EVALUATING DIAGNOSTIC ACCURACY OF HYSTEROSALPINGOGRAPHY VERSUS LAPAROSCOPY FOR TUBAL INFERTILITY IN BANGLADESH
Main Article Content
Keywords
Hysterosalpingography, Laparoscopy, Tubal Infertility, Diagnostic Accuracy, Infertility, Bangladesh
Abstract
Background: Tubal pathology is a major contributor to female infertility, particularly in developing countries. Hysterosalpingography (HSG) is widely used as a first-line diagnostic tool because of its availability and low cost; however, its accuracy remains debatable. Laparoscopy is the gold standard for evaluating tubal and pelvic pathologies. This study aimed to evaluate the diagnostic accuracy of HSG compared to laparoscopy in assessing tubal infertility among women in Bangladesh.
Methods: A cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology (Infertility), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January to December 2009. A total of 150 infertile women underwent HSG and laparoscopy. Data on tubal patency and pelvic findings were compared using laparoscopy as a reference standard. The sensitivity, specificity, predictive values, and diagnostic accuracy of HSG were calculated. SPSS version 25.0 was used for data analysis, with a significance threshold of p ≤ 0.05.
Results: HSG detected tubal blockage in 90 women, whereas laparoscopy confirmed blockage in only 50 cases. The sensitivity, specificity, positive predictive value, and negative predictive value of HSG were 76.0%, 48.0%, 42.2%, and 80.0%, respectively, with an overall diagnostic accuracy of 57.3%. Laparoscopy identified additional pelvic abnormalities in 31 patients, including adhesions (18.7%), endometriosis (5.3%), and genital tuberculosis (4.7%).
Conclusion: HSG demonstrated moderate sensitivity but poor specificity for detecting tubal blockage. Laparoscopy remains essential for a comprehensive evaluation, especially in cases with abnormal HSG or suspected pelvic pathology.
Methods: A cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology (Infertility), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January to December 2009. A total of 150 infertile women underwent HSG and laparoscopy. Data on tubal patency and pelvic findings were compared using laparoscopy as a reference standard. The sensitivity, specificity, predictive values, and diagnostic accuracy of HSG were calculated. SPSS version 25.0 was used for data analysis, with a significance threshold of p ≤ 0.05.
Results: HSG detected tubal blockage in 90 women, whereas laparoscopy confirmed blockage in only 50 cases. The sensitivity, specificity, positive predictive value, and negative predictive value of HSG were 76.0%, 48.0%, 42.2%, and 80.0%, respectively, with an overall diagnostic accuracy of 57.3%. Laparoscopy identified additional pelvic abnormalities in 31 patients, including adhesions (18.7%), endometriosis (5.3%), and genital tuberculosis (4.7%).
Conclusion: HSG demonstrated moderate sensitivity but poor specificity for detecting tubal blockage. Laparoscopy remains essential for a comprehensive evaluation, especially in cases with abnormal HSG or suspected pelvic pathology.
References
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13. Philipsen T, Hansen BB. Comparative study of hysterosalpingography and laparoscopy in infertile patients. Acta Obstetricia et Gynecologica Scandinavica. 1981;60(2):149-51.
14. Ikechebelu JI, Eke NO, Eleje GU, Umeobika JC. comparism of the diagnostic accuracy of Laparoscopy with dye test and Hysterosalpingography in the evaluation of Infertile women in Nnewi, Nigeria. Tropical Journal of Laparo Endoscopy. 2010;1(1):39-44.
15. Ngowa JD, Kasia JM, Georges NT, Nkongo V, Sone C, Fongang E. Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaoundé General Hospital, Cameroon. Pan African Medical Journal. 2015;22(1).
16. Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertility and sterility. 1995 Sep 1;64(3):486-91.
17. Goynumer G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World Journal of Laparoscopic Surgery. 2010 Aug 1;1(2):23-6.
18. Tvarijonavičienė E, Nadišauskienė RJ. The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. Medicina. 2008 Jun;44(6):439.
19. Ibinaiye PO, Lawan RO, Avidime S. Comparative evaluation of pattern of abnormalities in hysterosalpingography, diagnostic laparoscopy and hysteroscopy among women with infertility in Zaria, Nigeria. International Journal of Medicine and Medical Sciences. 2015 Feb 28;7(2):26-35.
20. Capobianco G, Crivelli P, Piredda N, Maiore M, Cherchi PL, Dessole M, Virdis G, Dessole S, Meloni GB. Hysterosalpingography in infertility investigation protocol: is it still useful. Clin Exp Obstet Gynecol. 2015 Aug 10;42(4):448-51.
21. National Institute for Health and Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence; 2004.
22. Tanahatoe SJ, Hompes PG, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Human Reproduction. 2003 Jan 1;18(1):8-11.
2. Rutstein SO, Shah IH. Infecundity, infertility, and childlessness in developing conuntries. InInfecundity, infertility, and childlessness in developing conuntries 2004 (pp. 56-56).
