Hysterolaparoscopy in the evaluation and management of female infertility

Abstract

Background: To study the role of hysterolaparoscopy in the evaluation and management of female infertility.Methods: A retrospective study of the 677 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2011 to December 2016 at Karnataka Institute of Medical Sciences, Hubli and Sushruta Multispeciality hospital, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interven-tions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized.Results: Out of 677 cases, 74% patients had primary, 26% patients had secondary infertility. As a whole pelvic pathology was confirmed in 59.5% and intrauterine pathology in 22.3% patients by hysteroscopy. The most common laparoscopic abnormality detected was Polycystic ovaries (27.1%), followed by pelvic adhesions (18.7%). Tubal block comprised 8.1% whereas distorted uterus by fibroid in 6.2% and pelvic endometriosis in 8.7%. In hysteroscopy, the incidence of uterine anomaly was 54 (7.9%). Septate uterus is the most common with a mean incidence of approximately 37 (67.8%).Conclusions: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities.

Role of hysterolaparoscopy in the diagnosis and management of infertility

“…The results were comparable to the studies done by Ramalingappa C et al and Prasanta KN et al, (Table 3). 11,13 Distal tubal blocks exhibit a wide spectrum of severity ranging from adherent fimbrial folds, to varying degrees of phimosis, to complete obstruction with hydrosalpinges. Proximal tubal blocks are caused by obliterative luminal fibrosis, salpingitis isthmica nodosa, chronic inflammation, and intratubal endometriosis.…”

Fallopian Tube Recanalization for the Management of Infertility: Review article

“…Accurate diagnosis of tubal blockage, peritubal adhesion, and endometriosis requires laparoscopy. Hysteroscopic tubal catheterization (HTC) is used for recanalization if laparoscopic chromopertubation reveals tubal blockage (5) .…”