Benefit of Diagnostic Laparoscopy for Patients with Unexplained Infertility and Normal Hysterosalpingography Findings

Tsuji I, Isao Tsuji, Ami K, Kazumi Ami, Ayako Miyazaki, Miyazaki A, Naoko Hujinami, Hujinami N, Hoshiai H, Hiroshi Hoshiai
The Tohoku journal of experimental medicine · 2009 · vol. 219(1) , pp. 39–42 · doi:10.1620/tjem.219.39 · PMID:19713683 · W1971155531
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Diagnostic laparoscopy revealed pelvic abnormalities in 80.7% of infertile patients with normal hysterosalpingography, enabling tailored management and leading to pregnancy in 50.9%.

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This study evaluated whether diagnostic laparoscopy adds value for 57 patients with unexplained infertility who had normal hysterosalpingography (HSG) findings, assessing what pathologies were present and how management and outcomes changed. Between 1997 and 2006, laparoscopy detected abnormalities in 46 patients (80.7%), most commonly endometriosis (36; 63.2%) and, in smaller numbers, peritubal/perifimbrial adhesions (5; 8.8%); in 8 patients (14.0%) plans were switched to ART due to severe tubal disease. Pregnancy was achieved in 29 of 57 patients (50.9%), including 6 ART-mediated pregnancies, and the authors conclude laparoscopy can both identify causes and inform management. This paper is centrally about endometriosis—diagnostic laparoscopy for unexplained infertility with normal HSG, with endometriosis detected as the most frequent pelvic abnormality.

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Abstract

Patients with unexplained infertility following standard infertility screening tests usually undergo timing therapy that coordinates the time of ovulation and coitus, controlled ovarian hyperstimulation, or intrauterine insemination. If the treatment is unsuccessful, diagnostic laparoscopy is performed. However, with recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparoscopy and proceeds directly to ART. Therefore, the value of diagnostic laparoscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography (HSG) findings. Between January 1997 and December 2006, 57 infertile patients with normal HSG findings underwent diagnostic laparoscopy at Kinki University Hospital. In 46 (80.7%) of these patients, diagnostic laparoscopy revealed pathologic abnormalities. Specifically, endometriosis and peritubal and/or perifimbrial adhesions were found in 36 (63.2%) and 5 (8.8%) of the patients, respectively. In 8 patients (14.0%), the management plan was switched to ART because of severe tubal diseases. Among the 57 patients, 29 pregnancies (50.9%) were achieved, including 6 ART-mediated pregnancies. We conclude that diagnostic laparoscopy is beneficial for patients with unexplained infertility and normal HSG findings. Indeed, by diagnostic laparoscopy, we are able to detect the cause(s) of infertility in the pelvic cavity and to design a suitable management plan, which could lead to postoperative pregnancy. Therefore, because of the potential diagnostic and therapeutic benefits, patients with unexplained infertility and normal HSG findings should undergo diagnostic laparoscopy prior to ART.
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Regular Contributions Benefit of Diagnostic Laparoscopy for Patients with Unexplained Infertility and Normal Hysterosalpingography Findings 2009 Volume 219 Issue 1 Pages 39-42 Details Abstract Patients with unexplained infertility following standard infertility screening tests usually undergo timing therapy that coordinates the time of ovulation and coitus, controlled ovarian hyperstimulation, or intrauterine insemination. If the treatment is unsuccessful, diagnostic laparoscopy is performed. However, with recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparoscopy and proceeds directly to ART. Therefore, the value of diagnostic laparoscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography (HSG) findings. Between January 1997 and December 2006, 57 infertile patients with normal HSG findings underwent diagnostic laparoscopy at Kinki University Hospital. In 46 (80.7%) of these patients, diagnostic laparoscopy revealed pathologic abnormalities. Specifically, endometriosis and peritubal and/or perifimbrial adhesions were found in 36 (63.2%) and 5 (8.8%) of the patients, respectively. In 8 patients (14.0%), the management plan was switched to ART because of severe tubal diseases. Among the 57 patients, 29 pregnancies (50.9%) were achieved, including 6 ART-mediated pregnancies. We conclude that diagnostic laparoscopy is beneficial for patients with unexplained infertility and normal HSG findings. Indeed, by diagnostic laparoscopy, we are able to detect the cause(s) of infertility in the pelvic cavity and to design a suitable management plan, which could lead to postoperative pregnancy. Therefore, because of the potential diagnostic and therapeutic benefits, patients with unexplained infertility and normal HSG findings should undergo diagnostic laparoscopy prior to ART. © 2009 Tohoku University Medical Press Favorites & Alerts Recently viewed articles - About this Journal The Tohoku Journal of Experimental Medicine (TJEM) was founded in 1920 by professors of Tohoku Imperial University, Medical School. The TJEM has been published continuously, except for the year of 1946 just after the World War II. The TJEM is open to original articles in all branches of medical sciences. The TJEM also covers the fields of disaster-prevention science, including earthquake archeology. - Submitted manuscripts will be screened for plagiarism with Similarity Check (https://www.crossref.org/services/similarity-check/). Announcements from publisher - Subscriptions Inland subscriptions should be sent to Tohoku University Medical Press, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, JAPAN. Subscriptions from abroad should be addressed to MARUZEN CO., LTD., EXPORT DEPARTMENT, Postal address: P.O.Box 75, Shinagawa, Tokyo 140-8799, JAPAN. e-mail: [email protected]

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Condition tags

endometriosisinfertility

MeSH descriptors

Infertility, Female Infertility, Female Laparoscopy Adult Clomiphene Clomiphene Endometriosis Endometriosis Endometriosis Fallopian Tube Diseases Fallopian Tube Diseases Fallopian Tube Diseases Female Fertilization in Vitro Gonadotropins Gonadotropins Humans Hysterosalpingography Infertility, Female Infertility, Female

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