Mol BWJ. Collins JA. Burrows EA. Van der Veen F. Bossuyt PMM.
Institution:
B.W.J. Mol, Academic Medical Centre, Dept. Clinical Epidemiol. Biostats.,
University of Amsterdam, PO Box 22700, 1100 DE Amsterdam; Netherlands.
Title:
Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome.
Source:
Human Reproduction. Vol 14(5) (pp237-1242), 1999.
Abstract:
In this study, we compare the prognostic significance of hysterosalpingography (HSG) and laparoscopy for fertility outcome. In a prospective cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study (CITES), consecutive couples who registered between 1 April 1984 and 31 March 1987 for the evaluation of subfertility and who underwent HSG and laparoscopy were included. Unilateral and bilateral tubal occlusion at HSG and laparoscopy mere related to treatment-independent pregnancy. Cox regression was used to calculate fecundity rate ratios (FRR). Of the 794 patients who were included, 114 (14%) showed one-sided tubal occlusion and 194 (24%) showed two-sided tubal occlusion on HSG. At laparoscopy, 94 (12%) showed one-sided tubal occlusion and 96 (12%) showed two-sided tubal occlusion. Occlusion detected on HSG and laparoscopy showed a moderate agreement beyond chance (weighted kappa-statistic 0.42). The adjusted FRR of one-sided tubal occlusion at HSG was 0.80, whereas two-sided tubal occlusion showed an FRR of 0.49. For laparoscopy, the FRR were 0.51 and 0.15 respectively. After a normal or one-sided occluded HSG, laparoscopy showed two-sided occlusion in 5% of the patients, and fertility prospects in these patients were virtually zero. If two-sided tubal occlusion was detected on HSG but not during laparoscopy, fertility prospects were slightly impaired. Fertility prospects after a two-sided occluded HSG were strongly impaired in cases where laparoscopy showed one-sided and two-sided occlusion, with FRR of 0.38 and 0.19 respectively. Although laparoscopy performed better than HSG as a predictor of future fertility, it should not be considered as the perfect test in the diagnosis of tubal pathology. For clinical practice, laparoscopy can be delayed after normal HSG for at least 10 months, since the probability that laparoscopy will show tubal occlusion after a normal HSG is very low.
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- 1 What is infertility?
- 2 How prevalent are infertility problems?
- 3 What are the main causes of infertility?
- 4 What are the objectives of our infertility investigations?
- 5 Have there been any noticeable changes in fertility requirements in recent years?
- 6 What is the effect of our age on fertility?
- 7 I smoke cigarettes. Can this have an effect on my fertility?
- 8 Does my weight influence fertility?
- 8A Obesity! How can I lose weight?
- 9 I have fibroids. Could these reduce my fertility?
- 10 I have been told that my womb has an abnormal shape and that was the way that I was born. Could this reduce my fertility?
- 11 I have endometriosis. Could this reduce my fertility?
- 12 I have been told that I have cervicitis or a cervical ectopy (erosion). Could this impair my fertility?
- 13 My doctor tells me that my womb is retroverted (tilts backwards). Could this reduce my fertility?
- 14 I have had an ectopic pregnancy. Does this affect my future fertility?
- 15 We are worried that we may have a fertility problem. What should we do?
- 16 How will our doctor be able to identify the cause of our infertility?
- 17 How can we tell if I am releasing my eggs (ovulating)?
- 18 Investigations have shown that I have a problem releasing my eggs (anovulation). What could be the cause of this?
- 19 How important are my Fallopian tubes in fertility?
- 20 How can we tell if my Fallopian tubes are functioning?
- 21a What are the causes of male factor infertility?
- 21 How can we assess male fertility?
- 22 What is the purpose of a post-coital test (PCT)?
- 23 We have had our infertility investigations and our problem remains unexplained. How can this be?
- 24 What are our chances of achieving a pregnancy?
- 25 Where can I obtain more information?
- 26 Could we have some recommended infertility support groups?
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