{"paper_id":"994256f2-2f2b-4cbe-a519-57805c3910e0","body_text":"~ 978 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2025; 9(6): 978-981 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2025; 9(6): 978-981 \nReceived: 17-08-2025 \nAccepted: 23-09-2025 \n \nDr. Priyansee D Patel \nSenior Resident, Department of \nObstetrics and Gynaecology, \nGMERS Medical College, Dharpur, \nPatan, Gujarat, India \n \nDr. Madhusudan H Gadhvi  \nAssociate Professor, Department of \nObstetrics and Gynaecology, \nGMERS Medical College, Dharpur, \nPatan, Gujarat, India \n \nDr. Poonam Londhe \nAssociate Professor, Department of \nObstetrics and Gynaecology, \nGMERS Medical College, Dharpur, \nPatan, Gujarat, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. Poonam Londhe \nDepartment of Obstetrics and \nGynaecology, GMERS Medical \nCollege, Dharpur, Patan, Gujarat, \nIndia \n \nEnhancing infertility diagnosis through laparoscopic \ntechniques \n \nPriyansee D Patel, Madhusudan H Gadhvi and Poonam Londhe \n \nDOI: https://www.doi.org/10.33545/gynae.2025.v9.i6d.1753  \n \nAbstract \nBackground: Laparoscopy remains a key diagnostic tool in evaluating female infertility, particularly for \ntuboperitoneal and peritoneal pathologies that may remain undetected through non-invasive methods. \nMaterials and Methods: This prospective study included 80 infertile women who underwent diagnostic \nlaparoscopy to identify underlying etiological factors. Findings were compared between primary and \nsecondary infertility. \nResults: Tubal block, ovarian abnormalities, adhesions, and endometriosis were commonly observed. \nSecondary infertility demonstrated higher rates of bilateral tubal block and adhesions, while primary \ninfertility frequently involved ovarian pathology and minimal en dometriosis. Normal findings remained an \nimportant subset, especially in primary infertility. \nConclusion: Diagnostic laparoscopy plays a crucial role in detecting pelvic pathology in both primary and \nsecondary infertility. Its simultaneous diagnostic and t herapeutic capacity enhances its value in modern \ninfertility management. \n \nKeywords: Infertility, diagnostic laparoscopy, tubal block, endometriosis \n \nIntroduction  \nInfertility is a major global health concern affecting nearly 15% of reproductive -age co uples, \nwith female factors contributing to almost half of all cases [1]. Despite advancements in \nreproductive technologies, accurate diagnosis of the underlying etiology remains crucial for \nappropriate management. Diagnostic laparoscopy continues to hold a n essential role in \nevaluating female infertility, particularly in resource -limited settings where noninvasive \nmodalities may be insufficient [2]. Although ultrasound, hysterosalpingography (HSG), and \nhormonal evaluation provide initial insight, many pelvi c pathologies —especially subtle \nperitoneal factors—are missed without direct visualization. Studies show that nearly one -third of \nwomen with normal findings on non -invasive tests are found to have significant pelvic \npathology on laparoscopy [3]. \nLaparoscopy enables simultaneous assessment of tubal patency, uterine contour, pelvic \nadhesions, peritoneal surfaces, and ovarian pathology, providing both diagnostic precision and \ntherapeutic opportunities in the same sitting [4]. Tuboperitoneal causes of infertili ty, including \npelvic adhesions, endometriosis, tubal obstruction, and sequelae of pelvic inflammatory disease, \nremain among the leading contributors to infertility worldwide, particularly in countries with \nhigh infection prevalence [5]. A 2023 cross -sectional analysis demonstrated that laparoscopy \nidentified pelvic pathology in more than 60% of infertile women whose basic infertility workup \nwas inconclusive, highlighting its indispensable value in diagnostic algorithms [6]. \nThe distinction between primary and secondary infertility is clinically important because disease \npatterns differ. Primary infertility is more commonly associated with congenital tubal \nabnormalities or endometriosis, whereas secondary infertility is frequently linked to infections, \nprevious obstetric events, and pelvic surgeries [7]. Laparoscopy