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Vitale SG, Angioni S, Parry JP, Di Spiezio Sardo A, Haimovich S, Carugno J, Alonso Pacheco L, Perez-Medina T, Moawad N, De Franciscis P, Riemma G. Efficacy of Hysteroscopy in Improving Fertility Outcomes in Women Undergoing Assisted Reproductive Technique: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gynecol Obstet Invest 2023; 88:336-348. [PMID: 37899034 PMCID: PMC10794974 DOI: 10.1159/000534794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Usefulness of hysteroscopy before assisted reproductive technique (ART) was considered debatable. However, over the last decade, several new trials have been added to available literature. We aimed to assess the impact of diagnostic and operative hysteroscopy on reproductive outcomes of infertile women with and without intrauterine abnormalities. MATERIALS AND METHODS MEDLINE, Scopus, SciELO, Embase, Cochrane Library at CENTRAL, PROSPERO, CINAHL, grey literature, conference proceedings, and international controlled trials registries were searched without temporal, geographical, or language restrictions. Randomized controlled trials (RCTs) of infertile women comparing hysteroscopy versus no hysteroscopy prior to the first ART or after at least one failed attempt were included. RCTs of infertile women with intrauterine pathology comparing diagnostic versus operative hysteroscopy were included in separate analysis. Random-effect meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Grading of Recommendations, Assessment, Development and Evaluation and Cochrane criteria were used for quality of evidence and risk of bias assessment. Primary outcome was live birth rate (LBR). Secondary outcomes were clinical pregnancy (CPR) and pregnancy loss rate. RESULTS Fifteen studies (5,038 women) were included. Compared to no hysteroscopy before first or after failed ART attempts, moderate-quality evidence showed that hysteroscopy increased the LBR (relative risk [RR] 1.24, 95% confidence interval [CI] 1.09-1.43, I2 = 21%), confirmed by subgroup analysis for women with failure after one or more ART cycles (RR 1.43, 95% CI: 1.19-1.72, I2 = 0%) but not before the first ART. Moderate-quality evidence showed that it increased the CPR (RR 1.36, 95% CI: 1.18-1.57; I2 = 51%), confirmed in subgroup analysis for both implantation failure (RR 1.40, 95% CI: 1.12-1.74, I2 = 52%) and before first ART (RR 1.32, 95% CI: 1.11-1.57, I2 = 42%). Low-quality data suggest that operative hysteroscopy increases CPR when used to treat intrauterine pathologies (RR 2.13, 95% CI: 1.56-2.92, I2 = 0%). CONCLUSIONS Although moderate-quality evidence supports performing hysteroscopy before ART in women with history of implantation failure, hysteroscopic evaluation of uterine cavity should be considered a first-line technique in all infertile women undergoing ART. Additional high-quality RCTs are still needed, particularly to assess yield during couple's initial evaluation even before ART is considered.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, MS, USA
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Laniado University Hospital, Netanya, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Jose Carugno
- Obstetrics, Gynecology, and Reproductive Science Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Luis Alonso Pacheco
- Unidad De Endoscopia Ginecológica, Centro Gutenberg, Hospital Xanit Internacional, Málaga, Spain
| | - Tirso Perez-Medina
- Department of Obstetrics and Gynecology, University Hospital Puerta De Hierro Majadahonda, Autonoma University of Madrid, Madrid, Spain
| | - Nash Moawad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Shen H, Lu Y, Su R, Wang K, Wang W, An J. Fertility Improvement of Hysteroscopy with Chromopertubation in the Management of Infertile Women with Hysterosalpingography Evidence of Abnormal Tubal Patency: A Prospective Comparative Study. Int J Womens Health 2022; 14:1613-1619. [DOI: 10.2147/ijwh.s386746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
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Igbodike EP, Badejoko OO, Fasubaa OB, Ibitoye BO, Loto OM, Ikechebelu JI, Eleje GU, Onwuegbuna AA, Okpala BC, Umeononihu OS, Ogelle OM. Correlation between hysterosalpingography diagnosis and final hysterolaparoscopy with dye-test diagnosis in women with utero-tubal infertility: A cross-sectional study of the implication for which test should be the first-line investigation. SAGE Open Med 2022; 10:20503121221104434. [PMID: 35722440 PMCID: PMC9201303 DOI: 10.1177/20503121221104434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the accuracy of hysterosalpingography in diagnosis of uterine
and/or tubal factor infertility, using hysterolaparoscopy with dye test as
the gold standard with an implication for which test should be the
first-line investigation. Methods: A prospective cross-sectional study of 96 women who underwent
hysterosalpingography and hysterolaparoscopy with dye test. All women within
reproductive age group with utero-tubal infertility who underwent both
hysterosalpingography and hysterolaparoscopy with dye-test procedure were
included. The outcome measures were proportions of tubal blockage and
intrauterine pathology. Individual and overall mean accuracy were calculated
for hysterosalpingography, using hysterolaparoscopy with dye test as the
gold standard. Patient had procedure of hysterosalpingography first and both
laparoscopic surgeons and patients were blinded to the outcome of
hysterolaparoscopy with dye test until analysis. Statistical significance
