Role of hysterolaparoscopy in management of infertility a retrospective clinical analysis

Geeta Shripad Wadadekar, Dattaprasad B. Inamdar, Vandana Nimbargi
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 9(11) , pp. 4437 · doi:10.18203/2320-1770.ijrcog20204789 · W3094967409
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This retrospective study evaluated hysterolaparoscopy in 41 infertile women, finding it effectively diagnoses and treats pelvic pathologies like endometriosis and adhesions to guide individualized treatment plans.

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This retrospective clinical analysis evaluated the diagnostic and therapeutic utility of combined hysterolaparoscopy in 41 women aged 20 to 40 years presenting with primary or secondary infertility. The study found that laparoscopic examination frequently identified adhesions and endometriosis, while hysteroscopy commonly revealed polyps and intrauterine synechiae, allowing for simultaneous surgical management of these pathologies. The authors concluded that this dual approach facilitates comprehensive evaluation and treatment planning by addressing pelvic, peritoneal, tubal, and uterine factors in a single procedure. Relevance to endometriosis: listed as one of the common laparoscopic abnormalities detected during infertility workup, though the paper's main focus is general infertility management rather than specific endometriosis pathology.

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Abstract

Background: Diagnosis and treatment of infertility is an elaborate process. The goal of treating clinician is to decide upon the plan of management best suited to the couple by selecting relevant investigations and procedures from available options. Objective was to determine the role of hysterolaparoscopy in the management of infertility. Methods: This retrospective study was conducted at a tertiary canter (Department of reproductive medicine and surgery) over a period of 12 months-January 2019 to December 2019. Women aged 20-40 years with primary or secondary infertility, except male factor infertility, undergoing hysterolaparoscopy were included. Results: Out of 41 cases, 71.84% patients had primary infertility. Common laparoscopic abnormalities were adhesions (36.5%) and endometriosis (17.07%) Hysteroscopy revealed polyps (9.7%) and intrauterine synechia (4.8%) as common pathologies. The diagnosed pathologies were dealt surgically in the same sitting. Plan of infertility treatment could be outlined in all patients based on intraoperative findings. Conclusion: Hysterolaparoscopy serves both diagnostic and therapeutic purpose. Various pelvic, peritoneal, tubal, endometrial and uterine factors can be diagnosed and treated at the same time. The clinician has to be well versed and skilled in selecting and performing the appropriate surgery. Clinical information gained from hysterolaparoscopy helps in decision making and designing individualized, evidence-based treatment plan can for the patients.
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Background

Diagnosis and treatment of infertility is an elaborate process. The goal of treating clinician is to decide upon the plan of management best suited to the couple by selecting relevant investigations and procedures from available options. Objective was to determine the role of hysterolaparoscopy in the management of infertility.

Methods

This retrospective study was conducted at a tertiary canter (Department of reproductive medicine and surgery) over a period of 12 months-January 2019 to December 2019. Women aged 20-40 years with primary or secondary infertility, except male factor infertility, undergoing hysterolaparoscopy were included.

Results

Out of 41 cases, 71.84% patients had primary infertility. Common laparoscopic abnormalities were adhesions (36.5%) and endometriosis (17.07%) Hysteroscopy revealed polyps (9.7%) and intrauterine synechia (4.8%) as common pathologies. The diagnosed pathologies were dealt surgically in the same sitting. Plan of infertility treatment could be outlined in all patients based on intraoperative findings.

Conclusion

Hysterolaparoscopy serves both diagnostic and therapeutic purpose. Various pelvic, peritoneal, tubal, endometrial and uterine factors can be diagnosed and treated at the same time. The clinician has to be well versed and skilled in selecting and performing the appropriate surgery. Clinical information gained from hysterolaparoscopy helps in decision making and designing individualized, evidence-based treatment plan can for the patients. Metrics

References

WHO definition of infertility in the International Classification of Diseases (ICD 10). Indian Council for Medical Research (ICMR) and National Academy of Medical Sciences (NAMS). National Guidelines for Accreditation, Supervision and Regulation of ART clinics in India. New Delhi: Ministry of Health and Family Welfare, Government of India. 2005. World Health Organization. Challenges in Reproductive Health Research: Biennial Report 1992-1993.Geneva, WHO. 1994;125. World Health Organization, Progress in Reproductive Health Research. Assisted reproduction in developing countries facing up to the issues. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Progress. 2003;63:1-8. Balen FV, Gerrits T. Quality of infertility care in poor-resource areas and the introduction of new reproductive technologies. Hum Reprod. 2001;16(2):215-9. Unisa S. Infertility and Treatment Seeking in India: Findings from District Level Household Survey. FV and V IN OBGYN, monograph. 2010;59-65. Nayak PK, Mahapatra PC, Mallick JJ, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero hysterolaparoscopy in the evaluation of infertility. J Hum Reprod Sci. 2013;6:32. Shetty SK, Shetty H, Rai S. Laparoscopic evaluation of tubal factor in cases of infertility. Int J Reprod Contracept Obstet Gynecol. 2013;2:410-3. Ahmed MS, Bhalerao AN. Role of diagnostic hysterolaparoscopy in evaluation of female infertility. Int J Reprod Contracept Obstet Gynecol. 2017;6:4048-51. Tsevat DG, Wisenfeld HC, Parks C, Piepert JF Sexually transmitted diseases and infertility Am J Obstet Gynecol. 2017:216(1):1-9. Puri S, Jain D, Puri S, Kaushal S, Deol SK. Laparohysteroscopy in female infertility: A diagnostic cum therapeutic tool in Indian setting. Int J App Basic Med Res. 2015;5:46-8. Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BW. Surgical treatment for tubal disease in women due to undergo in vitro fertilization. Cochrane Database Syst Rev. 2010:CD002125. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. Fertility and Sterility®. 2010;98:3, Mitra S, Nayak PK, Agrawal S. Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome. J Nat Sci Biol Med. 2015;6(1):40-8. Bougie O, Lortie K, Shenassa H, Chen I, Singh SS. Treatment of Asherman’s syndrome in an outpatient hysteroscopy setting. J Minim Invasive Gynecol. 2015;22:446-50. Guo J, Li TC, Xia E, Xiao Y, Zhou F, Yang X. A prospective randomized controlled trial comparing two doses of estrogen therapy after hysteroscopic Adhesiolysis to prevent intrauterine adhesion recurrence. Reprod Biomed Online. 2017:35(5):555.

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