Laparoscopic evaluation of tubal factor in cases of infertility
Keywords:
Chromopertubation, Infertility, Laparoscopy, Tubal factorsAbstract
Background: Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The evaluation of the fallopian tube is necessary to determine the management plan for infertility. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. The aim of this study was to determine the role of laparoscopy in the evaluation of tubal factor in infertile women.
Methods: Fifty women presenting with complaints of primary and secondary infertility were investigated for tubal disease by laparoscopy at K. S. Hegde Charitable Hospital, Mangalore, from January 2007 to July 2008. Tubal patency was tested by chromopertubation using Methylene blue dye.
Results: Thirty four (68%) patients were in primary infertility group while 16 (32%) patients were in secondary infertility group. 88% women were in the age group of 21 to 35 years. In 64% of women, the duration of infertility was between 1 to 5 years whereas 32% cases had been infertile for 6 to 10 years. Tubal pathology was detected in 64.7% cases of primary infertility and 68.7% cases of secondary infertility. Bilateral tubal occlusion was found in 8% and unilateral occlusion in 28% cases.
Conclusion: Laparoscopy is an effective diagnostic tool for evaluation of tubal pathology. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.
References
Wallter JB, Isreal MS. Healing of specialized tissues. Text book of pathology, chapter 10, pages 135-136.
diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update. 2001;7:547-55.
Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2008 Nov;90(5 Suppl):S144-9.
Cheong YC, Laird SM, Li TC, Shelton JB, Ledger WL, Cooke ID. Peritoneal healing and adhesion formation and reformation. Human Reproduction 2001;7:556-66.
Bigatti G, Boeckx W, Gruft L, Segers N, Brosens I. Experimental model for neoangiogenesis in adhesion formation. Hum Reprod 1995;10:2290-4.
Cheong YC, Laird SM, Li TC, Shelton JB, Ledger WL, Cooke ID. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol 2009;147:3-8.
Zareian Z, Zareian P. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct; 128(1-2):267-9.
Shahzia Shakeel, Azra Batool, Nilofer Mustafa. Peritoneal non- closure at caesarean section- A study of short term post-operative morbidity. Pakistan Armed Forces Medical journal 2008;30:9648.
Chanrachakul B, Hamontri S, Herabutya Y. A randomized comparison of post cesarean pain between closure and nonclosure of peritoneum. Eur J Obstet Gynecol Reprod Biol 2002;101:31-5.
Lyell DJ, Chaughey AB, Hu E, Daniels K. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol. 2005;106(2):275-80.
