Diagnostic laparoscopy in infertile women with normal hysterosalpingograms.
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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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- Does laparoscopy still has a role in modern fertility practice? 2017
- HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN EVALUATING FALLOPIAN TUBES IN THE MANAGEMENT OF INFERTILITY IN COTONOU, BENIN REPUBLIC. 2015
- Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ? 2015
- Aspectos clínicos de la endometriosis 2015
- Pain typology and incident endometriosis 2015
- A prospective study to evaluate the role of laparohysteroscopy in unexplained infertility 2014
- Diagnostic Laparoscopy in Infertility - A Retrospective study 2013
- Gynecologic laparoscopy and reproductive failure: Review of 4103 infertile Egyptian women 2013
- Comparison of patient- and physician-based descriptions of symptoms of endometriosis: a qualitative study 2013
- Rol de la laparoscopia en la infertilidad inexplicada: Experiencia del Hospital Clínico de la Pontificia Universidad Católica de Chile 2012
- Role of Laparoscopy in Infertility : Review Article 2012
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- Laparoscopic evaluation of female infertility. 2011
- Peut-on réellement se passer de la cœlioscopie en cas d’infertilité a trompes normales en hystérosalpingographie ? 2011
- Pour la pratique systématique d’une cœlioscopie dans le bilan d’une infertilité 2010
- RETRACTED ARTICLE: Laparoscopy – or not – for management of unexplained infertility 2010
- Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination 2010
- Benefit of Diagnostic Laparoscopy for Patients with Unexplained Infertility and Normal Hysterosalpingography Findings 2009
- Hysterosalpingography, Laparoscopy or Both in the Diagnosis of Tubal Disease in Infertility 2008
- The position of diagnostic laparoscopy in current fertility practice 2007
- Laparoscopy should be strongly considered for women with unexplained infertility 2007
- Prise en charge de l'endométriose: évaluation clinique et biologique 2007
- Síntomas dolorosos de la endometriosis 2006
- The usefulness of laparoscopy and hysteroscopy in the diagnostics and treatment of infertility. 2006
- Utility of screening for other causes of infertility in women with “known” polycystic ovary syndrome 2006
- Relation between severity of dysmenorrhea and endometrioma 2006
- Symptômes douloureux de l'endométriose 2006
- Quality of sex life in women with endometriosis and deep dyspareunia 2005
- Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications 2005
- The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study 2005
- Symptômes douloureux de l'endométriose 2005
- Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology? 2004
- Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease 2003
- Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination 2003
- Experience with 109 Cases of Transvaginal Hydrolaparoscopy 2003
- Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis 2002
- Endoscopy in the Evaluation of the Woman Experiencing Infertility 2000
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