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Hum. Reprod. Advance Access originally published online on January 18, 2007
Human Reproduction 2007 22(4):1091-1094; doi:10.1093/humrep/del501
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prognostic capacity of transvaginal hydrolaparoscopy to predict spontaneous pregnancy

E.A.A. van Tetering1, M.Y. Bongers1, M.A.H.M. Wiegerinck1, B.W.J. Mol1,2 and C.A.M. Koks1,3

1 Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands 2 Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands

3 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Máxima Medical Center, P.O. Box 7777, 5500MB Veldhoven, The Netherlands. Tel.: +31 40 8888385; Fax: +31 40 8888387; E-mail: ovantetering{at}gmail.com

BACKGROUND: In 1998, transvaginal hydrolaparoscopy (THL) was introduced as a new outpatient procedure for exploration of tubo-ovarian structures and tubal patency in subfertile patients. At present, there are no large studies that relate the findings at THL to fertility outcome.

METHODS: Consecutive patients undergoing THL for subfertility between 2000 and 2004 were included in this prospective cohort study. Follow-up ended when ongoing pregnancy or tubal surgery occurred or at the day of last contact. Kaplan–Meier curves for the occurrence of intrauterine pregnancy (IUP) (spontaneous or after intrauterine insemination) were constructed for a normal THL, a THL with a one-sided tubal pathology and a THL with a two-sided tubal pathology. Fecundity rate ratios (FRRs) were calculated to express the association between THL findings and the occurrence of IUP. Patients rated their pain experiences and acceptability on a visual analogue scale (VAS).

RESULTS: We included 272 women. In 96% (261) of the patients, access to the pouch of Douglas was achieved. Complications occurred in 2% of the procedures. In 203 (78%) patients, both tubo-ovarian structures could be visualized and tubal patency was shown. One-sided tubal occlusion was found in 10%, whereas two-sided tubal occlusion was seen in 4% of the patients. Adhesions and/or endometriosis were observed in 8% of the patients. The FRRs for one-sided tubal pathology, two-sided tubal pathology and adhesions/endometriosis were 0.59, 0 and 0.80, respectively. The VAS scores showed pain to be limited and the procedure to be acceptable.

CONCLUSION: THL is a feasible technique. Its capacity to predict spontaneous ongoing pregnancy is comparable to that of laparoscopy.

Key words: laparoscopy/pregnancy/subfertility/transvaginal hydrolaparoscopy/tubal pathology

Submitted on July 15, 2006; resubmitted on September 21, 2006; accepted on September 27, 2006.


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