Unexplained infertility: laparoscopy first or art directly

AlGergawy, Adel E.; Alhalwagy, A.; Shehata, Ayman; Salem, Hesham A.; Alnaby, A. Abd

doi:10.1016/j.fertnstert.2016.07.132

Cited by 5 publications

(5 citation statements)

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“…Thirty out of the 62 (48.38%) of these women achieved a natural conception within the first post-operative year. Similar data provided from this study are also provided from two other studies investigating the role of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalpingography [9,14]. The chaotic nature of endometriosis related infertility depicts the rather ambiguous stance of the scientific community on the consensus regarding the initial infertility investigation, and whether it should include screening for endometriosis on the grounds of unexplained infertility.…”

Section: Discussionsupporting

confidence: 69%

“…In the present study, we prospectively report on the natural conception rate following laparoscopic investigation and correction of underlying pathologies-when required-for patients with unidentified infertility aetiology following basic infertility investigation and RIF [14]. Our results indicate that the great majority of the patients (57.94%) referring to our clinic as patients of unidentified infertility aetiology with at least three failed IVF attempts, were diagnosed with endometriosis following laparoscopic investigation, as the sole infertility etiology factor.…”

Section: Discussionmentioning

confidence: 99%

“…The value of diagnostic laparoscopy in current fertility practice is debatable for more than a decade, and the existing evidence point to the practice that diagnostic laparoscopy should not be performed generically and horizontally as a routine step prior to IVF treatment [12,13]. Recent studies on the value of diagnostic laparoscopy for infertility patients of unidentified aetiology demonstrate that undiagnosed endometriosis, or other abnormalities of pelvic floor such as adhesions, or undiagnosed tubal diseases, namely hypo plastic tubes, may be the underlying causes of infertility [9,14]. All the aforementioned pathologies, and particularly endometriosis, severely compromise fertility as well as the efficiency of IVF treatment leading to RIF [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, with respect to the possible asymptomatic nature of endometriosis presenting in 20%–25% of the cases, infertile women suffering from undiagnosed endometriosis could be misdiagnosed and mismanaged as unexplained infertility patients [19,20]. Studies under the school of thought that diagnostic laparoscopy should be performed prior to IVF treatment in patients categorized as unexplained infertility contribute significantly in highlighting the importance of successful diagnosis in the era of precision medicine [9,14]. Furthermore, published studies indicate that laparoscopic diagnosis and correction of undiagnosed endometriosis leads to an increase of spontaneous pregnancy rates, rendering IVF treatment redundant.…”

Section: Introductionmentioning

confidence: 99%

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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

Pantou¹,

Simopoulou

Sfakianoudis³

et al. 2019

JCM

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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.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pantou¹,

Simopoulou

Sfakianoudis³

et al. 2019

JCM

View full text Add to dashboard Cite

show abstract

“…In cases of unexplained infertility, laparoscopic surgery provides diagnostic findings that are helpful in the overall management of the cases and enable some patients to become pregnant without the physical, psychological, and financial burden associated with ART. In cases treated with laparoscopic surgery prior to ICSI, the chance of success is not affected but even increased by repositioning the ovary correcting tubo-ovarian relationship [13].…”

Section: Discussionmentioning

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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