الفهرس 
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Abstract
Infertility is generally defined as one year of unprotected intercourse without conception. Approximately 85-90% of healthy young couples conceive within one year. Infertility therefore, affects 10-15% of couples and is an important part of clinical practice of most clinician. The major causes of infertility include ovulatory dysfunction (15%), tubal and peritoneal pathology (30-40%), and male factors (30-40%); uterine pathology is generally uncommon, and the rest is generally unexplained. Pelvic inflammatory disease (P.I.D), septic abortion, ruptured appendix, tubal surgery, or ectopic pregnancy suggests the possibility of tubal damage. Other causes of tubal infertility include inflammation related to endometriosis, inflammatory bowel disease, surgical trauma, or congenital malformation.
Investigations of tubal factor of infertility include hysterosalpingography, saline infusion sonohysterography as well as diagnostic laparoscopy with chromotubation. HSG is a contrast study of the uterine cavity and fallopian tubes. It is a simple, inexpensive, safe, and rapid diagnostic procedure that, when performed properly, provides valuable information about the uterine cavity&tubal architecture. Patency of the tube, a vital determination during HSG, is usually readily recognizable by spill of contrast from the fimbriated end of the ampulla into the peritoneal cavity. Persistence of contrast in an immediate peritubal location may signify inflammatory adnexal disease. The free flow of contrast deep into the pelvis and along peritoneal reflections is common criteria of patency.
Laparoscopy is inspection of the pelvic cavity through a cold light endoscope, passed through the abdominal wall under anesthesia. During this procedure a dye can be injected through a cannula in uterine cervix to test the patency of fallopian tubes. This investigation is now frequently performed, but it does carry potentially serious risks. (E.g. perforation of viscous, hemorrhage due to blood vessel damage, or a trocar punctures). This technique only indicates patency of entire hysterosalpingeal complex and does not provide information concerning the location of the potential abnormality
This study was carried out on sixty patients attending the gynecology outpatient clinic of KASR EL AINI HOSPITAL. It included thirty patients with primary infertility and thirty patients with secondary infertility, all with minimum duration of one year after taking a written consent. Age of the studied patients ranged between 20 and 35 years (mean of 26.72 years ±4.291 SD), for patients with primary infertility, age range was21 to 35 (mean of 26.93 ± 4.193 SD), While for patients with secondary infertility age range was 20 to 35(mean of 26.50 ± 4.447). The duration of infertility of all patients ranged from 2 to 9 years (mean 3.07± 1.539 SD).The parity of the studied patients with secondary infertility ranged from Zero to two births (mean 0.37± .551 SD) and the number of abortions ranged from zero to tree abortions (with a mean of 0 .32± 0.651 SD).
Detailed medical history was taken from each patient followed by full general and local examination; accordingly patients were included or excluded from the study.
Patient’s Inclusion Criteria:
• Age of patients: between 20 and 35.
• History suggestive of tubal factor of infertility for example history of previous pelvic operation. History of previous appendectomy or history of puerperal sepsis.
• History suggestive of endometriosis for example dyspareunia, dysmenorrhea, deep pelvic pain.
• History suggestive of previous pelvic inflammatory disease or sexually transmitted diseases.
Patient’s exclusion criteria:
• Male factor of infertility (abnormal semen parameters and/or sexual dysfunctions).
• History suggestive of an ovulation like history of irregular menstrual cycles, documented an ovulation by previous repeated folliculometry, history of hirsutism and galactorrhoea or abnormal hormonal profile.
• History suggestive of active infection like history of cervical or vaginal discharge, leukocytosis, elevated erythrocyte sedimentation rate and C reactive protein. Such patients were first subjected to full course of antimicrobial treatment before including them into the study.
Then the patients who are included in the study under goes hysterosalpingography in the proliferative phase of the first cycle as an outpatient procedure, then in the proliferative phase of the following cycle, patients were admitted to the inpatient department for laboratory investigation, anesthetic checkup and evaluation, and diagnostic laparoscopy with laparoscopic chromotubation.
Results of Comparison of Tubal Patency assessment during Laparoscopy and its Compatibility with previous Hysterosalpingography results in case of female infertility were:
In the 41 cases that were diagnosed as Free from tubal block by DL only 30 cases were confirmed by HSG (73.2%). While the other 11 cases were diagnosed as (2 cases bilateral block (4.9%), 4 cases Lt.block (9.8%), 3 cases minimal spill (7.3%) and 2 cases as Rt. Block (4.9%)).
In the 7 cases that were diagnosed as bilateral tubal block by DL, only 3 were confirmed by HSG (42.9%), while the other 4 cases were diagnosed as free by HSG (57.1%).
9 cases were diagnosed as unilateral tubal block by DL, from which : 6 cases were diagnosed as Lt block ( only one was confirmed by HSG(16.7%) , while the other 5 cases were diagnosed as : 4 cases were free from block(66.7%) and one case as minimal spill(16.7%) by HSG). The other 3cases who were diagnosed as RT block by DL, only one was confirmed by HSG (33.3%) and the other two cases HSG diagnosed as (one was free (33.3%) and one was diagnosed as bilateral block (33.3%)).
3 cases were diagnosed as delayed spill by DL, while HSG diagnosed of them as free.
Peritubal adhesions were seen in 18.3% in all cases, of which, 18.8% had RT block, 27.3% had Lt Block and 54.5% had bilateral tubal patency.
Endometriosis stage 1-2 was diagnosed in 13.3% of all cases, of which, 12.5% had RT block, 12.5% had delayed spill and 75% had bilateral tubal patency.
In the assessment of other tubal finding, 91.7% cases that were diagnosed as free of other tubal finding by diagnostic laparoscopy, 87.3% of cases hysterosalpingogram was confirmed by diagnostic laparoscopy, 12.6% of cases were not confirmed by diagnostic laparoscopy results.
Intrauterine cavity can be assessed by hysterosalpingogram, while diagnostic laparoscopy cannot assess it. State of ovary and fibroids not encroaching on ’cavity can be assessed by diagnostic laparoscopy, while hysterosalpingogram cannot assess it.
Diagnostic laparoscopy was found to have more accuracy in diagnosis of uterine malformation than hysterosalpingogram.