Tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy and minihysteroscopy) versus hysterosalpingography in an outpatient infertility investigation.

Objective: To compare the acceptance and tolerability of the mini-pan-endoscopic approach (transvaginal hydrolaparoscopy [THL] combined with minihysteroscopy) versus hysterosalpingography (HSG) for evalu- ating tubal patency and the uterine cavity in an outpatient infertility investigation. Design: Randomized controlled study. Setting: University hospital. Patient(s): Twenty-three infertile patients without obvious pelvic pathology. Intervention(s): Women were randomly divided into two groups. One group underwent minihysteroscopy and THL with tube chromoperturbation as first investigation and HSG within the following 7 days, while in the other group the investigation sequence was inverted. Women reported pain experienced before and at the end of procedures. Main Outcome Measure(s): Mean duration of procedures, level of pain experienced, diagnostic agreement about tubal patency and uterine cavity normality. Result(s): THL and minihysteroscopy took significantly more time but was significantly less painful than HSG. Regarding tubal patency, in 95.5% of cases THL agreed with HSG. In one case, HSG diagnosed a bilateral obstruction of tubes, whereas at THL a bilateral spreading of methylene blue was seen. Agreement on intrauterine pathologies between minihysteroscopy and HSG was poor (43%); the number of intrauterine abnormalities found at hysteroscopy was significantly greater than at HSG. Conclusion(s): THL in association with minihysteroscopy provided more information and was better toler- ated than HSG in an outpatient infertility investigation.