Evaluation of diagnostic and therapeutic strategies in reproductive medicine: studies on hysterosalpingography and assisted conception

Abstract

In this thesis two studies are presented dealing with diagnostic and therapeutic strategies in reproductive medicine. The first subject is to investigate whether hysterosalpingography (HSG) prior to laparoscopy and dye should be maintained as a diagnostic procedure in the routine fertility workup. The results of a randomized controlled trial with or without HSG showed that routine use of HSG at an early stage in the fertility workup prior to laparoscopy and dye does not influence cumulative pregnancy rate compared to routine use of laparoscopy without HSG. HSG can be omitted form the routine investigation in the fertility workup and should only be applied for specific conditions like contraindication for laparoscopy or examining tubal mucosal fold configuration when tubal microsurgery is considered. Chlamydia antibody testing and endovaginal ultrasound may replace HSG as screening test prior to laparoscopy. The second subject focuses on therapy in reproductive medicine with the clinically relevant question whether adverse perinatal outcome is related to assisted conception in both singleton and twin pregnancies. We describe the results of a systematic review of 25 controlled studies. We concluded that singleton pregnancies conceived after assisted conception have significantly worse perinatal outcomes than naturally conceived singletons, but this is substantially less so for twins.