Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome

B. W J Mol, John A. Collins, Elizabeth A. Burrows, Fulco Van Der Veen, P. M M Bossuyt

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

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 mere 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 κ-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.

LanguageEnglish
Pages1237-1242
Number of pages6
JournalHuman Reproduction
Volume14
Issue number5
DOIs
Publication statusPublished - 1 Jan 1999

Keywords

  • Hysterosalpingography
  • Laparoscopy
  • Prognosis
  • Subfertility
  • Tubal occlusion

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Mol, B. W. J., Collins, J. A., Burrows, E. A., Van Der Veen, F., & Bossuyt, P. M. M. (1999). Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Human Reproduction, 14(5), 1237-1242. https://doi.org/10.1093/humrep/14.5.1237
Mol, B. W J ; Collins, John A. ; Burrows, Elizabeth A. ; Van Der Veen, Fulco ; Bossuyt, P. M M. / Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. In: Human Reproduction. 1999 ; Vol. 14, No. 5. pp. 1237-1242.
@article{0fbbc8e6acdd403996bb3c98becca424,
title = "Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome",
abstract = "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 mere 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 κ-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.",
keywords = "Hysterosalpingography, Laparoscopy, Prognosis, Subfertility, Tubal occlusion",
author = "Mol, {B. W J} and Collins, {John A.} and Burrows, {Elizabeth A.} and {Van Der Veen}, Fulco and Bossuyt, {P. M M}",
year = "1999",
month = "1",
day = "1",
doi = "10.1093/humrep/14.5.1237",
language = "English",
volume = "14",
pages = "1237--1242",
journal = "Human Reproduction",
issn = "0268-1161",
publisher = "Oxford University Press",
number = "5",

}

Mol, BWJ, Collins, JA, Burrows, EA, Van Der Veen, F & Bossuyt, PMM 1999, 'Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome', Human Reproduction, vol. 14, no. 5, pp. 1237-1242. https://doi.org/10.1093/humrep/14.5.1237

Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. / Mol, B. W J; Collins, John A.; Burrows, Elizabeth A.; Van Der Veen, Fulco; Bossuyt, P. M M.

In: Human Reproduction, Vol. 14, No. 5, 01.01.1999, p. 1237-1242.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome

AU - Mol, B. W J

AU - Collins, John A.

AU - Burrows, Elizabeth A.

AU - Van Der Veen, Fulco

AU - Bossuyt, P. M M

PY - 1999/1/1

Y1 - 1999/1/1

N2 - 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 mere 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 κ-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.

AB - 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 mere 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 κ-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.

KW - Hysterosalpingography

KW - Laparoscopy

KW - Prognosis

KW - Subfertility

KW - Tubal occlusion

UR - http://www.scopus.com/inward/record.url?scp=0032930025&partnerID=8YFLogxK

U2 - 10.1093/humrep/14.5.1237

DO - 10.1093/humrep/14.5.1237

M3 - Article

VL - 14

SP - 1237

EP - 1242

JO - Human Reproduction

T2 - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - 5

ER -

Mol BWJ, Collins JA, Burrows EA, Van Der Veen F, Bossuyt PMM. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Human Reproduction. 1999 Jan 1;14(5):1237-1242. https://doi.org/10.1093/humrep/14.5.1237