Tubo-peritoneal infertility: comparision of pre-operative hysterosalpingography and laparotomy findings (Tikur Anbessa Hospital, 1995 - 2002)

OBJECTIVES: To assess the value of hysterosalpingography (HSG) in diagnosing abnormalities of the fallopian tube in infertile women suspected to have infertility associated with a tubo-peritoneal cause. PATIENTS AND METHODS: Laparotomy and hydrochromopertubation was performed on 294 women after HSG using oil soluble contrast medium. RESULTS: There were 241 women with HSG bilateral tubal block and 53 with patent tubes (19 bilateral and 34 unilateral). The operative findings were 214 bilateral obstructions and 80 tubal patencies (49 bilateral and 31 unilateral). About 2/3 of the true patent tubes were identified by HSG. The true positive rate of HSG bilateral tubal occlusion was 89%. A quarter of HSG cornual occlusion was patent and 14% of the bilateral patent tubes were defective. The false negative rate among the bilateral patent tubes was 10%. The prediction of HSG tubal occlusion and patency was high. The false positive cornual block was significant and the association of its true positivity and tuberculous salpingitis was high. CONCLUSION: The HSG and laparotomy findings concurred in most of the cases. In the sub-Saharan Africa where three-fourth of female infertility is attributed to tubo-peritoneal cause, the diagnostic value of HSG is unquestionable as HSG is a simple outpatient investigation, is relatively affordable, has well establishied therapeutic advantages and is associated with low frequency of complications. In cornual occlusions, where genital tuberculosis is ruled out, and in patent tube, after some months of grace period, laparoscopy/laparotomy follow-up may be helpful.