Comparison of hysterosalpingography and laparoscopy in infertile Iranian women with tubal factor

Abstract

Introduction: Semen analysis is an important part of male infertility diagnosis and should be performed according to international recommendations. The reliability of the results depends mainly on the qualifications of the laboratory analysts. External Quality Assessment Programmes (EQAP) are performed in laboratories worldwide in order tostandardize the results. The aim of this study was to perform the first in Poland comparison of the results of sperm analysis from different laboratories. Materials and methods: Forty two Polish laboratories were invited to participate in the EQAP and eight laboratories agreed to take part in the analysis. They were sent uniform semen samples, prepared in accordance with the WHOstandards: one sample for the assessment of concentration, two for motility (on DVD) and two for the morphology of the sperm (Papanicolau staining). The reference group was comprised of three employees of the Andrologic Laboratory of Poznań University of Medical Sciences, who regularly take part in EQAP organized by ESHRE. Objective: Mechanical factors are responsible for approximately 30% of female infertility and various methods such as transvaginal ultrasonography, hysterosalpingography (HSG), hysteroscopy and laparoscopy have been used to investigate these factors. The aim of this study was to evaluate if HSG alone can be accurately used, compared with laparoscopy, in order to reduce health care costs in high medical standard setting in infertile women with tubal factor. Methods: Retrospectively, medical records of women admitted to a local Iranian hospital were selected. Records of those who underwent both HSG and laparoscopy were studied. Afterwards, the findings were compared in regard to tubal obstruction. Results: A total number of 181 records was included into the study. By both methods, 99 women were evaluated to have normal findings, and 37 women - abnormal findings, i.e. 136 of 181 (75%) HSG reports were accurate in reference to laparoscopy. However, there were 3 patients with abnormal fallopian tubes that were not detected by HSG and, moreover, 42 patients with normal tubes which were reported as abnormal by HSG. The calculated sensitivity and specificity of HSG in our study were 0.92 and 0.70, respectively. Conclusion: Although laparoscopy is considered as the reference standard in infertility workup, HSG can be performed first and, therefore, the use of laparoscopy should be limited to cases suspected for etiologies other than intratubal, such as endometriosis and peritubal adhesions.