Diagnostic hystero-laparoscopy in work-up of female infertility

Infertility is the failure to conceive (regardless of cause) after 1 year of unprotected intercourse. Infertility affects approximately 10-15% of reproductive-aged couples. 2 Its overall prevalence has been stable during the past 50 years; however, a shift in etiology and patient age has occurred. As the woman's age increases, the incidence of infertility also increases.The common factors responsible for infertility in female are tubal factors, anovulatory disorder, endometriosis, uterine and cervical factors. 3 An accurate diagnosis the ABSTRACT Background: Infertility is a global reproductive health issue that affects many individuals and family. The aim of the present study was to evaluate the laparoscopic finding in infertility cases. Methods: Present study is a prospective study on laparoscopic evaluation of female infertility at Panna Dhai Mahila Chikitsalaya, Udaipur, Rajasthan, India. This study was done for the duration of one year from January 2017 to December 2017. Present study included total 100 cases randomly selected attending OBG OPD with both primary and secondary infertility. Results: Out of 100 cases infertile women 62 cases (62%) were of primary infertility and 38 cases (38%) were of secondary infertility. The mean duration of infertility was 3.7 years. Laparoscopic finding were as follow 42% had polycystic ovaries, 33% women had tubal pathology diagnosed on laparoscopy in which 22 women had tubal blocks diagnosed on chromopertubation and among them 19 had cornual block and 3 had ampullary block ,11% uterine finding and 7 women had adhesions in the pouch of douglas and one women had obliterated. About 20 women (20%) conceived during the period of study. Seven women had post laparoscopic complication two women complained of shoulder pain and another four of abdominal pain post operatively. Conclusions: Laparoscopy is the gold standard for diagnosing tubal factors, peritoneal factors, endometriosis and adhesions, because no other imaging technique provides the same degree of sensitivity and specificity and it should be considered in infertility workup for early treatment decision.

Section: Discussionsupporting

confidence: 87%

The prospective study of laparoscopic finding in infertility cases

Shruti¹,

Sen²

2019

“…In our study uterine factors responsible for infertility in 11% in primary and 0% in secondary & the results are comparable to Chaitra K et al (11) 10%in primary and 6% in secondary, Rai A et al 11.5% in primary and 6% in secondary & Mehta AV et al studies. 12,13 In our study, tubal factors were responsible for (18.4) of primary and (23%) of secondary infertility. Overall it accounted for 22% cases.…”

Section: Discussionmentioning

confidence: 49%

“…The results are comparable to Chaitra K et al 20% in primary and 8% in secondary, Rai A et al 27% primary and 8% secondary & Mehta AV et al 17% in primary and 5% secondary but however among findings of various other ovarian factors, in our study PCOS is more prevalent. [11][12][13] In hysteroscopic evaluation (Table 5) endometrial polyp was seen in 40% cases of primary and 17.4% cases of secondary infertile patient .out of 23 secondary infertile patient 34.8% had intrauterine adhesions, 8.7% had uterine septum, submucous fibroid seen in 17% cases of secondary infertile patients. Diagnosis of endometrial polyps via hysteroscopy is 94% sensitive and 92% specific.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of female factors in infertility by diagnostic laparohysteroscopy in a tertiary health care centre

Garg

Paul

Ray

2020

Background: The inability to conceive is one of the most distressing conditions for a couple. It not only makes the female incomplete but also the social taboos attached are phenomenal. The problem of infertility as long as the recorded history of mankind. Fertility in our culture stands for reproductivity, growth and continuity. Reproduction is one of the basic essential for the survival of a species. Diagnostic laparoscopy & hysteroscopy have emerged as an accurate method of assessing, evaluating and treating infertility. Direct visualization of the abdominal and pelvic organs in laparohysteroscopy allows a definitive diagnosis to be made in many conditions where clinical examination and less invasive techniques such as ultrasound and hysterosalpingography fail to identify the problem.Methods: A prospective study was conducted in Department of Obstetrics and Gynaecology, AGMC& GBP Hospital Agartala. 50 infertile women suspected with pelvic (tubal, peritoneal, adnexal) and intrauterine (uterine polyp, septa, submucous fibroid, intrauterine adhesions) pathologies were included in the study for further evaluation and correlation of clinical findings with Laparohysteroscopy observations.Results: Out of 50 cases, 27 (54%) patients had primary infertility. While laparoscopy detected abnormalities in 60% of the cases, significant hysteroscopy findings were noted in 66% of cases. The most common laparoscopic abnormality was tubal (22%) ovarian and peritoneal (16%) in primary and secondary infertile patients respectively. On hysteroscopy, endometrial polyp (30%) was found as the commonest abnormality in both the groups.Conclusions: Laparoscopy and hysteroscopy are both diagnostic and therapeutic procedures. If pathology is discovered, it can often be treated simultaneously. Laparoscopy combined with hysteroscopy is the sole technique to have a direct view of the female reproductive tract and to find out the various causes of infertility.

“…Amrita et al, at Patna, Bihar reported tubal factor was responsible for infertility in 35.5% in her study. 13 Uterine factors constitute (16.3%) in 18 patients in present study. Commonest finding was fibroid uterus constituting to 6.7%.…”

Section: Discussionmentioning

confidence: 50%

Role of hysterolaparoscopy in the evaluation of female infertility in a tertiary care centre

Parihar

Gowri

2019

Background: Infertility is one of the most important and underappreciated reproductive health problems in developing countries. Inability to conceive bears a social stigma which causes societal repercussion and personal suffering. The advent of hysterolaparoscopy have redefined the evaluation and treatment of infertile women. Study aimed to assess the role of hysterolaparoscopy in the evaluation of female infertility.Methods: This prospective observational study was done in the department of obstetrics and gynaecology, Gandhi Medical College, Sultania Zanana Hospital, Bhopal, during the period between 1st December 2016 to 30th November 2017. 104 infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 104 infertile patients, 82(78.8%) women had primary infertility and rest 22(21.1%) women had secondary infertility. In primary infertility group, most common laparoscopic finding was PCOD in 24(29%) women and in secondary infertility group, tubal blockage was seen in 9(40%) women. The most common pathology seen in hysteroscopy was submucous fibroid in 6(7.3%) women with primary infertility, whereas in secondary infertility group, synechiae was found in 2(9%) patients and septum was seen in 1(4.5%) patient. Out of 104 patients, 33 (31.7%) patients underwent various interventions. The most common intervention was ovarian drilling for PCOS in 21(63.3%) patients followed by hysteroscopic cannulation in 5(15.5%) patients.Conclusions: Hysterolaparoscopy is a very useful tool that can detect various structural abnormalities in multiple sites like uterus, tubes, ovaries and peritoneal cavity in the same sitting. When done by experienced hands and proper selection of patients, hysterolaparoscopy can be considered as a definitive investigative procedure for evaluation of female infertility.