[Diagnostic and prognostic evaluations of sterility and the Sierre Hospital. 389 cases]

The management of infertile couples at regional hospital level is rarely reported and is generally less known, whereas the activity of university infertility clinics is usually the reference. We evaluate the diagnostic approach to infertile couples at the Regional Hospital of Sierre.

The medical charts of 389 couples presenting with infertility between 1989 and 1996 were reviewed. The investigations and interpretation of results were always performed by the same investigator.

A lower pregnancy rate was observed in the case of a pathological postcoital test and when proximal tubal occlusion or phimosis were diagnosed by hysterosalpingography or laparoscopy. In our population, age of the female partner > 40 years, duration of infertility of more than 36 months and multifactorial, male and female, aetiology of infertility were significantly associated with a poor prognosis (p < 0.001). For the assessment of tubal patency, hysterosalpingography and laparoscopy with chromopertubation showed an acceptable level of agreement (kappa coefficient = 0.58). Hysterosalpingography does not provide a precise diagnosis in peritoneal and ovarian pathology (72.9% sensitivity, 55.7% specificity). A third of pregnancies were obtained without treatment during the diagnostic study of the menstrual cycle, or after hysterosalpingography and laparoscopy with chromopertubation.

Most diagnostic procedures for infertility can be performed in a regional hospital by an infertility specialist collaborating closely with a university centre. When infertile couples are transferred to a university centre their evaluation is simplified, as they have already completed an initial systematic investigation and treatment plan at the regional hospital. This two-step approach may be beneficial in selecting couples who need specific treatment not available in a regional hospital.