3. Haque S. Role of hysterosalpingography for evaluation of infertility. Bangladesh Medical Journal. 2010;39(1):16-23.
4. Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. American family physician. 2015 Mar 1;91(5):308-14.
5. Nahar S, Jahan D, Akter N, Das B. Laparoscopic evaluation of tubo-peritoneal causes of infertility. Bangladesh Medical Journal Khulna. 2013;46(1-2):16-20.
6. Piccotti K, Guida D, Carbonetti F, Stefanetti L, Macioce A, Cremona A, David V. Comparison of diagnostic quality in hysterosalpingography between iodinated non-ionic contrast media with low and high osmolarity. La Clinica Terapeutica. 2015 Jan 1;166(2): e91-7.
7. Chalazonitis A, Tzovara I, Laspas F, Porfyridis P, Ptohis N, Tsimitselis G. Hysterosalpingography: technique and applications. Current problems in diagnostic radiology. 2009 Sep 1;38(5):199-205.
8. Broeze KA, Opmeer BC, Van Geloven N, Coppus SF, Collins JA, Den Hartog JE, Van der Linden PJ, Marianowski P, Ng EH, Van der Steeg JW, Steures P. Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis. Human reproduction update. 2011 May 1;17(3):293-300.
9. Goynumer G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World Journal of Laparoscopic Surgery. 2010 Aug 1;1(2):23-6.
10. Cheong YC, Li TC. Evidence-based management of tubal disease and infertility. Current Obstetrics & Gynaecology. 2005 Oct 1;15(5):306-13.
11. Foroozanfard F, Sadat Z. Diagnostic value of hysterosalpingography and laparoscopy for tubal patency in infertile women. Nursing and midwifery studies. 2013 Jun 27;2(2):188.
12. Jansen FW, Kapiteyn K, Trimbos‐Kemper T, Hermans J, Trimbos JB. Complications of laparoscopy: a prospective multicentre observational study. BJOG: An International Journal of Obstetrics & Gynaecology. 1997 May;104(5):595-600.
13. Philipsen T, Hansen BB. Comparative study of hysterosalpingography and laparoscopy in infertile patients. Acta Obstetricia et Gynecologica Scandinavica. 1981;60(2):149-51.
14. Ikechebelu JI, Eke NO, Eleje GU, Umeobika JC. comparism of the diagnostic accuracy of Laparoscopy with dye test and Hysterosalpingography in the evaluation of Infertile women in Nnewi, Nigeria. Tropical Journal of Laparo Endoscopy. 2010;1(1):39-44.
15. Ngowa JD, Kasia JM, Georges NT, Nkongo V, Sone C, Fongang E. Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaoundé General Hospital, Cameroon. Pan African Medical Journal. 2015;22(1).
16. Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertility and sterility. 1995 Sep 1;64(3):486-91.
17. Goynumer G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, laparoscopy or both in the diagnosis of tubal disease in infertility. World Journal of Laparoscopic Surgery. 2010 Aug 1;1(2):23-6.
18. Tvarijonavičienė E, Nadišauskienė RJ. The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. Medicina. 2008 Jun;44(6):439.
19. Ibinaiye PO, Lawan RO, Avidime S. Comparative evaluation of pattern of abnormalities in hysterosalpingography, diagnostic laparoscopy and hysteroscopy among women with infertility in Zaria, Nigeria. International Journal of Medicine and Medical Sciences. 2015 Feb 28;7(2):26-35.
20. Capobianco G, Crivelli P, Piredda N, Maiore M, Cherchi PL, Dessole M, Virdis G, Dessole S, Meloni GB. Hysterosalpingography in infertility investigation protocol: is it still useful. Clin Exp Obstet Gynecol. 2015 Aug 10;42(4):448-51.
21. National Institute for Health and Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. National Institute for Health and Clinical Excellence; 2004.
22. Tanahatoe SJ, Hompes PG, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Human Reproduction. 2003 Jan 1;18(1):8-11.
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Dec 30, 2016
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Humaira Alam, Sayeba Akhter, & Nigar Sultana. (2016). EVALUATING DIAGNOSTIC ACCURACY OF HYSTEROSALPINGOGRAPHY VERSUS LAPAROSCOPY FOR TUBAL INFERTILITY IN BANGLADESH. Journal of Population Therapeutics and Clinical Pharmacology, 23(3), 194-200. https://doi.org/10.53555/wykqzj10
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Author Biographies
Humaira Alam
Assistant Professor, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Sayeba Akhter
Former Professor, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Nigar Sultana
Assistant Professor, Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
How to Cite
Humaira Alam, Sayeba Akhter, & Nigar Sultana. (2016). EVALUATING DIAGNOSTIC ACCURACY OF HYSTEROSALPINGOGRAPHY VERSUS LAPAROSCOPY FOR TUBAL INFERTILITY IN BANGLADESH. Journal of Population Therapeutics and Clinical Pharmacology, 23(3), 194-200. https://doi.org/10.53555/wykqzj10