{"paper_id":"b3cd0315-a3c8-44f8-9605-855e82375e98","body_text":"~ 372 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(1): 372-376 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(1): 372-376 \nReceived: 23-11-2025 \nAccepted: 26-12-2025 \n \nDr. Saheli Kapat \nSenior Resident, MBBS, DNB \n(Gynae & Obs), FMAS, \nDepartment of Obstetrics and \nGynaecology, KPC Medical College \n& Hospital, Kolkata, West Bengal, \nIndia \n \nDr. Biswajit Sarkar \nSpecialist Medical Officer, MBBS, \nDGO, MS (Gynae & Obs), FMAS, \nDepartment of Gynaecology & \nObstetrics, Khiddirpore Maternity \nHome, Kolkata, West Bengal, \nIndia \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. Biswajit Sarkar \nSpecialist Medical Officer, MBBS, \nDGO, MS (Gynae & Obs), FMAS, \nDepartment of Gynaecology & \nObstetrics, Khiddirpore Maternity \nHome, Kolkata, West Bengal, \nIndia \n \nLaparoscopic evaluation of tubal factors in infertility \npatients a cross sectional study \n \nSaheli Kapat and Biswajit Sarkar \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i1e.1898 \n \nAbstract \nIntroduction: Infertility affects a significant proportion of reproductive -age women , with tubal factors \ncontributing to 25 -35% of cases globally. Laparoscopy remains the gold standard  for evaluation of tubal \npatency, pelvic adhesions, and associated pathology , offering both diagnostic and therapeutic advantages. \nEarly laparoscopic assessment is particularly valuable in settings with high rates of pelvic inflammatory \ndisease, endometriosis, and previous pelvic surgery. \nAims and Objectives: This study aimed to evaluate tubal factors contributing to infertility using diagnostic \nlaparoscopy and to assess the prevalence and pattern of tubal and associated pelvic pathology in women \npresenting with primary and secondary infertility. \nMaterials and Methods:  This was a cross -sectional observational study conducted in the Department of \nObstetrics and Gynaecology , KPC Medical College & Hospital , Kolkata, West Bengal. The study was \ncarried out over a  period of one year (July 2019 to June 2021) and included a total of 88 infertile women \nundergoing evaluation for tubal and ovarian factors as part of infertility work-up. \nResults: Among 88 infertility patients , most were aged 25 -30 years (41%) with infert ility <5 years (46%) \nand normal BMI (87%). Menstrual irregularity was seen in 53% , hirsutism in 11% , and hormonal \nabnormalities were uncommon. Ultrasound showed polycystic ovaries in 42% , ovarian cysts in 5% , and \nhydrosalpinx in 2%. Laparoscopy revealed no rmal tubes in 72%, blocked tubes in 17%, adhesions in 22%, \nand endometriosis in 4%. Ovarian drilling (43%) and cystectomy (30%) were the most frequent \ninterventions. \nConclusion: Laparoscopic evaluation plays a critical role in identifying tubal and associa ted pelvic \npathologies contributing to infertility. A significant proportion of patients demonstrated tubal factor \ninvolvement, highlighting the importance of early laparoscopy in guiding appropriate management. \nIncorporating laparoscopy into infertility w ork-ups enhances diagnostic accuracy , aids therapeutic \nplanning, and may improve reproductive outcomes. \n \nKeywords: Infertility, laparoscopy, tubal factor , chromopertubation, pelvic adhesions , hydrosalpinx, \nendometriosis \n \nIntroduction  \nInfertility is a glob al public health concern affecting millions of couples and carries significant \nmedical, psychological, social, and economic consequences. The World Health Organization \n(WHO) defines infertility as the failure to achieve a clinical pregnancy after 12 months  or more \nof regular unprotected sexual intercourse , and recent estimates indicate that nearly one in six \nindividuals worldwide will experience infertility at some point in their lives [1]. Female infertility \ncontributes to almost half of all infertility cases, with tubal factor infertility remaining one of the \nmost important etiological categories, especially in low-and middle-income countries [2]. \nThe fallopian tubes play a fundamental role in human reproduction by facilitating oocyte \ncapture, sperm transport, fertilization, and early embryonic development before implantation