Patient history as a simple predictor of pelvic pathology in subfertile women

The objective of this study is to determine in a group of subfertile women whether patient history can differentiate women with a healthy pelvis from those with endometriosis or adnexal adhesions. In this prospective study, consecutive subfertile women undergoing laparoscopy and tubal hydrotubation for the sole indication of subfertility were evaluated at the teaching hospital fertility unit. They had a minimum of 2 years subfertility. The main outcome measures were: patients' response to a 7-point physical symptom and medical history questionnaire, laparoscopic findings of endometriosis and adnexal adhesions quantified according to the American Fertility Society classification. Of 104 patients, 99 patients were retained in the analysis. Forty per-cent had endometriosis, 19% pelvic adhesions and 40% a normal pelvis. Severe dysmenorrhoea was the only symptom predictive for endometriosis (relative risk 1.7). Severe dysmenorrhoea, a vaginal discharge, past use of a coil and previous laparotomies were all predictive for pelvic adhesions (relative risks 2.1, 3.3, 2.1, 1.9, respectively). The relative risk increased with severity of the disease. Patients with moderate and severe adhesions were 4.2 and 5.3 times more likely to have severe dysmenorrhoea and a vaginal discharge than patients with a normal pelvis. Subfertile women giving a positive response to selected questions about their medical history are at increased risk of endometriosis and pelvic adhesions. Where resources are limited, such a system could be used to plan effective use of available diagnostic facilities.