Jara DJF, Reyes ME

Language: Spanish
References: 21
Page: 106-111
PDF size: 79.62 Kb.

ABSTRACT

Background: Tubal-peritoneal affections are implied in 30% to 35% of infertility-cases. The diagnostic value of hysterosalpingography is a topic of controversy.
Objective: To know the effectiveness of hysterosalpingography for the diagnosis of tubal patency in patients with infertility treated at National Perinatology Institute of Mexico.
Patients and method: In a cross-sectional study 142 patients who went to the infertility clinic and fulfilled the inclusion criteria were included. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value and positive [LR(+)] and negative [LR(-)] likelihood ratio of hysterosalpingography to assess bilateral tubal patency, and to diagnose bilateral tubal occlusion and pelvic adhesions were assessed. Chromotubation by laparoscopy was considered gold standard.
Results: To determine bilateral tubal patency hysterosalpingography had: sensitivity: 77.4% (CI 95% 65.7-86.2), specificity: 80.2 (CI 95% 68.8-88.4), PPV: 79.7% (CI 95% 67.9- 88.1), NPV: 78.1% (CI 95% 66.5-86.59), LR(+): 3.9 (CI 95% 2.4-6.4), LR(-): 0.28 (CI 95% 0.18-0.44). For the diagnosis of bilateral tubal occlusion: sensitivity: 65.9% (CI 95% 50-79.07), specificity: 93.88 (CI 95% 86.6-97.5), PPV: 86.8% (CI 95% 65.7-92.8), NPV: 85.9% (Cl 95% 77.6-91.6), LR(+): 10.7 (IC 95% 4.8-24), LR(-): 0.36 (CI 95% 0.24-0.55) and for the diagnosis of pelvic adhesions: sensitivity: 86.6% (CI 95% 74.8-93.6), specificity: 28.05 (CI 95%18.9-39.2), PPV: 46.8% (CI 95% 37.4-56.5), NPV: 74.1% (CI 95% 55-87.4), LR(+): 1.2 (Cl 95% 1.02-1.42), LR(-): 0.48 (CI 95% 0.23-0.99).
Conclusions: Hysterosalpingography is a diagnostic tool with great effectiveness in the evaluation of tubal patency, although, it has a poor predicting value for pelvic adhesions.

REFERENCES

1. Practice Committee ASMR. Definition of infertility and recurrent pregnancy loss. Fertil SteriI 2008;89:1603.

2. Mosher WD, Pratt WF. Fecundity and infertility in the United States; incidence and trends. Fertil Steril 1991;56:192-193.

3. Speroff L, Fritz M. Esterilidad femenina. En: Speroff L, Fritz M, editores. Endocrinología ginecológica clínica y esterilidad. 7a ed. España: Lippincott Williams, 2006;p:1049- 1067.

4. The Practice Committee of the American Society for Reproductive Medicine. Optimal evaluation of the infertile women. Fertil Steril 2006;86:S264-S267.

5. Papaioannou S, Afnan M, Jafettas J. Tubal assessment test: still have not found what we are looking for. Reprod Biomed Online 2007;15:376-382.

6. The ESHRE Capri workshop group. Optimal use of infertility diagnostic test and treatments. Hum Reprod 2000;15:723-732.

7. Lavy Y, Lev-Sagle A, Holtzer H, Revel A, et al. Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology? Eur J Obstet Gynecol Reprod Biol 2004;114:64-68.

8. NICE: National Collaborating Centre for Women’s Health. Fertility: Assessment and treatment fro people with fertility problems. Clinical guideline. London: RCOG Press, 2004.

9. Hartog JE, Lardenoije CM, Severens JL. Screening strategies for tubal factor subfertility. Hum Reprod 2008;23:1840-1848.

10. Tanahatoe SJ, Hompes PG, Lambalk CR. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Hum Reprod 2003;18:8-11.

11. Evers JL, Land JA, Mol BW. Evidence-based medicine for diagnostic questions. Semin Reprod Med 2003;21:9-15.

12. Swart P, Mol S, Van der Veen F, Beurden MV, et al. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis, Fertil Steril 1995;64:486-491.

13. Papaioannou S, Bourdrez P, Varma R, Afnan M, et al. Tubal evaluation in the investigation of subfertility: a structured comparison test. Br J Obstet Gynecol 2004;111:1313-1321.

14. Okunlola MA, Adebayo OJ, Odukogbe AA. Assessment of tubal factor contribution to female infertility in low resource setting (southwest Nigeria): hysterosalpingography vs laparoscopy, J Obstet Gynecol 2005;25:803-804.

15. Bosteels J, Van Herendael B, Weyers SD, D’Hooghe T. The position of diagnostic laparoscopy in current fertility practice. Hum Reprod 2007;13:477-485.

16. Perquin DA, Dörr PJ, De Craen AJ, Helmerhorst FM. Routine use of hysterosalpingography prior to laparoscopy in the fertility workup: a multicentre randomized controlled trial. Hum Reprod 2006;21:1227-1231.

17. Mol BW, Collins JA, Burrows EA, Van der Veen F, et al. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 1999;14:1237-1242.

18. Tanahatoe S, Lambalk C, McDonnell J, Dekker J, et al. Diagnostic laparoscopy is needed after abnormal hysterosalpingography to prevent over-treatment with IVF. Reprod Biomed Online 2008;16:410-415.

19. Tanahatoe S, Hompes PG, Lambalk CB. Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril 2003;79:361-366.

20. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2006;20:2698-2704.

21. Werbrouck E, Spiessens C, Meuleman C, D’Hooghe T. No difference in cycle pregnancy rate and in cumulative live birth rate between women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril 2006;86:566-571.