Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women.

OBJECTIVES To compare tuboperitoneal factors of infertile women by hysterosalpingography (HSG) and laparoscopy. METHODS In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey, between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. RESULTS Out of the 82 infertile women, pathological findings were observed in 45.1% by HSG, and 54.9% had no pathological finding. On laparoscopic evaluation, however, pathological findings were observed in 65.85%, and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45(44.4%) patients who had no pathological findings by HSG, and no pathological findings were detected by laparoscopy in 3 of the 37 (8.1%) patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of the 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3%, and the positive predictive value was 92%, with a 55% predictive value, and the accuracy ratio was 72%. CONCLUSIONS Laparoscopy is a superior method for the research of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies, and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis, and other pathologies. Therefore, these 2 methods are not alternative, but complementary.