was set at p < 0.05. Results: Overall, 128 women were assessed for eligibility while 96 women finally
completed the study. Hysterosalpingography demonstrated diagnostic accuracy
of 77.8% (p < 0.001), 76.3% (p < 0.001) and 78.3% (p < 0.001) for
right, left and bilateral tubal blockage, respectively. Overall accuracy of
hysterosalpingography tubal factor assessment was 77.4 ± 0.8% (95%
confidence interval = 76.5% to 78.4%). Hysterosalpingography showed an
accuracy of 85.7%, 86.6% and 76.7% for right, left and bilateral
hydrosalpinx, respectively, given overall diagnostic accuracy of 83.0 ± 5.1%
(95% confidence interval = 77.9% to 88.1%). Overall accuracy of
hysterosalpingography in diagnosing intrauterine pathology was 68.5 ± 9.8%
(95% confidence interval = 53.9% to 83.1%). Conclusion: Hysterosalpingography detects tubal blockade and intrauterine pathology
poorly compared to hysterolaparoscopy with dye test. Hysterosalpingography
may face unpredictable clinical situations biased by technological error,
leading to unsuccessful evaluation and uncertain diagnosis. Although the
cost-effectiveness, risk of surgery or anaesthesia flaws hysterolaparoscopy
with dye test. Hysterosalpingography should not be the first-line
utero-tubal assessment tool rather hysterolaparoscopy with dye test.
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Affiliation(s)
- Emeka Philip Igbodike
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun Olalekan Badejoko
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Benjamin Fasubaa
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Bolanle Olubunmi Ibitoye
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olabisi Morebise Loto
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria.,Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | - Boniface Chukwuneme Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Onyecherelam Monday Ogelle
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria.,Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Donan PC, Pace KA, Ruiz CW, Gracia MM. Distending Media Used During Hysteroscopy: Perioperative Nursing Implications. AORN J 2021; 112:634-648. [PMID: 33252805 DOI: 10.1002/aorn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hysteroscopy is a gynecological procedure that may be indicated for abnormal uterine bleeding, diagnosis and management of infertility, contraception, or sterilization. Surgeons use distending media during hysteroscopy to view the uterine cavity. Media options include carbon dioxide gas and both electrolytic and nonelectrolytic fluids. All distending media is absorbed by the patient's body, but the manner in which each media is absorbed is unique to its chemical composition. Understanding the properties of each distending medium and the risks involved with its use is critical to safe perioperative nursing care for patients undergoing hysteroscopy. This article provides perioperative nurses with a review of uterine anatomy and evidence-based information on the types of distending media used during hysteroscopy and the corresponding perioperative nursing implications.
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Vitale SG, Laganà AS, Török P, Lasmar RB, Carugno J, Palumbo M, Tesarik J. Virtual sonographic hysteroscopy in assisted reproduction: A retrospective cost-effectiveness analysis. Int J Gynaecol Obstet 2021; 156:112-118. [PMID: 33615469 DOI: 10.1002/ijgo.13651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To analyze the cost-effectiveness of virtual sonographic hysteroscopy (VSH) performed before in vitro fertilization (IVF) (Scenario 1), frozen embryo transfer (Scenario 2), and oocyte donation (Scenario 3) attempts. METHODS A retrospective analysis of data extracted from patients' files was conducted. Before undergoing the assigned treatment, VSH was offered to all patients. Cost-effectiveness was calculated on the basis of cost per live birth. The total cost was compared with a control group of patients who declined to have hysteroscopy before their treatment. RESULTS A total of 292 women were involved. Virtual sonographic hysteroscopy was performed in 192 women. Conventional operative hysteroscopy was subsequently required in 34 of them (17.7%). Subsequent assisted reproduction attempts resulted in live birth in 111 women-34/69 (49.3%), 35/69 (50.7%), and 42/54 (77.8%) in Scenarios 1, 2, and 3, respectively. This compared favorably with 100 women who declined VSH, with live birth achieved in 15/39 (38.5%), 14/37 (37.8%), and 15/24 (62.5%) in Scenarios 1, 2, and 3, respectively. The overall cost-effectiveness of VSH compared favorably with straightforward treatment performed without this test. CONCLUSION The overall cost-effectiveness of treatment attempts carried out after previous VSH compared favorably with straightforward treatment performed without this test.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Unit, University of Miami Miller School of Medicine, Miami, USA
| | - Marco Palumbo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Panda SR, Kalpana B. The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients. Cureus 2021; 13:e12526. [PMID: 33569257 PMCID: PMC7863999 DOI: 10.7759/cureus.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background and objective Hysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility. Methodology This study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study. Results A total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302). Conclusion Compared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.
