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7 - Fertiloscopy

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

Reproductive medicine is now mainly in the hands of nonsurgical doctors. Several reasons may explain this fact: first of all, the success of IVF and therefore the decreasing of surgical indications especially in tubal surgery and then the fact that, since 1986, egg collection is performed through ultrasonography and so requires no surgical skill.

Indeed, it is was a major progress to be able to perform IVF procedure without the need of laparoscopy, but as a consequence, reproductive surgery was progressively abandoned even at the stage of diagnosis. Therefore, today, very frequently, only noninvasive methods like hysterosalpingography (HSG) or ultrasonography are used to assess the normality of the genitalia.

Using only nonsurgical method of diagnosis leads to a false-negative rate between 20 and 40 percent, according to the works published. Swart et al. (1) in a meta-analysis found for HSG a point estimate of 0.65 for sensitivity and of 0.83 for specificity and underline the fact that HSG was not suitable for the evaluation of periadnexal adhesions.

In contrast, laparoscopy is considered as the gold standard to explore tuboperitoneal infertility. Nevertheless, laparoscopy is often performed without discovering any significant pathology.

Unfortunately, laparoscopy presents some risks that can be very serious, as recently shown in the French register of laparoscopic accidents, where six major injuries occurred in diagnostic laparoscopies (2).

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

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References

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