Combined laparoscopy and hysteroscopy in the investigation of the ovulatory infertile female.

A previous study had demonstrated the superiority of hysteroscopy over hysterosalpingography for the detection of intrauterine lesions in infertile patients. One hundred and sixty-nine patients were examined by a combined laparoscopic and hysteroscopic technique as the means of detecting tubal, peritubal, peritoneal, or intrauterine causes of infertility. Laparoscopy was successful in 168 and hysteroscopy in 162. The rate of diagnosis by laparoscopy of 49.4% was increased to 66% when the hysteroscopic findings were included. Only one serious complication was recorded, the inadvertent visualization of an intrauterine pregnancy. Arguments are advanced for the replacement of hysterosalpingography with combined laparoscopy and hysteroscopy as the primary means of investigating the ovulatory infertile female.