Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

Kamath, Mohan S; Rikken, J. F. W.; Bosteels, Jan

doi:10.1055/s-0040-1718942

Cited by 16 publications

(14 citation statements)

References 51 publications

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“…Laparoscopy reveals the underdiagnosed pelvic pathologies that can contibute to subfertility, and can have a positive therapeutic effect on spontaneous conception by allowing surgical correction of these findings. However, its cost-effectiveness has not been demonstrated when applied systematically, and its effect on patients treated with OS-IUI later on is yet to be proven ( Kamath et al , 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic laparoscopy for unexplained subfertility: a comprehensive review

Arab

2022

JBRA Assisted Reproduction

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Dealing with unexplained infertility is still non-guided, and patients are prone to different and sometimes discordant management strategies based on physician's preferences. However, much has been discussed in this matter, especially when it comes to the use of laparoscopy in patients with unexplained subfertility. In this debate article, we discussed data found in the literature concerning the utility of laparoscopy in these patients, leading us into establishing a new paradigm that will serve in orienting the physicians to when the procedure should be performed.

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Section: Discussionmentioning

confidence: 99%

Diagnostic laparoscopy for unexplained subfertility: a comprehensive review

Arab

2022

JBRA Assisted Reproduction

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“…In cases of infertility and pelvic pain, laparoscopy is routinely performed to examine the abdomen and pelvic organs. Laparoscopy is a diagnostic and therapeutic procedure for pelvic and abdominal disorders performed in the same sitting [18].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopy is the best diagnostic procedure of female infertility as out lined by the WHO guideline [18].…”

Section: Detectedmentioning

confidence: 99%

Laparoscopic Assessment of the Tubo Ovarian Relationship in Unexplained Infertility

Hadwa

Farahat

Dawood

et al. 2022

JAMMR

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Background: Unexplained infertility is usually a diagnosis of exclusion. Thus, there must be an absence of an identifiable cause of infertility despite thorough testing and medical investigation demonstrating tubal patency, normal semen parameters, regular ovulation, normal ovarian reserve, and a normal endometrial cavity. Aim: This study aims to assess the prevalence of abnormal tubo-ovarian relationship in women with unexplained infertility by using laparoscopy. Methodology: This was a prospective study which was conducted on 30 couples with unexplained infertility. Evaluation of the tubo ovarian relation with laparoscopy for patient with unexplained infertility who desire spontaneous pregnancy. The main object of the corrective procedure is to get free mobile fallopian tube along with satisfactory tubo-ovaian relation. Results: There were 53.3% of cases had disturbed tubo-ovarian relation, many corrective measures done by laparoscopy, such as adhesiolysis for 30% of cases, excision of cysts for 6.7% of cases, MSH for 16.6% of cases and cauterization of endometriotic patches for 16.6% of cases. In the present study a pregnancy rate of 53,3% (9/16) was seen in cases that showed disturbed tubo ovarian relation and required operative intervention higher than other cases with no detected pathology (4/14) 47.7%. We were able to achieve a higher conception rate among cases owing to operative procedure. Conclusions: The ovum pick up by the fimbrial end of the tube is an essential determining factor for female infertility. The present study confirmed that laparoscopy provided a precise diagnosis of tubo ovarian factor and may switch the initial treatment of unexplained infertility.

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“…Due to the low PPV of an abnormal HSG, it necessitates an additional laparoscopy to confirm or refute the findings. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Role of hysterosalpingography in diagnosing tubal blockage – A prospective diagnostic study

et al. 2021

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Background: Women with abnormal hysterosalpingography (HSG) are anxious regarding the presence of tubal pathology. It is important to know the predictive value of HSG and the need for subsequent laparoscopy following an abnormal report. In the era of assisted reproductive technology, the role of invasive testing such as diagnostic laparoscopy is being increasingly questioned due to its invasiveness and associated risks. There is a need to explore the positive predictive value (PPV) of HSG in detecting bilateral tubal block in our population as PPV changes with the prevalence of disease. Aim: The aim of this study was to evaluate the diagnostic accuracy of HSG in identifying tubal blockage in subfertile women. Setting and Design: This was a prospective diagnostic study conducted in the department of reproductive medicine and surgery in a university-level hospital. Materials and Methods: The study included 199 subfertile women who had undergone HSG earlier and were planned for laparoscopy from April 2017 to January 2021. Findings of HSG and laparoscopy were compared with HSG as index test and laparoscopy as reference test, and the outcomes analysed were PPV of HSG for a bilateral tubal block, bilateral hydrosalpinx, abnormal HSG (unilateral or bilateral tubal block) and agreement between HSG and diagnostic laparoscopy in detecting normal and abnormal findings. Statistical Analysis: Kappa statistics, Stuart–Maxwell tests of marginal homogeneity and prevalence-adjusted bias-adjusted kappa (PABAK) statistics were used. Results: The PPV for a bilateral block with HSG was 20.9% (95% CI: 13.7–29.7). The PPV of HSG for bilateral hydrosalpinx was 50.0% (95% CI: 6.8–93.2). PABAK was estimated to be 0.42 (95% CI: 0.30–0.55), suggestive of moderate agreement between the tests. Findings of laparoscopy in women with at least one patent tube in HSG showed that in 12.3% of cases, the management was likely to change due to the operative findings. Conclusion: The current study showed low PPV for bilateral tubal block diagnosed with HSG which translates into a need for further confirmation by laparoscopy. In one out of every eight women with at least one patent tube on HSG, performing laparoscopy changed the management.

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Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

Cited by 16 publications

References 51 publications

Diagnostic laparoscopy for unexplained subfertility: a comprehensive review

Diagnostic laparoscopy for unexplained subfertility: a comprehensive review

Laparoscopic Assessment of the Tubo Ovarian Relationship in Unexplained Infertility

Role of hysterosalpingography in diagnosing tubal blockage – A prospective diagnostic study

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