in \nthe uterus. Any disruption to these processes due to structural or functional tubal pathology can \ntherefore significantly impair fertility. Globally, tubal factors account for approximately 25-35% \nof female infertility, although the prevalence tends to be higher in regions with increased rates of \nsexually transmitted infections (STIs) , pelvic inflammatory disease (PID) , and genital \ntuberculosis [3]. The most common causes of tubal da mage include previous pelvic infections , \nendometriosis, prior pelvic or abdominal surgery , puerperal sepsis, post-abortal infections, and \ncomplications associated with intrauterine devices (IUDs) [4]. These conditions can result in \ntubal occlusion , hydrosalpinx, fimbrial damage , or peritubal adhesions , ultimately interfering \nwith fertilization and embryo transport. \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 373 ~ \nAccurate evaluation of tubal patency is therefore a key \ncomponent of infertility assessment. Various diagnostic methods \nare available , including hysterosalpingography (HSG) , saline \ninfusion sonography (SIS), hysterosalpingo-contrast sonography \n(HyCoSy), and laparoscopy. HSG is commonly used as a first -\nline screening tool; however , it has limitations , such as false -\npositive findings from tubal sp asm and inability to reliably \nevaluate peritubal adhesions or subtle pelvic pathology [5]. While \nSIS and HyCoSy have emerged as valuable noninvasive \nalternatives offering improved patient comfort and avoidance of \nradiation exposure, they still cannot repla ce the comprehensive \npelvic assessment that laparoscopy provides [6]. \nDiagnostic laparoscopy is widely regarded as the gold standard \nfor evaluating tubal factor infertility because it allows real -time \nvisualization of pelvic anatomy , direct assessment of t ubal \npatency through chromopertubation , and identification of \nassociated pelvic abnormalities such as endometriosis , \nadhesions, and inflammatory sequelae [7]. Additionally , \nlaparoscopy serves as both a diagnostic and therapeutic tool. \nProcedures such as ad hesiolysis, endometriotic lesion excision , \nand tubal reconstructive surgery can be performed during the \nsame session, offering improved fertility outcomes in carefully \nselected patients [8]. \nPatterns of tubal pathology often vary between women with \nprimary and secondary infertility. While primary infertility may \nbe associated with congenital anomalies or unexplained causes , \nsecondary infertility is more frequently linked to acquired tubal \ndamage from previous pregnancies , obstetric complications , or \npelvic infections. Consequently, the prevalence of tubal disease \ntends to be higher in women with secondary infertility , \nparticularly in settings where reproductive tract infections are \ncommon and healthcare access is limited [9]. In many South \nAsian cultures , infertility is associated with significant stigma , \nemotional stress , and marital strain , making prompt evaluation \nand timely management essential for improving both clinical \noutcomes and psychosocial well-being. \nIn the Indian context , tubal factor infertilit y contributes \nsubstantially to the overall infertility burden. High rates of \nuntreated STIs , genital tuberculosis , delayed presentation , and \nlimited awareness of reproductive health amplify the risk of \ntubal damage. Although noninvasive screening modalitie s such \nas HSG and HyCoSy play an important initial role , diagnostic \nlaparoscopy remains indispensable in cases with suspected \npelvic pathology, inconclusive imaging findings , or failed prior \ntreatments [10]. Furthermore , institution-specific data on the \nprevalence and pattern of tubal abnormalities are vital for \nimproving infertility services , tailoring therapeutic strategies , \nand guiding evidence-based clinical decision-making. This study \naimed to evaluate tubal factors contributing to infertility using \ndiagnostic laparoscopy and to assess the prevalence and pattern \nof tubal and associated pelvic pathology in women presenting \nwith primary and secondary infertility. \n \nMaterials and Methods \nStudy design: It was a cross-sectional observational study. \n \nPlace of study: Department of Obstetrics and Gynaecology , \nKPC Medical College & Hospital , Kolkata, West Bengal \n700032. \nPeriod of study: 1 Year. (July 2019 to June 2021)  \nStudy Variables \nAge, Duration of Infertility (years) , Menstrual Cycle , \nSymptomatic Status, BMI, Hirsutism, Serum Prolactin, Thyroid \nStatus, Intervention etc. \n \nSample size:  88 Infertile women undergoing evaluation for \ntubal and ovarian factors. \n \nInclusion Criteria \n Women aged 20 -40 years presenting with primary or \nsecondary infertility. \n Patients under going diagnostic laparoscopy as part of \ninfertility evaluation. \n Patients with at least 12 months of inability to conceive \ndespite regular unprotected intercourse. \n Women willing to provide informed consent for \nparticipation.  \n \nExclusion Criteria \n Women with known uterine or ovarian malignancy. \n Patients with contraindications to laparoscopy or general \nanesthesia. \n Women with acute pelvic infection at the time of \nevaluation. \n Patients previously treated with tubal sterilization or tubal \nligation. \n Pregnant women or those with confirmed early pregnancy.  \n \nStatistical Analysis: Data were entered into Microsoft Excel \nand analyzed using SPSS software version 25.0. Descriptive \nstatistics such as mean , standard deviation , frequencies, and \npercentages were used to summari ze demographic variables and \nlaparoscopic findings. Categorical variables were compared \nusing the chi -square test or Fisher’s exact test as appropriate , \nand a p-value <0.05 was considered statistically significant. \n \nResults \n \nTable 1: Demographic and Clinical Characteristics of Study \nParticipants \n \n Number (n) Percentage (%) \nAge Group (years) \n≤ 20 7 8% \n20-25 34 39% \n25-30 36 41% \n31-40 11 12% \nTotal 88 100% \nDuration of Infertility (years) \n< 5 40 46% \n6-10 38 43% \n11-20 10 11% \nTotal 88 100% \nMenstrual Cycle \nRegular 41 47% \nIrregular 47 53% \nTotal 88 100% \nSymptomatic Status \nSymptomatic 14 16% \nAsymptomatic 74 84% \nTotal 88 100% \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 374 ~ \nTable 2: Clinical Characteristics, Hormonal Profile, and Laparoscopic \nInterventions of Study Participants \n \n Number (n) Percentage (%) \nBMI  \n(kg/m²) \n< 18 7 8% \n18-25 77 87% \n25-30 4 5% \nTotal 88 100% \nHirsutism \nPresent 10 11% \nAbsent 78 89% \nTotal 88 100% \nSerum  \nProlactin \nNormal 84 95% \nRaised 4 5% \nTotal 88 100% \nThyroid  \nStatus \nHypothyroid 2 2% \nNormal 86 98% \nTotal 88 100% \nIntervention \nOvarian Drilling 38 43% \nCystectomy 26 30% \nCystectomy & Cyst Aspiration 1 1% \nCystectomy & Adhesiolysis 1 1% \nCyst Aspiration 4 4% \nAdhesiolysis 4 5% \nBilateral Salpingectomy 1 1% \nTotal 88 100% \n \nTable 3: Distribution of BMI Across Age , Duration of Infertility , and \nHirsutism Among Study Participants \n \n BMI < 18 BMI 18-25 BMI 25-30 Total (n) \nAge Group (years) \n≤ 20 3 5 0 8 \n20-30 4 61 4 69 \n31-40 0 10 1 11 \nTotal 7 76 5 88 \nDuration of  \nInfertility (years) \n< 5 6 35 2 43 \n6-10 2 32 0 34 \n11-20 0 8 3 11 \nTotal 8 75 5 88 \nHirsutism \nPresent 0 8 2 10 \nAbsent 8 67 3 78 \nTotal 8 75 5 88 \nTable 4: Laparoscopic and Ultrasound Findings in Infertility Patients \n \nFinding Number (n) Percentage (%) \nNormal 45 51% \nPolycystic Ovary 37 42% \nOvarian Cyst 4 5% \nHydrosalpinx 2 2% \nTotal 88 100% \nNormal 63 72% \nAbsent tube 1 1% \nPeritubal adhesions 5 6% \nHydrosalpinx 4 4% \nBlocked tubes (total) 15 17% \nUnilateral block 5 6% \nBilateral block 10 11% \nCornual block 1 2% \nAmpullary block 0 0% \nTotal 88 100% \nAdhesions 5 6% \nObliterated 1 1% \nNormal 82 93% \nTotal 88 100% \nNo Adhesions 69 78% \nPelvic Adhesions 5 6% \nPeritubal Adhesions 5 6% \nPerihepatic Adhesions 4 4% \nTotal 88 100% \nEndometriosis (overall) 4 4% \nChocolate Cyst 4 4% \nEndometriotic Deposits 0 0% \nTotal 88 100% \nEndometriosis 4 4% \nChocolate Cyst 4 4% \nEndometriotic Deposits 0 0% \nTotal Participants 88 100% \n \n \n \nFig 1: Distribution of Gram-Positive Cocci (GPC) Isolates \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 375 ~ \n \n \nFig 2: Distribution of Gram-Negative Bacteria (GNB) Isolates \n \nThe study included 88 participants, with the majority