[Transvaginal hydrolaparoscopy for infertility investigation: a retrospective study, about 262 patients].
OBJECTIVE
To evaluate fertiloscopy's results and to redefine its place in the management of female infertility.


METHODS
Retrospective study including 262 cases of fertiloscopy and 260 patients with primary or secondary idiopathic infertility. Analysis of infertility assessment's findings (hysterosalpingography), perioperative data (operating technique, laparoscopic conversion, failures and complications). Comparison of hysterosalpingography's findings and peroperative data; comparison of fertiloscopy and laparoscopy's findings.


RESULTS
Access to peritoneal cavity was possible for 248 fertiloscopies (95%), and pelvic exploration was considered as complete for 226 cases (86%). Laparoscopic conversion was necessary in 54 cases (21%) and indicated by surgical pathology in more of one third of the cases (n=20). Our failure rate was only 5,3% (n=14), partially thanks to posterior colpotomie (70% of failures avoided). We deplored 8 complications (3.05%) which were not severe (no bowel injury), among which half were linked with the hysteroscopy (uterus perforation). In the cases of laparoscopic conversion, laparoscopic findings confirmed per-fertiloscopic data, considering adhesions and tubal patency. Hysterosalpingography had poor sensibility and positive predictive value.


CONCLUSIONS
Fertiloscopy is a safe, reproducible and not much invasive procedure. It can be substituted to laparoscopy in infertility assessment when there is no obvious surgical indication. Moreover, it could be considered as a first line way of investigation in female infertility management, instead of hysterosalpingography which has poor sensibility and positive predictive value.
Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France. Electronic address: aurelie_abergel@hotmail.com.
A
A
Abergel
Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
C
C
Rubod
Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
B
B
Merlot
Service de biologie, médecine de la reproduction et gynécologie endocrinienne, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
E
E
Petit
Service de biologie, médecine de la reproduction et gynécologie endocrinienne, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
M
M
Leroy
Service de biologie, médecine de la reproduction et gynécologie endocrinienne, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
D
D
Dewailly
Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
J-P
JP
Lucot
D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D007247:Infertility, Female / Q000175:diagnosis* / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D012189:Retrospective Studies; D014595:Uterine Perforation / Q000209:etiology
Drilling ovarien; Fertiloscopie; Fertiloscopy; Hydropelviscopie transvaginale; Hysterosalpingography; Hystérosalpingographie; Infertility; Infertilité; Ovarian drilling; Plastie tubaire; Transvaginal hydrolaparoscopy; Tubal patency