Predictors for Successful Pregnancy Following Hystro-Laparoscopic Intervention among Infertile Females: A Cohort Study

Rafal Mustafa Murshid, Wassan Nori, Reshed Zeki Obaid, Wisam Akram
In: Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) · 2024 · vol. 7(1) , pp. 57–63 · doi:10.54133/ajms.v7i1.1016 · W4400540105
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This cohort study found that laparoscopic adhesion removal and tubal block correction predicted successful pregnancy in infertile females after hystero-laparoscopic intervention, with younger age and urban residence also being significant factors.

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This retrospective cohort study evaluated combined hystero-laparoscopic interventions in 142 eligible infertile women, assessing intraoperative hysteroscopic (polyp and septum removal) and laparoscopic treatments (pelvic adhesiolysis, removal of a “chocolate cyst,” ovarian drilling, and laparoscopic chromotubation) with follow-up for six months. Clinical pregnancy occurred in 48/142 (33.8%), and women who became pregnant were significantly younger and more often lived in urban areas. Logistic regression indicated that laparoscopic adhesion removal and tubal block correction were reliable predictors of clinical pregnancy (adjusted odds ratios 0.25 and 0.40, with stated confidence intervals), whereas none of the hysteroscopic interventions were statistically significant. The paper does not highlight key limitations such as selection bias inherent to retrospective design, generalizability, or detailed handling of confounders beyond reporting logistic regression results. This paper is centrally about endometriosis-related pelvic pathology only insofar as laparoscopy is described as including endometriosis and a “chocolate cyst” was among the interventions, linking its findings to endometriosis-associated infertility.

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Abstract

Background: Infertility is a major medical and sociopsychological problem that impacts a couple's life. Investigations help guide therapeutic intervention by exploring underlying causes. Hysteroscopy can identify and treat intrauterine pathologies such as adhesion, septum, and endometrial polyps. Laparoscopy has a diagnostic and therapeutic role in the pelvic cavity, including tubal blockage, pelvic adhesions, endometriosis, and polycystic ovaries. Objective: To evaluate the value of combined hystro-laparoscopic interventions in managing female infertility and to explore predictors for a successful pregnancy. Methods: A retrospective cohort study enrolled (142) eligible females who underwent hystro-laparoscopy. Participants' demographic criteria were recorded. Additionally, intraoperative interventions (hysteroscopic removal of the polyp and septum) and laparoscopic removal of pelvic adhesions, removal of the chocolate cyst, ovarian drilling and laparoscopic chromotubation). All patients were followed up for six months. Logistic regression and odd ratio were used to assess the intervention's reliability in predicting pregnancy. Results: Clinical pregnancy was reported in 48/142, with a success rate of 33.8%. Pregnant women had significantly lower ages and lived in urban areas. Laparoscopic adhesion removal and tubal block correction reliably predicted clinical pregnancy, with adjusted odds ratios (AOR) of 0.25; 95% CI (0.08–0.78) and 0.40; 95% CI (0.16-0.98), respectively. None of the hysteroscopic interventions was statistically significant. Conclusions: Because hystero-laparoscopic procedures improve the chances of getting pregnant and are minimally invasive, they are an important part of fertility workups and can be used to diagnose and treat fertility problems.
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Background

Infertility is a major medical and sociopsychological problem that impacts a couple's life. Investigations help guide therapeutic intervention by exploring underlying causes. Hysteroscopy can identify and treat intrauterine pathologies such as adhesion, septum, and endometrial polyps. Laparoscopy has a diagnostic and therapeutic role in the pelvic cavity, including tubal blockage, pelvic adhesions, endometriosis, and polycystic ovaries. Objective: To evaluate the value of combined hystro-laparoscopic interventions in managing female infertility and to explore predictors for a successful pregnancy. Methods: A retrospective cohort study enrolled (142) eligible females who underwent hystro-laparoscopy. Participants' demographic criteria were recorded. Additionally, intraoperative interventions (hysteroscopic removal of the polyp and septum) and laparoscopic removal of pelvic adhesions, removal of the chocolate cyst, ovarian drilling and laparoscopic chromotubation). All patients were followed up for six months. Logistic regression and odd ratio were used to assess the intervention's reliability in predicting pregnancy. Results: Clinical pregnancy was reported in 48/142, with a success rate of 33.8%. Pregnant women had significantly lower ages and lived in urban areas. Laparoscopic adhesion removal and tubal block correction reliably predicted clinical pregnancy, with adjusted odds ratios (AOR) of 0.25; 95% CI (0.08–0.78) and 0.40; 95% CI (0.16-0.98), respectively. None of the hysteroscopic interventions was statistically significant. Conclusions: Because hystero-laparoscopic procedures improve the chances of getting pregnant and are minimally invasive, they are an important part of fertility workups and can be used to diagnose and treat fertility problems. Downloads

References

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JBRA Assist Reprod. 2022;26(1):22-27. doi: 10.5935/1518-0557.20210038. DOI: https://doi.org/10.5935/1518-0557.20210038 Additional Files Published How to Cite Issue Section License Copyright (c) 2024 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ) This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).

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