy in the Evaluation of Infertility: A Prospective Study.

Background: Worldwide one of the major problems of human reproduction that haunts men and women is infertility. Hysterosalpingography (HSG) and laparoscopy (LS) are the two most important modalities to evaluate infertility. Our aim is to compare the efficacy of both.

Methodology: This is a prospective study. One hundred and five females of both primary and secondary infertility together were included. Detailed history, examination and routine investigations were carried out. Tuberculosis polymerase chain reaction (TBPCR) was made from endometrial biopsy sample for all patients. Ovulation study was done by transvaginal ultrasonography. Hysterosalpingography and diagnostic laparoscopy were done.

Results: Out of 105 infertile patients, 51.42% were in 26-30 years group. 52.3% were from lower economic group. 55.23% presented between 1 to 5 years of infertility. Twelve patients had used contraception in the past. Sixteen patients were serologically positive. Twenty-nine patients were with positive TBPCR among 105 females. Fifty-four and fifty-six patients had patent tubes by HSG and laparoscopy, respectively. Uterine filling defects and congenital anomalies could be detected four times more by HSG than by laparoscopy. TO mass was detected only by laparoscopy. Bilateral spill was present in 66.6% by HSG and 67.6% by laparoscopy and unilateral spillage in 22.8% and 21.9%, respectively. The sensitivity, specificity and accuracy of HSG in predicting unilateral block taking laparoscopy as gold standard are 85%, 96.4% and 94.2%, respectively, and sensitivity and specificity of bilateral tubal block are 81.8% and 98%, respectively.

Conclusions: HSG and laparoscopy are not alternative, but complimentary in diagnosing tubal pathologies. HSG remains as primary screening procedure, but laparoscopy is gold standard.