The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

Abstract

The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients’ diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

“…An additional 21.78% (22/101) of patients benefited from laparoscopy by correcting pelvic adhesions. Prevalence of endometriosis in this specific population is concordant with previous literature on patients diagnosed with unexplained infertility 15,16 .…”

“…The increase in clinical pregnancy rate, following endometriosis correction, is supported by standing literature 18,19 . Similar clinical pregnancy rate improvements have been observed with respect to natural conception following corrective laparoscopy in patients with more than 3 failed IVF attempts and unexplained infertility 16,20 .…”

“…TVUS may stand as the first-line diagnostic tool 21 . Nonetheless, a number of pelvic pathologies, such as superficial or deep endometriotic spots on the peritoneum or filmy adhesions on the ovaries, may not be detected via TVUS or/and clinical examination 16,20,22 . Interestingly, in four cases presented herein, it was laparoscopic investigation that revealed the existence of undiagnosed microscopic deep ovarian endometriosis lesions which were not detected via preoperative TVUS.…”

Evaluating the value of day 0 of an ICSI cycle on indicating laboratory outcome

“…Basic infertility investigation was performed as previously described 30 . Briefly, it included semen analysis, hysterosalpingography in order to evaluate patency of the fallopian tubes, and assessment of ovulatory function via evaluating FSH levels, LH levels, estradiol (E2) levels, and progesterone’s levels during the menstrual cycle combined with ultrasound screening.…”

Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

“…Newer studies suggest that laparoscopic surgery as an investigative and corrective tool of the underlying pathologies prior to initiating numerous and various therapeutic attempts, should be taken into consideration for women suffering from unidentified infertility etiology, as it can greatly impact the outcome, as well as improving the overall costs of the lengthy treatment plan and ultimately the quality of life of the women going through this journey towards child conceiving [ 181 ]. The same view on laparoscopic investigation prior to concentrating on assisted reproduction techniques is shared when focusing on mild male factor infertility cases, especially if previous failed IVF have attempts attributed to an infertility etiology [ 182 ].…”