Laparoscopy as first line investigation in diagnosing Tubo-peritoneal factors in Infertility

Abstract

Introduction Hysterosalpingography has been used as first line investigation in assessing the Tubo-peritoneal causes of infertility. But it has lot of limitations. So the present study was conducted to prove the significance of laparoscopy as first line investigation for detecting tuboperitoneal abnormalities in infertile patients. Methods: A prospective study was conducted on 100 patients who presented with complaint of infertility in Department of Obstetrics & Gynaecology, Acharya Shree Chander College of Medical Sciences and Hospital, Sidhra Jammu from July 2013 to July 2014. HSG findings were compared with laparoscopic findings. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HSG were calculated. Results The mean age of the patients was 33 years. Sixty five (65%) cases were having primary infertility 35 (35%) had secondary infertility. Fifty nine patients (43%) had infertility of 5–10 years duration. The mean duration of infertility was found to be 6.46 ± 3.24 years. Out of 100 patients, 67 (67%) showed tubal pathology on HSG and 33% showed normal findings. Out of 67 patients with tubal pathology, only 48(62.85%) had tubal pathology while 19 (28.35%) patients had no pathology on laparoscopy. So findings on hysterosalpingogram can be misleading. Out of 33 patients with normal HSG, 8 (21.2%) showed tubal disease and 11(36.36%) showed peritubal adhesions while 14 (42.42%) were normal on laparoscopy. So patients with normal HSG also show tubal disease and peritubal adhesions on laparoscopy. Senstvity of HSG was calculated as 71.64%(59.31 to 81.99%), Specificity of 42.42% (25.48% to 60.78%), Positive predictive value of 74.64%(64.51% to 77.84%), Negative predictive value of 42.42% (29.82% to 56.09%), negative predictive value of 42.42%(29.82% to 56.09%) and accuracy of 62.00%(51.75% to 71.52%). Conclusion Laparoscopy can be used as first line approach in detecting tubo- peritoneal factors in infertile patients. It is more effective than HSG in detecting tubal and peritoneal pathologies and in treating the pathology at the same sitting.