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A randomized, prospective, controlled study of laparoscopic dye studies and selective salpingography as diagnostic
R Woolcott1, S Fisher, J Thomas
1Lingard Fertility Centre, Merewether, New South Wales, Australia. woolcott@hunterlink.net.au
Objective:
To determine and compare the relative merits of laparoscopic dye (LD) studies and selective salpingography (SS) as diagnostic tests of fallopian tube patency.
Design:
Randomized, prospective, controlled study.
Setting:
University-associated assisted reproduction unit.
Patient(S):
Two hundred seventy-eight women undergoing investigation of infertility.
Intervention(S):
Allocation to the performance of either LD studies followed by SS or SS followed by LD studies conducted sequentially under general anesthesia.
Main Outcome Measure(S):
Detection of fallopian tube occlusion, including the site of obstruction and evidence of peritubal or pelvic disease.
Result(S):
When diagnosis was compared by the first test used, 16 (11.9%) of 135 patients had proximal tubal occlusion at LD studies versus 5 (3.6%) of 138 at SS. Twelve (5.6%) of 122 patients had distal tubal occlusion at LD studies versus 14 (10.5%) of 133 at SS. Fifteen (11.1%) of 135 patients had peritubal disease at LD studies versus 3 (2.52%) of 119 at SS. When diagnosis was compared by individual tubes, the results were similar. Among patients who had proximal occlusion and otherwise normal tubes by both methods, endometriosis was present in 72.2%.
Conclusion(S):
Selective salpingography is a better diagnostic test of proximal tubal occlusion than are LD studies. There is no difference between SS and LD studies as a diagnostic test of distal tubal occlusion. Laparoscopic dye studies are a better diagnostic test for assessing peritubal disease than is SS. There may be an association between endometriosis and proximal tubal occlusion. Selective salpingography and LD studies are complementary investigations of the fallopian tubes.