Justifying Role of Diagnostic Hysrero-Laparoscopy in An Infertile Patient

Background: Infertility is defined as the inability to conceive after one year of regular unprotected sexual intercourse and affects nearly 10–15% of couples worldwide. Female infertility may result from uterine, tubal, ovarian, or peritoneal factors. Diagnostic hysterolaparoscopy, which combines hysteroscopy and laparoscopy, is considered the gold standard for comprehensive evaluation of female infertility as it allows direct visualization of pelvic and intrauterine pathology. Aim: To justify the role of diagnostic hysterolaparoscopy in the evaluation of female infertility and to assess uterine, tubal, ovarian, and peritoneal factors contributing to infertility. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Pacific Institute of Medical Sciences. Women aged 18–45 years presenting with primary or secondary infertility were included after obtaining informed consent. Detailed history, clinical examination, and routine investigations were performed. Diagnostic hysteroscopy and laparoscopy with chromopertubation were carried out simultaneously in all eligible patients. Results: The majority of infertile women belonged to the 26–30 years age group (50%), followed by 31–45 years (35%) and 18–25 years (15%). Primary infertility constituted 62% of cases, while 38% had secondary infertility. On hysteroscopy, ostial stenosis (31%) was the most common abnormality in primary infertility, whereas tubal blockage, endometritis, and Asherman’s syndrome (20% each) were common in secondary infertility. Laparoscopic findings revealed ovarian cysts (25%) as the commonest abnormality in primary infertility, while pelvic inflammatory disease, tuberculosis, and endometriosis (20% each) predominated in secondary infertility. Chromopertubation demonstrated bilateral tubal patency in 56% of cases, unilateral patency in 14%, and bilateral tubal blockage in 30% cases. Simultaneous therapeutic interventions were performed in 62% of patients, including cannulation, ovarian drilling, cystectomy, hysteroscopic polypectomy, and septum resection. Conclusion: Diagnostic hysterolaparoscopy is a safe, effective, and comprehensive modality for evaluation of female infertility. It helps identify intrauterine, tubal, ovarian, and pelvic pathologies that may be missed by conventional imaging techniques and also provides the advantage of simultaneous therapeutic intervention, thereby improving infertility management outcomes.