Is Laparoscopy Still Necessary in the Management of Tubal Infertility?

Objectives: To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. Methods: This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. Results: Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. Conclusion: HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.