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A careful vaginal examination allows detection of pathology of the pouch of Douglas, such as nodules of the rectovaginal septum or fixed retroverted uterus. The five steps in the fertiloscopy procedure are: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. Hydropelviscopy is performed by first inserting a Verres needle into the pouch of Douglas. This needle is inserted 1 cm below the cervix, and then saline solution is instilled through a perfusion line using no other pressure than gravity. Introduction of a Verres needle and then of the fertiloscope in the pouch of Douglas sometimes raises fear of rectal injury. The fundamental question was to know at an early stage whether fertiloscopy was as accurate as laparoscopy, which was considered at that time the "gold standard" in infertility investigation. The only real complication is represented by rectal injury. However, such injury may be always treated conservatively with antibiotics without surgical intervention.
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