A couple presents with primary infertility for 2 years. The female partner is 29 years old with regular cycles. Hysterosalpingography shows bilateral tubal block. Which investigation is the gold standard for confirming tubal patency and assessing pelvic pathology?
- A Laparoscopy with chromopertubation ✓
- B Saline infusion sonography (SIS)
- C Hysterosalpingography (HSG)
- D Hysteroscopy
Correct answer: A. Laparoscopy with chromopertubation
Explanation
Laparoscopy with chromopertubation (dye test) is the gold standard for assessing tubal patency, as it allows direct visualization of dye spill from fimbrial ends and simultaneous assessment of pelvic pathology like endometriosis and adhesions. HSG is a screening test with false-positive rates of 15-25% for proximal tubal block. SIS assesses uterine cavity, not tubes. Hysteroscopy evaluates the cavity only.
Reference: Te Linde's Operative Gynecology, 12th ed.
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