Diagnostic hystero-laparoscopy in work-up of female infertility

Infertility is a growing concern of the society. In many cases the exact cause of infertility may not be elucidated, whether it is tubal, ovarian, uterine, or a combination of factors. This paper aims to understand the role of diagnostic hystero-laparoscopy in evaluation of cases of infertility.

This prospective study included 200 infertile women and it was conducted at department of Obstetrics and Gynaecology, MGM Hospital, during the period between January 2016 to December 2016. All the infertile patients either with primary or secondary infertility were included after thorough evaluation.

Out of 200 cases, 118(59%) patients had primary infertility and 82(41%) had secondary infertility. While laparoscopy detected abnormalities in 49% of the cases, significant hysteroscopy findings were noted in only 23.5% of cases. The most common laparoscopic abnormalities were endometriosis (32%) and unilateral tubal lockage (24%). On hysteroscopy, periosteal adhesions were the commonest abnormality in both the groups.

Diagnostic hystero-laparoscopy is a safe and cost-effective method and should be considered when there are abnormal HSG results, a past history of pelvic infection, pelvic surgery and /or unexplained secondary infertility during management of infertile couple. Evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies which are usually missed by other imaging modalities, can be diagnosed as well as managed in some cases by hystero-laparoscopy. Metrics

Dyer SJ. International estimates on infertility prevalence and treatment seeking potential need and demand for medical care. Hum Reprod. 2009;24(9):2379-80. Yu SL, Yap C. Investigating the Infertile Couple. Ann Acad Med Singapore. 2003;32:611-4. Mohapatra P, Swain S, Pati T. Hysteroscopic tubal cannulation: our experience. J Obstet Gynaecol India. 2004;54(5):498-9. Olajide AA. The role of laparoscopy, hysteroscopy and falloposcopy in tubal causes of infertility. Tropical J Laparo Endoscopy. 2010;1(1):19-23. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: Lippincott, Williams and Wilkins;2011:1137-91. Crosignani PG, Rubin BL. The ESHRE Capri Workshop Group. 2000. Optimal use infertility diagnostic tests and treatments. Human Reprod. 2000;15:723-32. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment -seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22:1506-12 Aflatoonian A, Seyedhassani SM, Tabibnejad N. The epidemiological and etiological aspects of infertility in Yazd province of Iran. Iranian J Reprod Med. 2009;7:117-22.. Rehana R, Majid SS. Aetiological factors of infertility. J Postgrad Med Inst. 2004;18:166-71. Reiter RC. Evidence based management of chronic pelvic pain. Clin Obstet Gynecol. 1998;41:422-35. Lessey BA, Forstein DA, Miller PB, Egbuniwe MN, Dodds R. Laparoscopic surgery improves outcome and diagnostic accuracy in unexplained infertility. Fertil Steril. 2010;94:S38. Nayak PK, Mahapatra PC, Mallick JJ, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci. 2013;6:32-4. Makled AK, Farghali MM, Shenouda DS. Role of hysteroscopy and endometrial biopsy in women with unexplained infertility. Arch Gynecol Obstet. 2014;289:187-92. Jayakrishnan K, Koshy AK, Raju R. Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination. J Hum Reprod Sci 2010;3:20-4. Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. WHO manual for the standardized investigation of the infertile couple. Cambridge: Cambridge University Press;1993. Gomel V, McComb PF. Investigation of tubal and peritoneal causes of infertility. In: Gomel V, Brill AI, editors . Reconstructive and reproductive surgery in gynecology. 1st ed. London: Informa Healthcare. 2010:243-59. Glatstein IZ, Harlow BL, Hornstein MD. Practice patterns among reproductive endocrinologists: Th e infertility evaluation. Fertil Steril. 1997;67:443-51. Bosteels J, Van Herendael B, Weyers S, D’Hooghe T. Th e position of diagnostic laparoscopy in current fertility practice. Hum Reprod Update. 2007;13:477-85. Poncelet C, Bonneau C. Sifer C, Chanelles O. Interest of laparoscopy for Unexplained Infertility. Fertil Steril. 2011;96:S148-9. Capelo FO, Kumar A, Steinkampf MP, Azziz R. Laparoscopic evaluation following failure to achieve pregnancy after ovulation induction with clomiphene citrate. Fertil Steril. 2003;80:1450-3. Goldman MB, MacKenzie TA, Regan MM, Alper MM, Thornton KL, Reindollar RH. The role of diagnostic laparoscopy in couples treated for unexplained infertility in the fast track and standard treatment (FASTT) trial. Fertil Steril. 2009;92(Suppl):S32-3. Shimizu Y, Yamaguchi W, Takashima A, Kaku S, Kita N, Murakami T. Long-term cumulative pregnancy rate in women with unexplained infertility aft er laparoscopic surgery followed by in vitro fertilization or in vitro fertilization alone. J Obstet Gynaecol Res. 2011;37:412-5. Tanahatoe S, Hompes PG, Lambalk CB. Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril. 2003;79:361-6.