provides high -resolution \ndocumentation of these etiological variations, enabling clinicians to characterize disease burden \nwith greater accuracy. A recent 2024 prospective study reaffirmed that the  diagnostic yield of \nlaparoscopy remains significantly higher in secondary infertility due to post -infective tubal \ndamage and pelvic adhesions [8]. \nFurthermore, the role of laparoscopy extends beyond diagnosis. Therapeutic interventions such \nas adhesiolysi s, cauterization of endometriotic lesions, ovarian drilling for polycystic ovary \nsyndrome (PCOS), and tubal cannulation can be performed during the same procedure,   \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 979 ~ \nsignificantly improving fertility outcomes [9]. Current evidence \ncontinues to support laparo scopy as the gold standard for \ndiagnosing peritoneal and tubal factors, despite debates \nregarding its routine use in all infertility cases. A comprehensive \n2022 review highlighted that selective laparoscopy —based on \nclinical, hormonal, and imaging indicato rs—optimizes \ndiagnostic accuracy while minimizing unnecessary surgical \nexposure [10]. \nGiven the variability in etiological factors between primary and \nsecondary infertility, regional differences in disease patterns, \nand the limitations of alternative diagn ostic modalities, the \npresent study aims to evaluate the various causes of female \ninfertility using diagnostic laparoscopy and compare their \nrelative frequency in primary and secondary infertility. This \napproach is expected to provide better insight into t he role of \nlaparoscopy in contemporary infertility management and guide \nevidence-based decision-making. \n \nMaterials and Methods \nThis prospective observational study was conducted in the \nDepartment of Obstetrics and Gynecology over a defined study \nperiod, enrolling a total of 80 women presenting with infertility. \nInfertility was defined as the inability to conceive after at least \none year of regular unprotected intercourse. Eligible participants \nincluded women between 18 and 40 years of age who had \nundergone ro utine infertility evaluation, including hormonal \nassays, transvaginal ultrasonography, semen analysis of the \npartner, and hysterosalpingography, yet required further \nassessment through diagnostic laparoscopy. Both primary and \nsecondary infertility cases we re included to facilitate \ncomparative analysis. Women with contraindications to \nlaparoscopy, severe cardiopulmonary disease, known pelvic \nmalignancy, uncontrolled pelvic infection, or those unwilling to \nundergo surgical evaluation were excluded from the st udy. \nEthical approval was obtained from the institutional review \nboard, and informed written consent was secured from all \nparticipants. \nA detailed history was recorded for each patient, including age, \nduration and type of infertility, menstrual pattern, pr evious \npelvic surgeries, history of pelvic inflammatory disease, \nobstetric outcomes, and associated hormonal disorders. Clinical \nexamination was performed to assess pelvic tenderness, uterine \nsize, adnexal masses, and features suggestive of endometriosis \nor pelvic adhesions. All patients underwent diagnostic \nlaparoscopy under general anesthesia using a standard three -port \ntechnique. A systematic evaluation of the uterus, fallopian tubes, \novaries, pelvic peritoneum, pouch of Douglas, and adhesions \nwas carrie d out. Tubal patency was assessed using \nchromopertubation with methylene blue dye. Findings such as \ntubal obstruction, peritubal or periovarian adhesions, \nendometriotic implants, ovarian cysts, fibroids, and congenital \nanomalies were documented. Therapeuti c procedures including \nadhesiolysis, cauterization of endometriotic lesions, or \ncystectomy were performed whenever indicated and feasible \nduring the same sitting. \nData collection was performed using predesigned proformas, \nand all operative findings were re corded immediately after the \nprocedure. Patients were monitored in the postoperative period \nfor complications and discharged once stable. The primary \noutcome variables included the frequency and distribution of \nvarious