İnfertilitede tanısal laparoskopi mutlak gerekli midir?

Histerosalpingografi (HSG) infertilite için vazgeçilmez bir tanı yöntemidir. Tanısal laparoskopi infertil olguların değerlendirilmesinde son yıllarda neredeyse rutin yapılırken günümüzde tartışılır hale gelmiştir. Kliniğimizde 2004-2006 yıllarında önceden HSG çekilen 121 infertil olgunun yapılan Tanısal Laparoskopi sonuçlarını değerlendirdik. Bu olguları HSG sonuçlarına göre değerlendirip grupladık. 1. gruptaki 68 olgunun HSG’si normal, 2. gruptaki 16 olgunun tubaları tek taraflı kapalı, 3. gruptaki 37 olgunun ise tubalarının çift taraflı kapalı olduğu görülmektedir. Tanısal laparoskopi sonuçlarına baktığımızda, 1. ve 2. grup olguların tubal değerlendirme sonuçlarının HSG sonuçları ile uyum gösterdiği ancak 3. grup olgulardan 14’ünün tubalarında anormal bir durum saptanmamıştır. Tubal faktör değerlendirilirken HSG ilk uygulanması gereken prosedürdür. Ancak peritubal adhezyonlar açısından tek başına değersizdir. HSG sonucunda bilateral tıkanıklık izlenmişse tanısal laparoskopi mutlaka yapılmalıdır.

Is diagnostic laparoscopy absolutely indicated in infertility?

Hysterosalpingography (HSG) is a basic diagnostic procedure in infertility. In recent years diagnostic laparoscopy has become popular and used in almost every infertile patient. However nowadays agreement on this approach is not so clear. In our clinic, between years of 2004-2006 we have evaluated the result of diagnostic laparoscopy of 121 infertile women who had HSG formerly. We classified the cases according to HSG results. 68 cases in the first group the HSG results was normal. In the second group with 16 cases there was unilateral tubal obstruction. In the third group with 37 cases obstruction was bilateral. Diagnostic laparoscopy and HSG results of 1. and 2. group revealed similarity. In contrast no abnormality was observed in 14 cases of the 3. group. HSG is the first line procedure while evaluating tubal alone patency. However regarding peritubal adhesions alone it has of no value. In the case of bilateral tubal obstruction determined in HSG, diagnostic laparoscopy is absolutely indicated.

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