HYSTEROSALPINOGRAPHY VERSUS DIAGNOSTIC LAPAROSCOPY IN ASSESSMENT OF TUBAL PATENCY

Background: Investigations of tubal factor of infertility include hystero-salpingography, saline infusion sonohysterography as well as diagnostic laparoscopy with chromotubation. Hysterosalpingography (HSG) is a contrast study of the uterine cavity and fallopian tubes. Objective: To compare the role of laparoscopy and hysterosalpingograpy in the assessment of tubal factor of infertility. Patients and Method: This study was carried out on eighty patients attending the gynecology outpatient clinic of Al-HusseinHospital, Al-AzharUniversity. It included forty patients with primary infertility and forty patients with secondary infertility, all with minimum duration of one year after taking a written consent. complete laboratory investigation was done including CBC, PT, PTT, INR, HBV, HCV, HIV, Cr, Urea, ALT, AST. This study started at Oct 2017 and finished at Aug 2019. Results: Results of comparison of tubal patency assessment during Laparoscopy and its compatibility with previous hysterosalpingography results in case of female infertility were: In  55 cases that were diagnosed as free from tubal block by diagnostic laparoscopy {DL}, only 40 cases were confirmed by HSG (73.2%), while the other 11 cases were diagnosed as (2 cases bilateral block (4.9%), 4 cases Lt. block (9.8%), 3 cases minimal spill (7.3%) and 2 cases as Rt. Block (4.9%). In the 9 cases that were diagnosed as bilateral tubal block by DL, only 4 were confirmed by HSG (42.9%), while the other 5 cases were diagnosed free by HSG (57.1%). Twelve cases were diagnosed as unilateral tubal block by DL, 3 cases were confirmed by HSG, while 7 cases were diagnosed as free and one case was diagnosed as bilateral block by HSG. Peritubal adhesions were seen in 18.3% in all cases, of which 18.8% had Rt block, 27.3% had Lt block, and 54.5% had bilateral tubal patency. In 11 cases diagnosed as unilateral peritubal adhesion by DL, only 2 cases (Rt & Lt) were confirmed by HSG (39.3%). Fifty three cases were diagnosed as the Rt tube was free of adhesion by DL, 4 cases HSG were diagnosed as Rt peritubal adhesion (7.5%), while 56 cases were diagnosed as Lt tube free of adhesion by DL and 5 cases HSG were diagnosed as Lt peritubal adhesion (8.9%). Conclusion: Diagnostic laparoscopy has more accuracy in assessment of tubal patency in infertile patients more than hysterosalpingogram.