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Affiliation(s)
- Soumya R Panda
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Mangalagiri, IND
| | - B Kalpana
- Obstetrics and Gynaecology, Guru Hospital, Madurai, IND
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Waheed KB, Albassam MA, AlShamrani AAG, Aloumi SA, Amin MS, Rashid L, AlGodayan SM, Ahmad SFB. Hysterosalpingographic findings in primary and secondary infertility patients. Saudi Med J 2019; 40:1067-1071. [PMID: 31588489 PMCID: PMC6887874 DOI: 10.15537/smj.2019.10.24538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To highlight and compare spectrum of hysterosalpingography (HSG) findings in primary and secondary infertility patients. Methods: This retrospective record-based cross-sectional study was performed in the Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia between August 2016 and 2018. All patients (N=303) who underwent successful HSGs were included, and grouped under primary and secondary infertility cases. Patients with failed, limited or incomplete studies were excluded. Imaging findings were documented as N (Normal) or Ab (Abnormal). Abnormal HSG findings were further categorized as: C=congenital malformation, I=infection or inflammation, S=surgery, T=tumor or tear. Abnormal findings were confirmed on further imaging or intervention. Chi-square test was used to determine any association of HSG findings with type of infertility, and p-value less than 0.05 was considered significant. Results: Of the 303 patients, 166 patients (54.8%) had primary infertility while the rest had secondary infertility. Abnormal studies were found in less than one-third of patients (n=93, 30.7%). Primary infertility patients exhibited more congenital (C) malformations, while surgery (S) was seen more in secondary infertility patients (p=0.01). Conclusion: Congenital malformations are commonly found abnormalities on HSGs in primary infertility patients, while surgery related findings are seen in secondary infertility cases.
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Affiliation(s)
- Khawaja B Waheed
- Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia. E-mail.
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Zhao CY, Ye F. Live birth after hysteroscopy performed inadvertently during early pregnancy: A case report and review of literature. World J Clin Cases 2018; 6:559-563. [PMID: 30397614 PMCID: PMC6212613 DOI: 10.12998/wjcc.v6.i12.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 02/05/2023] Open
Abstract
Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who continued pregnancy after a diagnostic hysteroscopy was performed in early pregnancy and delivered a healthy baby. The patient had a history of infertility and oligomenorrhea, probably due to a previous induced abortion. A hysteroscopy was performed after the end of her “menstruation” for assessment of her uterine cavity. Early pregnancy, instead of the expected intrauterine adhesions, was suspected, and the procedure was immediately ceased. Subsequent tests confirmed the diagnosis of pregnancy. She had a full-term delivery by elective caesarean section. The success of this case was attributed to the use of vaginoscopic techniques in hysteroscopy and correct judgment and decision-making during the procedure. This case report provides some useful methods and experience that might be helpful when a similar situation occurs in clinical practice.
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Affiliation(s)
- Chong-Yi Zhao
- Department of Gynecology, First People’s Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
| | - Feng Ye
- Department of Neurosurgery, People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
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Agrawal N, Fayyaz S. Can hysterolaparoscopic mediated chromopertubation obviate the need for hysterosalpingography for proximal tubal blockage?: An experience at a single tertiary care center. J Gynecol Obstet Hum Reprod 2018; 48:241-245. [PMID: 29689309 DOI: 10.1016/j.jogoh.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients. METHODS We prospectively evaluated 103 female patients (age range 19-35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT. RESULTS Out of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa - 0.447; 95% CI -0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal. CONCLUSION We concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.
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Affiliation(s)
- Namita Agrawal
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India.
| | - S Fayyaz
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India
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