title: [Laparoscopy in the decision of treatment strategy for the infertile couple].
abstract: OBJECTIVE
  to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple.
  
  
  METHODS
  retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI).
  
  
  RESULTS
  the laparoscopy revealed 21 cases of endometriosis (24.4%), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%), and 16 cases of pelvic inflammatory disease (18.6%). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%), revealed unilateral obstruction in 21 cases (25.3%) and bilateral obstruction in 17 cases (20.5%). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%). HSG sensitivity was 0.79 (95%CI=0.62-0.9) and its specificity was 0.58 (95%CI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, whether this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95%CI=0.24-0.71) and 0.77 (95%CI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3%) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2%) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion.
  
  
  CONCLUSIONS
  the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.
authors.affiliation: Interno Complementar de Ginecologia e Obstetrícia, Maternidade Bissaya-Barreto, Coimbra, Portugal. nunobaptistapereira@gmail.com
authors.forename: Nuno Ricardo Goçalves Baptista
authors.initials: NR
authors.lastname: Pereira
authors.forename: Maria Helena Vasconcelos Barbosa Barros
authors.initials: MH
authors.lastname: Leite
authors.forename: Ricardo Nuno Teixeira
authors.initials: RN
authors.lastname: Ribeiro
authors.forename: Rita Marquez
authors.initials: RM
authors.lastname: Passarinho
authors.forename: Maria Geraldina Pereira Silva
authors.initials: MG
authors.lastname: Castro
authors.forename: Sidónio Magalhães
authors.initials: SM
authors.lastname: Matias
mesh_terms: D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy*; D010535:Laparoscopy; D012189:Retrospective Studies; D055815:Young Adult