aged 25-30 \nyears (41%) , followed by 20 -25 years (39%) , ≤20 years (8%) , \nand 31 -40 years (12%). Most participants had a duration of \ninfertility of less than 5 years (46%) , followed by 6 -10 years \n(43%) and 11-20 years (11%). Menstrual cycles were regular in \n47% of participants and irregular in 53%. Regarding \nsymptomatic status, only 16% of participants were symptomatic, \nwhile the remaining 84% were asymptomatic. \nAmong the 88 participants , the majority had a normal BMI (18 -\n25 kg/m² , 87%), while 8% were underweight and 5% \noverweight. Hirsutism was present in 11% of participants and \nabsent in 89%. Serum prolactin was normal in 95% and raised in \n5% of participants. Thyroid dysfunction was uncommon , with \nonly 2% being hypothyroid. Regarding laparoscopic \ninterventions, ovarian drilling was the most frequent procedure \n(43%), followed by cystectomy (30%) , cyst aspiration (4%) , \nadhesiolysis (5%), cystectomy combined with cyst aspiration or \nadhesiolysis (1% each), and bilateral salpingectomy (1%). \nBMI distribution among participants showed that most had a \nnormal BMI (18 -25 kg/m²), with few underweight (<18 kg/m²) \nor overweight (25 -30 kg/m²). When stratified by age , \nparticipants aged 20 -30 years predominantly had normal BMI \n(61/69), whereas younger (≤20 years) and older (31 -40 years) \nparticipants showed more variation. Regarding duration of \ninfertility, normal BMI was most common across all groups , \nwith underweight and overweight participants being fewer. \nAmong participants with hirsu tism, the majority had normal \nBMI (8/10) , and none were underweight , while overweight \nparticipants comprised 20% (2/10) of those with hirsutism. \nUltrasound findings showed that 51% of participants had normal \novaries, while 42% had polycystic ovaries , 5% ha d ovarian \ncysts, and 2% had hydrosalpinx. Laparoscopic evaluation \nrevealed normal tubes in 72% of participants , with 17% having \nblocked tubes, including 6% unilateral and 11% bilateral blocks; \nother abnormalities included absent tubes (1%) , peritubal \nadhesions (6%), hydrosalpinx (4%), cornual block (2%), and no \nampullary block. Adhesion assessment showed 6% had \nadhesions, 1% were obliterated , and 93% were normal. Further \ndistribution indicated that 78% had no adhesions , while pelvic, \nperitubal, and perihepa tic adhesions were present in 6% , 6%, \nand 4% , respectively. Endometriosis was identified in 4% of \nparticipants, all of whom had chocolate cysts , while no \nendometriotic deposits were seen. \n \nDiscussion \nThe present study included 88 infertile women, with the majority \naged 25 -30 years (41%) , followed by 20 -25 years (39%) , ≤20 \nyears (8%) , and 31 -40 years (12%) , indicating that infertility \nevaluation predominantly occurs in women of reproductive age , \nconsistent with global and Indian trends [1, 2]. Most participa nts \nhad a duration of infertility of less than 5 years (46%) , followed \nby 6 -10 years (43%) and 11 -20 years (11%) , highlighting that \ncouples typically seek medical attention within a few years of \nconception difficulty [3]. Menstrual irregularities were obse rved \nin 53% of participants , with 47% reporting regular cycles. This \naligns with prior studies suggesting that menstrual dysfunction is \na common finding in women with tubal or ovarian etiologies of \ninfertility [4]. Symptomatic presentation was low (16%) , with the \nmajority (84%) being asymptomatic , reflecting the silent nature \nof many tubal and pelvic pathologies [5]. Regarding \nanthropometric measures , the majority of participants had a \nnormal BMI (18 -25 kg/m² , 87%), with a smaller proportion \nunderweight (8%) or overweight (5%). Hirsutism was observed \nin 11%, and serum prolactin was raised in only 5% , suggesting \nthat endocrine disorders , while important, were not the primary \ncontributing factor in most cases. Thyroid dysfunction was \nuncommon (2%) , consistent with previous observations in \nIndian cohorts where endocrine abnormalities contributed \nminimally to infertility [6, 7]. Ultrasound findings revealed that \n51% of women had normal ovaries , 42% had polycystic ovaries \n(PCO), 5% had ovarian cysts , and 2% had