Human Reproduction, Vol. 14, No. 5, 1237-1242,
May 1999
© 1999 European Society of Human Reproduction and Embryology
Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome
1 Departments of Clinical Epidemiology and Biostatistics and 2 Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands, Departments of 3 Obstetrics and Gynaecology and 4 Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Room 3N52, Hamilton, Ontario, Canada L8N 3Z5
In this study, we compare the prognostic significance of hysterosalpingography (HSG) and laparoscopy for fertility outcome. In a prospective cohort study in 11 clinics participating in the Canadian Infertility Treatment Evaluation Study (CITES), consecutive couples who registered between 1 April 1984 and 31 March 1987 for the evaluation of subfertility and who underwent HSG and laparoscopy were included. Unilateral and bilateral tubal occlusion at HSG and laparoscopy were related to treatment-independent pregnancy. Cox regression was used to calculate fecundity rate ratios (FRR). Of the 794 patients who were included, 114 (14%) showed one-sided tubal occlusion and 194 (24%) showed two-sided tubal occlusion on HSG. At laparoscopy, 94 (12%) showed one-sided tubal occlusion and 96 (12%) showed two-sided tubal occlusion. Occlusion detected on HSG and laparoscopy showed a moderate agreement beyond chance (weighted 
-statistic 0.42). The adjusted FRR of one-sided tubal occlusion at HSG was 0.80, whereas two-sided tubal occlusion showed an FRR of 0.49. For laparoscopy, the FRR were 0.51 and 0.15 respectively. After a normal or one-sided occluded HSG, laparoscopy showed two-sided occlusion in 5% of the patients, and fertility prospects in these patients were virtually zero. If two-sided tubal occlusion was detected on HSG but not during laparoscopy, fertility prospects were slightly impaired. Fertility prospects after a two-sided occluded HSG were strongly impaired in cases where laparoscopy showed one-sided and two-sided occlusion, with FRR of 0.38 and 0.19 respectively. Although laparoscopy performed better than HSG as a predictor of future fertility, it should not be considered as the perfect test in the diagnosis of tubal pathology. For clinical practice, laparoscopy can be delayed after normal HSG for at least 10 months, since the probability that laparoscopy will show tubal occlusion after a normal HSG is very low.
Key words: hysterosalpingography/laparoscopy/prognosis/subfertility/tubal occlusion
5 To whom correspondence should be addressed at: Academic Medical Centre, Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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