Laparoscopic presentation in unexplained infertility: a retrospective study

AshrafM Kansouh, AbdElatif M. Elbalshy
In: Journal of Medicine in Scientific Research · 2018 · vol. 1(4) , pp. 312 · doi:10.4103/jmisr.jmisr_79_18 · W2990285989
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This retrospective study of 250 infertile couples found that laparoscopy detected abnormalities like endometriosis and adhesions in 54% of unexplained infertility cases, guiding subsequent treatment plans.

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This retrospective study evaluated laparoscopic (with or without hysteroscopy) diagnostic findings in 250 infertile couples with unexplained infertility, aiming to identify abnormalities that could guide management planning. Across surgeries performed at Shibeen El Kom Teaching Hospital (2012–2017), 46% had no detectable pathology, while 22% and 16% had minimal and mild endometriosis; tubal and perifimbrial adhesions were present in 28%, and pelvic inflammatory disease in 4%. The authors reported that laparoscopy findings led to changes in the planned treatment, including recommendations for direct intrauterine insemination or assisted reproductive technology/intracytoplasmic sperm injection in cases of moderate to severe endometriosis, without additional time consumption, and they concluded laparoscopy was a safe and precise evaluation tool. Relevance to endometriosis: the paper’s key laparoscopic results included minimal and mild endometriosis and used endometriosis severity to tailor management recommendations, though its overall focus is unexplained infertility evaluation rather than endometriosis alone.

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Abstract

ObjectiveInfertility is a growing challenge for all gynecologists worldwide. There is no definite answer as to what should be the best approach to the management of the couples with unexplained infertility (UI). This study aimed to evaluate laparoscopic diagnostic findings that were helpful in planning the protocol for management of cases of UI.Patients and methodsThis retrospective study was conducted in Shibeen El Kom Teaching Hospital, Egypt, from January 2012 to October 2017. Data of 250 infertile couples were collected from patient case records and subjected to laparoscopy or combined with hysteroscopy. Intraoperative findings such as endometriosis, pelvic adhesion, presence of peritubal adhesion, pelvic inflammatory disease, uterine polyp, and septum were recorded.ResultsThe present study showed that performing laparoscopy in UI allowed to see and treat abnormalities that might interfere with a woman's ability to conceive a pregnancy. Our study revealed 46% cases had no detectable pathology on laparoscopy; 22 and 16% had minimal and mild endometriosis, respectively; 28% had tubal and perifimbrial adhesions; and 4% had pelvic inflammatory disease. Laparoscopy findings led to a change of treatment planned for the patients. They were advised either direct intrauterine insemination or assisted reproductive technology/intracytoplasmic sperm injection in cases of severe and moderate endometriosis, without time consumption.ConclusionLaparoscopic procedure is a safe and more precise tool in comprehensive evaluation of UI and can detect various structural abnormalities. This helps in formulating specific plans of management.
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Abstract Objective Infertility is a growing challenge for all gynecologists worldwide. There is no definite answer as to what should be the best approach to the management of the couples with unexplained infertility (UI). This study aimed to evaluate laparoscopic diagnostic findings that were helpful in planning the protocol for management of cases of UI. Patients and methods This retrospective study was conducted in Shibeen El Kom Teaching Hospital, Egypt, from January 2012 to October 2017. Data of 250 infertile couples were collected from patient case records and subjected to laparoscopy or combined with hysteroscopy. Intraoperative findings such as endometriosis, pelvic adhesion, presence of peritubal adhesion, pelvic inflammatory disease, uterine polyp, and septum were recorded. Results The present study showed that performing laparoscopy in UI allowed to see and treat abnormalities that might interfere with a woman's ability to conceive a pregnancy. Our study revealed 46% cases had no detectable pathology on laparoscopy; 22 and 16% had minimal and mild endometriosis, respectively; 28% had tubal and perifimbrial adhesions; and 4% had pelvic inflammatory disease. Laparoscopy findings led to a change of treatment planned for the patients. They were advised either direct intrauterine insemination or assisted reproductive technology/intracytoplasmic sperm injection in cases of severe and moderate endometriosis, without time consumption. Conclusion Laparoscopic procedure is a safe and more precise tool in comprehensive evaluation of UI and can detect various structural abnormalities. This helps in formulating specific plans of management. Article Type Original Study Recommended Citation M. Elbalshy, Abd ELatif and Kansouh, Ashraf M. (2018) "Laparoscopic presentation in unexplained infertility: a retrospective study," Journal of Medicine in Scientific Research: Vol. 1: Iss. 4, Article 18. DOI: https://doi.org/10.4103/JMISR.JMISR_79_18

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