title: Infertility work-up: To what degree does laparoscopy change the management strategy based on hysterosalpingography findings?
abstract: OBJECTIVE
  The aim of this study was to assess the diagnostic accuracy of hysterosalpingography (HSG) on tubal patency (TP) and to determine whether performing laparoscopy (LS) can change the original management strategy based on HSG findings.
  
  
  METHODS
  Records of all infertile couples (n = 1298) treated at a university-based infertility clinic between January 2002 and June 2010 were reviewed. All patients who had both HSG and LS testing (n = 264) were included in the study. HSG was performed in an attempt to rule out tubal and/or uterine pathologies. All patients included in the study were evaluated with LS not more than 12 months after HSG.
  
  
  RESULTS
  The validity of HSG screening for TP was calculated as 84.1%. The positive and negative predictive values of HSG were 54.6% and 98.3%, respectively. The sensitivity of HSG was higher in patients with distal tubal occlusion than in patients with proximal tubal occlusion (69.8% [44/63] vs 46.7% [28/60], respectively; P = 0.011). The rates of management plan change in patients with bilateral TP, unilateral tubal occlusion and bilateral tubal occlusion were 2.8%, 12.2% and 32.4%, respectively (P = 0.000).
  
  
  CONCLUSIONS
  Patients with both unilateral tubal occlusion and bilateral tubal occlusion on HSG should be reevaluated with LS to determine the appropriate management strategy.
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Berker
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Yavuz Emre
authors.initials: YE
authors.lastname: Şükür
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Ruşen
authors.initials: R
authors.lastname: Aytaç
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Cem Somer
authors.initials: CS
authors.lastname: Atabekoğlu
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sönmezer
authors.affiliation: Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Batuhan
authors.initials: B
authors.lastname: Özmen
mesh_terms: D000328:Adult; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging*; D005187:Fallopian Tubes / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D007247:Infertility, Female / Q000000981:diagnostic imaging*; D010535:Laparoscopy / Q000379:methods*; D011446:Prospective Studies
keywords: hysterosalpingography; infertility; laparoscopy; management; tubal occlusion