Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?

Fatum M, Mohammad Fatum, Laufer N, Neri Laufer, Alex Simon, Simon A
Human Reproduction · 2002 · vol. 17(1) , pp. 1–3 · doi:10.1093/humrep/17.1.1 · PMID:11756351 · W2135698063
Review OA: bronze CC0 ⤵ 45 in-corpus citations
📄 Open PDF View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This study found that diagnostic laparoscopy is not justified or cost-effective for couples with unexplained infertility and a normal hysterosalpingogram, recommending direct treatment with intrauterine insemination followed by assisted reproductive technologies.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.

My notes (saved in your browser only)

Condition tags

endometriosisinfertility

MeSH descriptors

Hysterosalpingography Hysterosalpingography Infertility Infertility Laparoscopy Laparoscopy Reproductive Techniques Reproductive Techniques Endometriosis Endometriosis Endometriosis Endometriosis Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Female Female Humans Humans

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (24)

Cited by (43)

Source provenance

europepmc
last seen: 2026-10-16T06:09:50.462052+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-10-08T21:00:15.595027+00:00
License: CC0 · commercial use OK