Is routine diagnostic laparoscopy for infertility still justified? A pilot study assessing the use of hysterosalpingo-contrast sonography and magnetic resonance imaging

We assessed the value of hysterosalpingo-contrast sonography (HyCoSY) and magnetic resonance imaging (MRI) as alternatives to laparoscopy and dye insufflation with or without hysteroscopy in the investigation of infertility. A total of 19 women has all three procedures, in addition, one became pregnant after HyCoSy alone. The findings were: uterine fibroids (n = 5), minimal-mild endometriosis (n = 4) and moderate-severe endometriosis (n = 3) including one case of bilateral endometriomas, endometrial polyp (n = 1), polycystic ovaries (n = 2), bilateral dermoid cysts (n = 1), haemorrhagic corpus luteal cyst (n = 1) and minimal adhesions (n = 3). At laparoscopy, 31/37 tubes were patent and there was 84% concordance with the tubal patency findings at HyCoSy. The uterine fibroids and ovarian cysts were detected using transvaginal scanning; the endometrial polyp and a congenital uterine anomaly were identified using HyCoSy. These findings were detected using MRI, but in addition the technique distinguished the dermoid cysts from the endometriomas, identified the two other cases of moderate-severe endometriosis, fibroids <2 cm (n = 2) and adenomyosis (n = 5), and interpreted the haemorrhagic corpus luteum as an endometriona. Our data suggest that women with normal HyCoSy and MRI findings have a normal pelvis and may not need routine surgical investigation.