Application Of Laparoscopy And Hysterosalpingography In Tubal Factor Infertility

Objective:Tubal factor infertility(TFI) accounts for 25%-35% in female infertility, and there is a rising trend annually. Common causes of TFI include salpingitis, endometriosis, pelvic inflammatory disease. Therefore, it is the decisive role in TFI managements to select one to diagnose the tubal patency and peritubal adhensions, to treat patients individually. Currently,the most commonly used diagnosises about tubal patency are Hysterosalpingography(HSG)and Laparoscopy with chromopertubation(LCC). To compared the diagnostic consistency with HSG and LCC in tubal patency, and to explore the pregnancy rates after Laparoscopy surgery, this paper provides a theoretical basis for managements of TFI.Methods:From May 2013 to February 2015, 180 patients in the First Hospital of Jilin University Reproductive Gynecology undergo the LCC. Retrospective analysis the clinical data, fistly,we compared the diagnostic consistency about HSG and LCC in tubal patency, proximal obstruction, peritubal adhensions and hydropyosalpinx. 180 patients were divided into four grpups(grade I-IV) according to tubal pathology, and all patients were followed up after surgery until 12 weeks intrauterine pregnancy, in order to analyse relevant factors to the pregnancy rates.All data were analysed by using SPSS18.0 statistical software. According to data distribution, respectively, we used the chi-square test, variance analysis, t test and rank sum test. The difference has statistically significant when P<0.05.Results:(1) The acurracy of HSG for the diagnosis of tubal patency was 85.9%, while 83.2% in sensitivity, 92.9% in specificity, 7.1% in false positive rate, 16.8% in false negative rate, and0.761 about the Youden index. In the comparison between HSG and LCCaboutthe diagnostic consistency in tubal patency, the Kappa value is 0.683 which is statistically significant(P<0.001), both diagnostic consistency in tubal patencywere relatively high.(2) The acurracy of HSG for proximal tubal obstruction was 87.2%, while 87.5% in sensitivity, 87.2% in specificity, 12.8% in false positive rate, 12.5% in false negative rate,and 0.747 about the Youden index. In the comparison between HSG and LCC about the diagnostic consistency in proximal tubal obstruction, the Kappa value is 0.367 which is statistically significant(P<0.001), both diagnostic consistency in proximal tubal obstruction were poor.(3) The acurracy of HSG for hydropyosalpinx was 97.7%, while 93.8% in sensitivity,98.7% in specificity, 1.3% in false positive rate, 6.2% in false negative rate, and 0.925 about the Youden index. In the comparison between HSG and LCC about the diagnostic consistency in hydropyosalpinx, the Kappa value is 0.931 which is statistically significant(P<0.001), both diagnostic consistency in hydropyosalpinx were very high.(4) The acurracy of HSG for peritubal adhensions was 84.5%, while 14.6% in sensitivity, 97.7% in specificity, 2.3% in false positive rate, 85.4% in false negative rate, and0.123 about the Youden index. In the comparison between HSG and LCC about the diagnostic consistency in peritubal adhensions, the Kappa value is 0.174 which is statistically significant(P<0.001), both diagnostic consistency in peritubal adhensions were poor.(5) The comparison among the age about four groups, respectively the grade I, II, and III, there were no significant difference(P>0.05). When the other three grades(the grade I,II, III) comopared with the grade IV,differences were significant(P<0.05). But the years of infertility about four groups weren’t significant difference(P>0.05).(6) 56 cases were pregnant after surgery among 180 cases, 50 cases intrauterine pregnant, 6 cases ectopic pregnant, therefore the pregnancy rates were 31.1%, 27.8% and3.4% respectively. 14 cases were pregnant in grade I, 19 cases in grade II, 13 cases in grade III and 10 cases in grade IV, the pregnancy rates were 38.9%, 40.2%, 38.9% and 19.6%respectively. The difference of pregnant rates about four grade were significant.(7) The number of the spontaneous conception and the ART conception were 12 and 2in grade I, 10 and 9 in grade II, 2 and 11 in grade III, 0 and 10 in grade IV. The difference of the spontaneous cenception about four grade were significant.(8) 24 cases had spontaneous conception in six months after Laparoscopy surgery. The number of spontaneous cenceptiom were negatively correlated with the postoperative time(P<0.05, r=-0.842), otherwise, the number of ART conception weren’t correlated with thepostoperative time(P>0.05).Conelusion:(1) The relationship between HSG and Laparoscopic surgery should be complementary and correction in tubal factor infertility management.(2) Patients diagnosed by HSG as unilateral or bilateral tubal patency or unilateral proximal obstruction, should expect spontaneous conception for 3-6 months. Patients diagnosed as hydropyosalpinx, all should undergo Laparoscopic surgery.(3) It is necessary to divided patients into four grpups(grade I-IV) according to their tubal pathology during Laparoscopic surgery, because the number of spontaneous cenceptiom reduces as the severity of tubal pathology. The patients who divided as grade I and II should expect spontaneous conception for 6-12 months, the remains and who divided as grade III and IV should undergo ART.