Comparison of diagnostic accuracy of laparoscopy, hysteroscopy, and hysterosalpingography in evaluation of female infertility.

The diagnostic accuracy and therapeutic value of hysterosalpingography (HSG), laparoscopy, and hysteroscopy were evaluated in 77 women who underwent these procedures as part of their infertility evaluation. HSG revealed in 32 women (42%) evidence of tubal or peritoneal disease, and 16 other women (21%) had radiographic evidence of intrauterine abnormalities. These findings were confirmed by laparoscopy in 84% of patients and by hysteroscopy in 69%, giving false-positive rates of 16% and 31% for HSG. HSG had a false-negative rate of 13% for tubal or peritoneal disease as subsequently uncovered by laparoscopy, and 1.3% for intrauterine lesions as revealed by hysteroscopy. The data suggest that while laparoscopy is of value in detecting previously unsuspected tubal disease, hysteroscopy adds little information in the management of the infertile patient. For optimum evaluation, a combined approach using all three procedures is recommended, especially in patients with a history of uterotubal and peritoneal lesions.