laparoscopic findings and their compa rison between \nprimary and secondary infertility. Statistical analysis was \nperformed using standard software. Continuous variables were \nexpressed as mean and standard deviation, while categorical \nvariables were represented as frequencies and percentages. Th e \nchi-square test was applied to determine associations between \ntype of infertility and laparoscopic findings, and a p -value of \n<0.05 was considered statistically significant. \n \nResults \nIn the present study of 80 infertile women undergoing diagnostic \nlaparoscopy, the age distribution of the participants is shown in \nTable 1. The largest proportion of patients belonged to the 21 -\n30-year age group, reflecting the typical reproductive age range \nwhen women most frequently seek evaluation for infertility. The \nproportion of women aged above 35 years was comparatively \nlower, although advanced age remains a recognized factor \ninfluencing both fertility potential and laparoscopic findings. \nTable 2 presents the distribution of cases according to the \nduration of married li fe. A greater proportion of women \npresented within 3 -5 years of marriage, indicating early medical \nconsultation and evaluation for infertility. Fewer women \nreported infertility beyond 10 years of marriage, suggesting that \nmost couples seek assistance withi n the first few years when \nconception does not occur spontaneously. \nThe distribution of laparoscopic findings is shown in Table 3. \nTubal factors constituted the most common abnormality, with \ntubal block identified in both primary and secondary infertility \ngroups. Bilateral tubal block was more frequent among women \nwith secondary infertility, likely reflecting post -inflammatory or \npost-infective sequelae. Normal laparoscopic findings were \nobserved in a notable proportion of women, particularly in those \nwith primary infertility, highlighting the importance of \nperitoneal and functional factors that may remain undetected \neven on laparoscopy. Other findings such as hydrosalpinx, tubo -\novarian masses, ovarian pathology including PCOS and cysts, \npelvic adhesions, and endometriosis were also documented. The \ncomparative distribution between primary and secondary \ninfertility reflects the differing etiological patterns, with \nsecondary infertility showing a higher frequency of tubo -\nperitoneal pathology. \n \nTable 1: Age Distribution in the Study (n = 80) \n \nAge Group (years) Number of Patients Percentage (%) \n≤20 6 7.5% \n21-25 18 22.5% \n26-30 28 35% \n31-35 16 20% \n>35 12 15% \n \nTable 2: Distribution According to Duration of Married Life (n = 80) \n \nDuration of Marriage (years) Number of Patients Percentage (%) \n<3 years 14 17.5% \n3-5 years 28 35% \n6-10 years 24 30% \n>10 years 14 17.5% \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 980 ~ \nTable 3: Laparoscopic Findings Regarding Cause of Female Infertility (n = 80) \n \nLaparoscopic Findings Primary Infertility (n=48) Secondary Infertility (n=32) Total (%) \nNormal findings 14 (29.1%) 6 (18.7%) 20 (25%) \nTubal block 12 (25%) 6 (18.7%) 18 (22.5%) \n• Unilateral 6 2 8 (10%) \n• Bilateral 6 4 10 (12.5%) \nHydrosalpinx 2 (4.1%) 1 (3.1%) 3 (3.7%) \nTO Mass 1 (2%) 2 (6.2%) 3 (3.7%) \nOvarian problems (PCOS, cysts) 8 (16.6%) 4 (12.5%) 12 (15%) \nAdhesions 2 (4.1%) 1 (3.1%) 3 (3.7%) \nEndometriosis 3 (6.2%) 2 (6.2%) 5 (6.2%) \n \nDiscussion \nThe findings of this study highlight the continued importance of \ndiagnostic laparoscopy in the evaluation of female infertility, \nparticularly in settings where tubal and pelvic pathologies \nremain prevalent. The distribution of etiological factors \ndemonstrated that tubal blockage and peritoneal factors such as \nadhesions and endometriosis constituted a significant proportion \nof abnormalities, supporting the global observation that \ntuboperitoneal pathology remains a major contributor to \ninfertility in low - and middle-income regions. Recent \ninternational analyses have reaffirmed that laparoscopy remains \nindispensable for detecting these subtle pelvic abnormalities, \nespecially when non -invasive diagnostic methods fail to provide \nsufficient information [11]. The high rate of tubal block observed \nin both primary and secondary infertility in this study aligns with \nrecent findings suggesting an increasing trend of tubal disease \ndue to persistent pelvic infections and post -inflammatory \ndamage in many populations [12]. \nDifferences in the etiological pattern between primary and \nsecondary infertility were also evident. Secondary infertility was \nmore frequently associated with bilateral tubal block, adhesions, \nand tubo -ovarian masses, reflecting the cumulative impact of \npostpartum infections, pelvic inflammatory disease, and prior \npelvic surgeries. Contemporary evidence supports this pattern, \nnoting that secondary infertility is disproportionately linked to \npreventable reproductive health conditions such as post -\ninfectious t ubal damage, which remains a major burden in \ndeveloping countries [13]. Such findings reinforce the necessity of \nearly gynecologic care and timely treatment of pelvic infections \nto reduce the long -term sequelae affecting reproductive \noutcomes. \nThe identifi cation of endometriosis and ovarian pathology \namong women with primary infertility further underscores the \nrole of laparoscopy in diagnosing conditions that may remain \nsilent on imaging. Endometriosis, in particular, is known for its \nsubtle presentation an d frequently requires laparoscopic \nconfirmation for accurate staging and targeted management. \nRecent laparoscopic studies have emphasized that minimal or \nmild endometriosis is often underdiagnosed, yet it carries \nsignificant implications for fertility due to altered peritoneal \nphysiology and pelvic adhesions [14]. Laparoscopy allows both \ndiagnosis and immediate surgical correction, offering a dual \nadvantage that enhances future fertility potential. \nThe presence of a substantial proportion of normal laparosc opic \nfindings, especially among women with primary infertility, \nhighlights the multifactorial and sometimes unexplained nature \nof reproductive failure. Even in the absence of structural \nabnormalities, functional, hormonal, or immunological factors \nmay cont ribute to infertility. This observation mirrors recent \ndata demonstrating that 20 -30% of infertile women may have \nnormal pelvic anatomy on laparoscopy, emphasizing that a \ncomprehensive evaluation must include both laparoscopic and \nnon-laparoscopic paramete rs [15]. Together, these findings \nreiterate that while diagnostic laparoscopy remains the gold \nstandard for assessing tubal and peritoneal pathology, it must be \nintegrated with a holistic infertility workup to maximize \ndiagnostic accuracy and treatment planning. \n \nConclusion \nDiagnostic laparoscopy continues to play a vital role in \nidentifying the underlying causes of female infertility, \nparticularly in relation to tubal and peritoneal pathology. In this \nstudy, tubal block, adhesions, ovarian disorders, and \nendometriosis were significant contributors, with differing \nfrequencies observed between primary and secondary infertility. \nLaparoscopy provided direct visualization and, when applicable, \nsimultaneous therapeutic intervention, reinforcing its value as \nboth a diagnostic and corrective tool. These findings support the \ncontinued use of selective diagnostic laparoscopy as part of a \nstructured infertility evaluation, especially in regions where \npelvic infections and delayed reproductive care remain \nprevalent. \n \nReferences \n1. Mascarenhas MN, Cheung H, Mathers CD, Stevens GA. \nMeasuring infertility prevalence: global estimates and \nregional variations. Reprod Biol Endocrinol. 2012;10:1-10. \n2. Rameez M, Awan AS, Tariq S, Manzoor S, Ilyas Z, \nRehman S. Diagnostic laparoscopy in female infertility: \nexperience from a tertiary care centre. Cureus. \n2022;14(3):e22890. \n3. Darwish AM, Ahmed SR, Ali SS. 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International Journal of Clinical Obstetrics and \nGynaecology. 2025;9(6):978-981.  \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -NonCommercial-ShareAlike 4.0 \nInternational (CC BY -NC-SA 4.0) License, which allows other s to remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}