Value of transvaginal hydrolaparoscopy in infertility evaluation

Diagnostic laparoscopy is still considered to be gold standard for detection of tubo-peritoneal infertility. It requires general anesthesia, hospitalization, and is not without risk of complications. For these reasons laparoscopy is frequently postponed until a later stage in the investigation process and hysterosalpingography (HSG) is widely used as a first line investigative procedure in infertility. However the diagnostic value of the HSG is still a matter for debate because of low sensitivity, high false negative and false positive rates. Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity. Its accuracy is comparable to laparoscopy for the diagnosis pelvic pathology. THL is performed under local anesthesia, is less traumatic than laparoscopy, and better tolerated than HSG. So it seems that THL is superior to HSG as a first line investigative procedure. However this issue has not been clarified with prospective randomized study. The aim of our randomized study is to compare the usefulness and effectiveness of our standard infertility work up with HSG as first line procedure with the same work up using THL instead of HSG as first line procedure.