PRESENTATION

1. HYSTEROLAPROSCOPY NEED OF THE TIME????.
DR SNEHA JADHAV JR2 OBGY DEPT SKN
DR KETKI JUNNARE AP OBGY DEPT SKN
Aims and Objectives
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Type – Retrospective analytical study.
Study period – Nov 2014 to oct 2016
A retrospective analytycal study done in
168 infertile women aged 19 to 42 years
underwent HSG and hysterolaparoscopy
with normal seminograms and hormonal
studies and the study group was selected
with appropriate inclusion and exclusion
criteria.
1.To correlate the findings of HSG on
hysterolaparoscopy and
2. To assess the change in treatment
plan of the patient after laparoscopic
assessment .
3.To compare the sensitivity and
specificity of HSG with
Hysterolaparoscopy
Infertility Definition-
1 year of unprotected
intercourse without
pregnancy
1. Primary
2. Secondary
Various investigations
1.Hormonal assays
2. Semen analysis
3.Tubal assessment- HSG
4. Hysteroscopy
5. laproscopy
Materials and methods.

2. Interventions
Correlation of uterine
findings
Hospital or
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Change in treatment
Adhesiolysis 8 4.7%
drilling 1
8
10.7
%
Ovarian
cystectomy
8 4.7%
Fimbrioplasty 2 1.1%
Sx for
endometriosis
1 0.59
%
Septum resction 4 2.3%
Cannulation 8 4.7%
Myomectomy 2 1.1%
Polypectomy 2 1.1%
Out of 168 patients 74 (44%)
patients had changed treatment
plan after hysterolaproscopy.
50 (29.7%) patients underwent
interventions in the same sitting
thus it was both diagnostic and
therapeutic.
On comparing HSG with hysteroscopy ,
uterine findings matched in 80% .
HSG failed to detect uterine pathology
in 20%
The difference in the results is highly
significant (p<0.001) by chisquare test.
Correlation of tubal findings
On comparing the tubal patency on HSG and
hysterolaproscopy sensitivity to detect b/l tubal
block was 92.4 % and specificity was 58.33 %.
The comparison of unilateral block was not
signigicant by chi square test.

3. Findings
HYSTERO
LAPAROS
COPY HSG
1 PELVIC ADHESIONS 7
2 OVARIAN CYSTS 11
3 PCOD 17
4 ENDOMETRIOSIS 5
5 TO MASS 1
6 MYOMAS 4
7 HYDROSALPINX 1 3
8 BEADED TUBES 2 1
9 SEPTATE UTERUS 4 3
1
0 POLYP 3
1
1
BICORNUATE
UTERUS 2 1
1
2
UNICORNUATE
UTERUS 2 3
1
3 KOCHS ABDOMEN 5
1
4 ARCUATE UTERUS 1 3
1
5
INTRAUTERINE
ADHESIONS 3
1
6 FIMBRIAL CYST 1
Conclusion
Hysterolaparoscopy is far superior to HSG , as
it is more accurate and therapeutic
intervention is possible at the same time .
In the patients where others causes are
excluded and tuboperitoneal pathology is
strongly suspected , hysterolaproscopy may
be recommended as the first and final
procedure rather than subjecting the patients
to two procedures .
Also it will be possible to prognosticate and
segregate the patients who will need ART and
they can be reffered at the earliest , thus
avoiding further emotional and financial
trauma to the couples .
1.Pan endoscopic approach "hysterolaparoscopy" as an initial procedure in selected infertile women Vaid K, Mehra S, Verma M, Jain S, Sharma A, Bhaskaran S
2. . Hourvitz A, Lédée N, Gervaise A, Fernandez H, Frydman R, Olivennes F. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal
hysterosalpingography? Reprod Biomed Online. 2002;4(3):256–60.
3. Giacomucci E, Flamignic, Rossi S, et al. Hysterosalpingography versus laparoscopy and hysteroscopy. The Journal of the American association of Gynecologic
Laparoscopists. 1999;6(3):s19.
4. Otubu J A, Saqay AS, Dauda S, et al. Hysterosalpingogram, laparoscopy and hysteroscopy in the assessment of the infertile Nigerian female. East Afr Med J. 1990 May;67(5):370–2.
HSG vs Hysterolaparoscopy
Hsg revealed that both tubes of 112/168
patients and 155 had normal uterine
cavities .
55 women (32.7%) were benefited by one
step procedure of hysterolaparoscpic
intervention and they were advised further
treatment in the form of superovulation
with IUI for 3-6 cycles .
Few were refered for IVF-ET with
consistent blocks
Rest of the women with corrected
pathologies on hysterolaparoscopy were
given trials for spontaneous conceptions
for a period of 6 months