[Application of fertiloscopy in infertile women].

Objective: To investigate the advantages of fertiloscopy in the examination and therapy of infertile women.

Methods: One hundred and fifteen infertile patients underwent fertiloscopy including transvaginal hydrolaparoscopy (THL), conventional dye-test, hysteroscopy, and dye-test using catheterization of the tubal ostium by hysteroscopy from May 2003 to Mar 2005. Access to the pouch of Douglas was achieved in 110 patients (95.7%). The primary infertile patients (primary group) and secondary infertile patients (secondary group) included respectively 49 and 61 cases. The patients of tubal occlusion in two groups were respectively 21 and 22 cases preoperatively. The fallopian tube patency, pelvic adhesions, complete evaluation (all pelvic organs seen) or not, and intra- and postoperative complications were observed.

Results: There was no significant difference in the percentage of uni- and bilateral tubal patency cases between two groups postoperatively (69.4%, 34/49 vs 68.9%, 42/61) (P > 0.05). Of the cases that were bilateral tubal occlusion in both groups preoperatively, the uni- and bilateral tubal patency cases accounted for respectively 47.6% (10/21) and 50.0% (11/22) (P > 0.05) postoperatively. There was no significant difference in the percentage of pelvic adhesions cases between two groups (42.9%, 21/49 vs 60.7%, 37/61; P > 0.05). The overall complete evaluation rate of pelvic organs was 69.1% (76/110), the rates of both groups were respectively 77.6% (38/49) and 62.3% (38/61, P > 0.05). The rate of additional transabdominal operative laparoscopy was 18.2% (20/110) after fertiloscopy, of which, the rate of primary group was only 8.2% (4/49), much less than that of secondary group (26.2%, 16/61; P < 0.05). Seventeen women underwent transabdominal operative minilaparoscopy after fertiloscopy. No complications including pelvic organ injury, rectum perforation, intra- and postoperative bleeding, and postoperative pelvic inflammation occurred.

Conclusions: THL is simple, convenient, and complication-free for the infertile women. Fertiloscopy could be used as a first-line and one-stop procedure in the pelvic assessment of infertile women without clinical or ultrasound evidence of pelvic disease instead of transabdominal laparoscopy. Transabdominal laparoscopy should be only used as a complementary procedure after fertiloscopy.