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THE ROLE OF HYSTEROLAPAROSCOPY OVER HYSTEROSALPINGOGRAPHY IN THE EVALUATION AND MANAGEMENT OF FEMALE INFERTILITY: A DIAGNOSTIC-CUM FERTILITY ENHANCING THERAPEUTIC TOOL

Background and objective:The technological advancement in endoscopic instruments has revolutionized the management of female infertility. Our objective was to compare the diagnostic and therapeutic efficacy of Hysterolaparoscopy over Hysterosalpingography in infertile patients and also to assess is there any needfor doing HSG ininfertility evaluation. Methods:100 infertile women who wereconfirmed to have normal ovulatory cycles, hormonal assays, and husband semen analysis were enrolled.HSG was performed as a basic test for the evaluation of tubes and the uterine cavity. All 100 women were also subjected to combine laparoscopic and hysteroscopy, and comparative evaluation done. Results:A total of 100 subjects were analyzed in this study. 81% of subjects had primary infertility and 19% had secondary infertility. 89%of patients had normal uterine cavity on HSG whereas 19 % patients had abnormal findings on Hysteroscopy. Hysteroscopy operative procedureswere done among 21% cases.In our study, 40 % patients had abnormal findings on laparoscopy, and corrective surgeries were performed in 23 % patients in the same setting. Laparoscopic operative procedures involved adhesiolysis in 7.0% of cases, PCOD ovarian drilling in 6.0% of patients, myomectomy in 2.0% of cases, Tubal reconstructive surgery in 2.0% of cases, ovarian cystectomy in2.0%of cases and ablation for endometriosis was done in eight (8.0%) cases. Conclusion: See and treat the infertility factors shall be the reality and future argument in modern Gynecology within the limitations of this study. We conclude that hysterolaparoscopy should be offered as the first- line gold standard modality for the evaluation of infertility wherever the procedure is available.