hy drosalpinx. These \nfindings corroborate earlier Indian studies reporting a high \nprevalence of PCO among infertile women , reflecting the \nsignificant burden of polycystic ovary syndrome (PCOS) in \nreproductive-aged women [8]. Laparoscopic evaluation \ndemonstrated normal tubes in 72% of participants , whereas 17% \nhad tubal blockages , with unilateral block in 6% and bilateral \nblock in 11%. Other abnormalities included absent tubes (1%) , \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 376 ~ \nperitubal adhesions (6%), hydrosalpinx (4%), and cornual block \n(2%). These results are consistent with studies in India reporting \ntubal factor infertility as a major contributor , accounting for \napproximately 20 -30% of female infertility cases [9]. Adhesion \nassessment showed that 6% had adhesions , 1% were obliterated, \nand 93% were nor mal. Specifically, 78% of participants had no \nadhesions, while pelvic , peritubal, and perihepatic adhesions \nwere present in 6% , 6%, and 4% , respectively. Endometriosis \nwas identified in 4% of participants , all of whom had chocolate \ncysts, whereas no endome triotic deposits were seen. This \nprevalence is comparable to previous studies from India , which \nreport endometriosis in 3-5% of women undergoing laparoscopy \nfor infertility [10]. \nTubal pathology, PCO, and pelvic adhesions remain significant \ncontributors to female infertility. Laparoscopy proved crucial for \nthe accurate assessment of tubal patency and pelvic pathology , \noften identifying asymptomatic conditions that could be missed \nby noninvasive imaging modalities like hysterosalpingography \nor ultrasound [5, 6]. Moreover, the distribution of BMI, hirsutism, \nand endocrine parameters suggests that while metabolic and \nhormonal factors are relevant, anatomical abnormalities remain a \ndominant cause in this cohort. \n \nConclusion \nIn conclusion , this study highlights t hat tubal factor infertility , \npolycystic ovarian changes , and pelvic adhesions are the \npredominant contributors to female infertility in the studied \npopulation. Laparoscopic evaluation proved to be a valuable \ndiagnostic and therapeutic tool , enabling accurate assessment of \ntubal patency, ovarian morphology, and pelvic pathology , even \nin asymptomatic women. Early identification and appropriate \ninterventions, such as ovarian drilling , cystectomy, or \nadhesiolysis, can improve fertility outcomes and guide \nindividualized management strategies , emphasizing the \ncontinued relevance of laparoscopy in comprehensive infertility \ncare. \n \nConflict of Interest \nNot available  \n \nFinancial Support  \nNot available \n \nReferences \n1. World Health Organization. Infertility prevalence esti mates \n1990-2021. Geneva: WHO; 2023. \n2. American Society for Reproductive Medicine. Definitions \nof infertility and recurrent pregnancy loss. Fertil Steril. \n2020;113(3):533-535. \n3. Zegers-Hochschild F , Adamson GD , Dyer S , et al . The \nInternational Glossary on Infertility and Fertility Care. Hum \nReprod. 2017;32(9):1786-1801. \n4. Judlin P. Pelvic inflammatory disease: epidemiology , \netiology and diagnosis. Int J Gynaecol Obstet. \n2018;131(Suppl 1):S67-S69. \n5. 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ESHRE Guideline Group on Female Infertility. ESHRE \nguideline for female infertility evaluation. European Society \nof Human Reproduction and Embryology (ESHRE); 2023. \n18. Berek JS. Berek & Novak’s Gynecology. 17th ed. \nPhiladelphia: Lippincott Williams & Wilkins; 2020. \n19. Singh N , Bansal A , Sharma P. Pattern of tubal factor \ninfertility in Indian women. J Obstet Gynecol India. \n2016;66(5):312-316. \n20. Stegmann BJ , Mol BW , van der Veen F. Tubal factor \ninfertility. Clin Obstet Gynecol. 2019;62(2):215-226. \n  \nHow to Cite This Article \nKapat S, Sarkar B. Laparoscopic evaluation of tubal factors in infertility \npatients a cross sectional study . International Journal of Clinical Obstetrics \nand Gynaecology. 2026;10(1):372-376.  \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 others to remix , \ntweak, and build upon the work non -commercially, as long as appro priate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}