Diagnostic laparoscopy in infertile women with normal hysterosalpingograms.

The Journal of reproductive medicine · 1999 · vol. 44(11) , pp. 953–7 · PMID:10589406 · W2419250110
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Diagnostic laparoscopy identified pelvic abnormalities in 49% of infertile women with normal hysterosalpingograms, with endometriosis and adhesions being the most common findings.

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Abstract

OBJECTIVE: To assess the value of laparoscopy in infertile women with normal hysterosalpingograms, with and without risk factors suggesting pelvic disease. STUDY DESIGN: We retrospectively reviewed 1,022 consecutive charts from a tertiary infertility practice. In 265 women, laparoscopies were performed after normal hysterosalpingograms. RESULTS: Laparoscopies were normal in 136 (51%) women, whereas 129 (49%) had one or more abnormal laparoscopic findings, including minimal or mild endometriosis (n = 85), moderate or severe endometriosis (n = 11), adnexal adhesions (n = 27), subserosal myomas (n = 17), ovarian neoplasms (n = 5), distal phimosis (n = 1) and salpingitis isthmica nodosa (n = 1). Only 7% of cases had findings that might require standard operative laparoscopy or laparotomy, although not all were causally related to infertility. A history of dysmenorrhea or dyspareunia increased the likelihood of detecting endometriosis from 41% to 64% and 69%, respectively. The presence of both symptoms increased the likelihood to 83%. CONCLUSION: In the presence of a normal hysterosalpingogram, laparoscopy identified other pelvic disease in about half of patients. Because most abnormalities were mild, this knowledge can be used to plan a micro-laparoscopic approach for many women, reserving traditional or operative laparoscopy for women with an abnormal hysterosalpingogram or extensive disease following micro-laparoscopy. Alternately, knowledge of the nature and severity of the expected laparoscopic findings might lead to bypassing laparoscopy in favor of assisted reproduction when the perceived benefit of surgical intervention is small.

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Condition tags

endometriosisdysmenorrheadyspareuniainfertility

MeSH descriptors

Adnexal Diseases Hysterosalpingography Infertility, Female Infertility, Female Laparoscopy Adnexal Diseases Adult Diagnosis, Differential False Negative Reactions Female Humans Predictive Value of Tests Retrospective Studies Risk Factors

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