الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fallopian tube abnormalities account for up to 40% of female subfertility.Tubal stenoocclusive and dilative disease is an important cause of infertility and should be specifically looked for. Tubal disease includes tubal obstruction, narrowing, dilatation, as well as conditions that alter tubal function due to changes in the tubal mucosal lining; muscular wall or any pathology present external to the tube.Moreover close association had been found between infections and tubal pathology.
Assessment of tubal patency is one of the first steps in fertility investigations. In the present study we assessed the clinical value of combined CAT and HSG as screening methods, and laparoscopy as a reference standard. The aim was to develop a useful minimally invasive screening strategy which can be used in the diagnostic work-up of subfertile couples to estimate the risk of tubal pathology preceding laparoscopy. CAT has been introduced in the fertility evaluation as a screening test to estimate the risk of tubal pathology, because an association exists between the presence of C. trachomatis IgG antibodies in serum and tubal pathology. The advantage of CAT is that it is a simple, inexpensive and minimally invasive test, which makes CAT recommended in subfertile women as the first screening test for tubal pathology after medical history taking.
The higher prevalence of Chlamydia Trachomatis antibody among infertile women with tubal disease and low prevalence of antibody among infertile women without tubal disease. So, Chlamydia Trachomatis is now recognized as one of the most common sexually transmissible bacterial infection throughout the world.
In the majority of women, Chlamydia Trachomatis infection remains asymptomatic. These unrecognized and untreated infections may increase the risk for tubal factor subfertility at a later age. Since the association between Chlamydia Trachomatis IgG antibodies in serum and tubal pathology was noticed, So CAT has been used as a screening test for tubal factor subfertility.
According to the fertility-guideline of the National Institute for Clinical Excellence , HSG should be offered to women who are not known to have co-morbidities (such as a history of pelvic inflammatory disease) to screen for tubal pathology. In women who are assumed to have co-morbidities, laparoscopy should be offered instead of HSG.
HSG is a frequently utilized diagnostic method in the assessment of tubal status and detection of intrauterine anatomical defects in the infertility diagnostic workup. However, the inadequacy of HSG in determining the state of tubal patency emphasizes the need for diagnostic laparoscopy (DL). Laparoscopy provides both a panoramic view of the pelvic reproductive anatomy and a magnified view of pelvic organs and peritoneal surfaces. It is generally accepted that, diagnostic laparoscopy is the gold standard in diagnosing tubal pathology and other intraabdominal causes of infertility.
Since Chlamdia trachomatis IgG serologic testing is non-invasive and relatively inexpensive, we recommend combining it with hysterosalpingography as an infertility work-up. More invasive testing such as laparoscopy may be postponed or completely eliminated.