Laparoscopy in the “Normal” Infertile Patient: A Question Revisited

Corson SL, Stephen L. Corson, S L Corson, A Cheng, Anne Cheng, Cheng A, Norma Jacqueline, J N Gutmann, Gutmann JN
The Journal of the American Association of Gynecologic Laparoscopists · 2000 · vol. 7(3) , pp. 317–324 · doi:10.1016/s1074-3804(05)60473-2 · PMID:10924624 · W2060271235
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This paper re-examines the role and indications of laparoscopy in infertile patients without apparent pelvic pathology to determine its diagnostic utility and therapeutic benefit.

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Abstract

Study objectiveTo determine the prevalence of reproductive pathology in a group of infertile women thought to be at low risk for altered pelvic anatomy.DesignRetrospective chart review and follow-up (Canadian Task Force classification II-2).SettingAcademic-affiliated, private reproductive endocrinology practice.PatientsOne hundred infertile women.InterventionDiagnostic and/or therapeutic laparoscopy.Measurements and main resultsOf 100 patients with a negative reproductive work-up up to the point of laparoscopy, 68 had pathology of reproductive significance: intrinsic tubal disease 24, peritubal adhesive disease 34, and endometriosis 43, some in combination. Laparoscopy was especially helpful in establishing treatment protocols for older women, who were referred for assisted reproductive techniques earlier than otherwise might have been the case. Women conceived after hormone therapy and after operative intervention. Although the hysterosalpingogram was read as normal in all women, tubal disease was diagnosed laparoscopically, independent of endometriosis, in 27 patients, with 2 having complete obstruction. Endometriosis stage I-II was found in 22 patients, stage III in 13, and stage IV in 6.ConclusionEven in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high. Although some pregnancies were achieved after operative intervention, frequently laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women. Frequently the degree of pathology was such that a full operating suite was necessary to provide adequate instrumentation and anesthesia for operative intervention, which would not have been the case with office laparoscopy.

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Condition tags

endometriosis

MeSH descriptors

Infertility, Female Laparoscopy Adult Endometriosis Endometriosis Fallopian Tube Diseases Fallopian Tube Diseases Female Humans Infertility, Female Infertility, Female Retrospective Studies

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