Fertility studies by means of laparoscopy.

This report summarizes 10 years experience with laparoscopy in infe rtility diagnosis and comments on technical aspects of the method and management of certain complications. During the 10 years laparoscopy was performed in a total of 566 patients with infertility. 104 were referred for evaluation of previously undiagnosed infertility. In this smaller series 46 had endometrial implants with and without pelvic adhesions 38 had stenoid ovaries and 20 had reocclusion after tuboplasty. In a personal series of 462 cases 162 showed bilateral tubal occlusion at fimbria with adhesions; 23 bilateral at cornua; and 53 unilateral at fimbria with adhesions. 61 showed stenoid ovaries and 42 pelvic adhesions interfering with ovum pick-up. Laparoscopy is p articularly appropriate for patients in whom no prior studies have been done those previously studied with inconclusive results and those who must travel a long distance or whose time is restricted. Prior to study the duration of failure to conceive should be at least 2 years for those under 25 1 year for those 25-30 and 6 months for those beyond 30. Semen analysis and penetration test should be normal and no contraindications to endoscopy should exist. The laparoscopy is performed after thorough laboratory tests for spinnbarkeit measurement serum follicle stimulating hormone and where indicated urine measurement of 17-ketosteroids 17-hydroxycorticoids and pregnanetriol. Laparoscopy significantly increases positive diagnosis gives definitive information regarding operability of tubal disease and when expertly done has low complication rate. However such surgical procedures as lysis of adhesions tubal sterilization diagnostic aspiration of ovarian cysts and other manipulations should not be performed by the untrained laparoscopist. It is far safer to do them at laparotomy until the operator has obtained the skill to perform complex maneuvers.