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HSG versus laparoscopy in infertility
evaluation
Title: Comparison of hysterosalpingography and laparoscopy in
predicting fertility outcome
Author: B. Mol, et al.
Address: Amsterdam, The Netherlands
Source: Human Reproduction 14(5): 1237-1242 (May) 1999
Summary: To compare the prognostic significance of HSG and laparoscopy
for fertility outcome, data was collected from couples in 1 of the 11 centers of
the Canadian Infertility Treatment Study who underwent HSG and laparoscopy. Only
treatment independent pregnancy rate was compared. Of the 794 patients included,
14% showed one-sided tubal occlusion and 24% two-sided tubal occlusion on HSG. It
was the same percents for HSG, but not necessarily the same patients. After a
normal or one-sided occluded HSG, laparoscopy showed two-sided occlusion in 5%.
If either 1 or both tube(s) were occluded at HSG and patent at laparoscopy,
pregnancy rate was decreased. Sensitivity of HSG was 0.81.
Comment: The authors state that this is the first direct comparison of
laparoscopy and HSG. This shows that tubal pathology is associated with
infertility, no matter how it is found. Nothing new. HSG seems to be an excellent
diagnostic tool for tubal disease. Surgical correction of tubal disease, except
in its mildest form, is of marginal benefit. In the CARS patient population,
endometriosis is much more prevalent than tubal occlusion, and I have been amazed
at how much pelvic disease can be found at laparoscopy after a normal HSG.
Laparoscopic treatment for endometriosis seems to be appropriate for both pain
and fertility. I continue to struggle with the value of HSG, given its cost,
pain, and lack of a definitive answer.
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