Triple evaluation of tubal patency

A series of 336 infertile patients were evaluated by tubal insufflation, hysterosalpingography, and laparoscopy. The treee procedures revealed patient tubes in 175 patients (52%) and occluded ones in 44 (13%) patients. Thus results with the three methods agreed in 219 patients (65%). False results of tubal insufflation were 18.5% (9.8% false negative and 8.6% false positive). False negative results of hysterosalpingography are 9.5% and false negative results of laparoscopy are 6.8%. Additional pelvic pathology detected by laparoscopy was seen 60 patients (17.8%). Pelvic adhesions (36 patients) and endometriosis (24 patients) were the pathologic processes most commonly missed by hysterosalpingography. Suspected pelvic pathology was corrected by laparocopy in nine cases (2.6%). Double evaluation, both by hysterosalpingography and laparoscopy was needed in 30% of the infertile patients, and therefore both methods should be considered supplementary. Provided that both hysterosalpingography and laparoscopy can be performed, tubal insufflation, since it gives no further information, should be abandoned or discrepant results rejected.