DIAGNOSTIC UTILITY OF HYSTERO-LAPAROSCOPY IN THE EVALUATION OF INFERTILITY

Infertility, Hysteroscopy, Laparoscopy, Diagnostic hystero-laparoscopy, Tubal pathology

Background: Infertility affects 10–15% of couples in the reproductive age group, and despite advances in diagnostics, many pelvic and intrauterine pathologies remain undetected by routine imaging. Diagnostic hystero-laparoscopy (DHL) offers a single-step, minimally invasive modality for comprehensive evaluation. The study aimed to assess the diagnostic utility of hystero-laparoscopy in identifying abnormalities among women with primary and secondary infertility.

This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Index Medical College Hospital & Research Centre, Indore, over 12 months. One hundred infertile women (70 primary, 30 secondary) fulfilling inclusion criteria underwent DHL in the early proliferative phase. Hysteroscopy assessed uterine cavity lesions, while laparoscopy evaluated tubal, ovarian, and peritoneal factors. Chromopertubation was performed for tubal patency. Data were analyzed using SPSS v25.0, with p < 0.05 considered significant.

Laparoscopic abnormalities were more frequent than hysteroscopic abnormalities (37% vs. 17% in primary infertility; 33% vs. 23% in secondary infertility). Endometriosis (16%) was the leading pelvic pathology in primary infertility, while adnexal adhesions (13%) predominated in secondary infertility. Other laparoscopic findings included tubal pathology (7%), myomas (5%), ovarian pathology (5%), and uterine anomalies (2%). On hysteroscopy, uterine septum was the most common intrauterine abnormality (11%), followed by polyps (6%) and myomas (3%). Chromopertubation revealed unilateral block in 9% and bilateral block in 8% of patients. Overall, 64% of women demonstrated at least one abnormality, with 9% showing combined findings on both procedures. Minor complications occurred in 6% of patients, with no major morbidity.

DHL effectively identified a high burden of pelvic and intrauterine pathologies, many undetected by conventional investigations. Its comprehensive diagnostic yield and safety profile reinforce its role as a gold standard in infertility evaluation, enabling early and targeted management to improve reproductive outcomes.

2. Chanu SM, Rudra Pal GS, Panda S, Santa Singh AS. Diagnostic hysterolaparoscopy for evaluation of infertility: Our experience in a tertiary Care Hospital. J Hum Reprod Sci 2018;11:19-23 3. World Health Organization. Infecundity, infertility, and childlessness in developing countries. DHS Comparative Reports No 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization; 2004. 4. Shamila S, Sasikala SL. Primary Report on the Risk Factors Affecting Female Infertility in South Indian Districts of Tamil Nadu and Kerala. Indian J Community Med. 2011;36(1):59-61. 5. Reproductive health indicators for global monitoring: Report of the second interagency meeting, 2001. Geneva: World Health Organization; 2001: 23. 6. Inhorn MC. Global infertility and the globalization of new reproductive technologies: illustrations from Egypt. Soc Sci Med. 2003;56:1837-51. 7. Makar RS, Toth TL. The evaluation of infertility. Am J Clin Pathol. 2002;117(Suppl):S95-103. 8. Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin? Hum Reprod. 2002;17(1):1-3 9. Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol. 1999;181:952-7. 10. Nayak PK, Mahapatra PC, Mallick J, Swain S, Mitra S, Panda S. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: a retrospective study of 300 cases. Int J Reprod Contracept Obstet Gynecol. 2015;4(2):413-8. 11. 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 12. Mol BW, Collins JA, Burrows EA, van der Veen F, Bossuyt PM. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod. 1999;14:1237-42. 13. Godinjak Z, Idrizbegovic E. Should diagnostic hysteroscopy is a routine procedure during diagnostic laparoscopy in infertile women. Bosn J Basic Med Sci. 2008;8:44-7 14. Garg K, Paul DP, Ray J. Evaluation of female factors in infertility by diagnostic laparohysteroscopy in a tertiary health care centre. Int J Reprod Contracept Obstet Gynecol 2020;9:3596-601. 15. Tsuji I, Ami K, Miyazaki A, Hujinami N, Hoshiai H. Benefit of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography findings. Tohoku J Exp Med. 2009;219:39-42. 16. Bosteels J, van Wessel S, Weyers S, Broekmans FJ, D’Hooghe TM, Bongers MY, et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. 2018;(12):CD009461. 17. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S. Evaluation of outpatient hysteroscopy, saline infusion hysterosonography, and hysterosalpingography in infertile women: A prospective, randomized study. Fertil Steril. 2000;74:1029-34 18. Mooney SB, Milki AA. Effect of hysteroscopy performed in the cycle preceding controlled ovarian hyperstimulation on the outcome of in vitro fertilisation. Fertil Steril. 2003;79:637-8. 19. Homer HA, Li TC, Cooke ID. The septate uterus: A review of management and reproductive outcome. Fertil Steril. 2000;73:1-14. 20. Kamiński P, Wieczorek K, Marianowski L. Usefulness of hysteroscopy in diagnosing sterility. Ginekol Pol.1992;63:634-7. 21. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod.2002;17:1424-30. 22. Pritts EA. Fibroids and infertility: A systematic review of the evidence. Obstet Gynecol Surv. 2001;56:483-91. 23. Hinckley MD, Milki AA. 1000 office-based hysteroscopies prior to in vitro fertilization: Feasibility and findings. JSLS. 2004;8:103-7. 24. Shalev J, Meizner I, Bar-Hava I, Dicker D, Mashiach R, Ben-Rafael Z. Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility. Fertil Steril. 2000;73:412-7. 25. Shokeir TA, Shalan HM, EI-Shafei MM. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res. 2004;30:84-9