Document Detail

The capacity of hysterosalpingography and laparoscopy to predict natural conception.
MedLine Citation:
PMID:  21088018     Owner:  NLM     Status:  In-Process    
BACKGROUND: Laparoscopy has been claimed to be superior to hysterosalpingography (HSG) in predicting fertility. Whether this conclusion is applicable to a general subfertile population can be questioned as data in support of this claim were collected in third line centres. The aim of this study was to assess the prognostic capacity of HSG and laparoscopy in a general subfertile population.
METHODS: In 38 centres, we prospectively studied a cohort of patients referred for subfertility between 2002 and 2004, who underwent HSG and/or laparoscopy as part of their subfertility work-up. Follow-up started immediately after tubal testing and ended 12 months thereafter. Time to pregnancy was censored at the of date last contact, when the woman was not pregnant or at the start of treatment. Kaplan-Meier curves for the occurrence of spontaneous intrauterine pregnancy were constructed for patients without tubal pathology, for those with unilateral tubal pathology and for patients with bilateral tubal pathology at HSG or laparoscopy. Multivariable Cox regression analysis was used to calculate fecundity rate ratios (FRRs) to express associations between tubal pathology and the occurrence of an intrauterine pregnancy.
RESULTS: Of the 3301 included patients, 2043 underwent HSG only, 747 underwent diagnostic laparoscopy only and 511 underwent both. At HSG, 322 (13%) patients showed unilateral tubal pathology and 135 (5%) showed bilateral tubal pathology. At laparoscopy, 167 (13%) showed unilateral tubal pathology and 215 (17%) showed bilateral tubal pathology. Multivariable analysis resulted in FRRs of 0.81 [95% confidence interval (CI): 0.59-1.1] for unilateral, and 0.28 (95% CI: 0.13-0.59) for bilateral, tubal pathology at HSG. The FRRs at laparoscopy were 0.85 (95% CI: 0.47-1.52) for unilateral, and 0.24 (95% CI: 0.11-0.54) for bilateral, tubal pathology.
CONCLUSIONS: Patients with unilateral tubal pathology at HSG and laparoscopy had a moderate reduction in pregnancy chances, whereas those with bilateral tubal pathology at HSG and laparoscopy had a severe reduction in pregnancy chances. This reduction was similar for HSG and laparoscopy, suggesting that HSG and laparoscopy have a comparable predictive capacity for natural conception.
H R Verhoeve; S F P J Coppus; J W van der Steeg; P Steures; P G A Hompes; P Bourdrez; P M M Bossuyt; F van der Veen; B W J Mol;
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Publication Detail:
Type:  Journal Article     Date:  2010-11-18
Journal Detail:
Title:  Human reproduction (Oxford, England)     Volume:  26     ISSN:  1460-2350     ISO Abbreviation:  Hum. Reprod.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701199     Medline TA:  Hum Reprod     Country:  England    
Other Details:
Languages:  eng     Pagination:  134-42     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
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MeSH Terms
Y M van Kasteren / ; P F M van der Heijden / ; W A Schöls / ; M H Mochtar / ; G L M Lips / ; J Dawson / ; H R Verhoeve / ; S Milosavljevic / ; P G A Hompes / ; L J van Dam / ; A V Sluijmer / ; H E Bobeck / ; R E Bernardus / ; M C S Vermeer / ; J P Dörr / ; P J Q van der Linden / ; H J M Roelofs / ; J M Burggraaff / ; G J E Oosterhuis / ; M H Schouwink / ; M H Emanuel / ; P X J M Bouckaert / ; F M C Delemarre / ; C J C M Hamilton / ; M van Hoven / ; C M Renckens / ; J A Land / ; J H Schagen-van Leeuwen / ; J A M Kremer / ; C van Katwijk / ; M H A van Hooff / ; H J H M van Dessel / ; F J M Broekmans / ; H J L A Ruis / ; C A M Koks / ; P Bourdrez / ; W W J Riedijk / ; B J Cohlen /

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