Background: Hysterosalpingography (HSG) is a non-invasive diagnostic and therapeutic modality that has been used as the first-line tool for tubal patency assessment in cases of infertility. Trans-vaginal hydro-laparoscopy (THL) appears to become the new solution for HSG and standard laparoscopy's obstacles. This has not been evidenced yet; because there is a lack of medical literature directly comparing the diagnostic value and the fertility prognosis between THL and HSG.
Methods: We searched five databases; PubMed, Scopus, Science Direct, Web of Science, and Medline Plus. We included four studies. The applicable outcomes for meta-analysis were four outcomes; this includes; detection of tubal patency and tubal occlusion, in addition to the ability of detection of intrauterine anomalies, and finally the pain score during both procedures.
Results: The number of cases with endometriosis and adnexal adhesion was significantly higher in the THL group compared with the HSG group (RR= 12.36 [1.61, 95.06], p= 0.02) and (RR= 10.82 [1.38, 84.63], p= 0.02) respectively. Moreover, THL was associated with significantly lower pain scores compared with HSG (MD= -0.82 [-1.37, -0.26], p= 0.004).
On the other hand, there was no significant difference between THL and HSG regarding detected number of patent tubes (RR= 0.96 [0.91, 1.00], p=0.06), occluded tubes; (RR= 1.19 [0.70, 2.03], p= 0.51), and intrauterine anomalies (RR= 0.16 [0.02, 1.30], p= 0.09).
Conclusion: We conclude that THL has a potentially higher ability for accurate diagnosis of different adnexal abnormalities and less pain scoring compared with HSG.