Laparoscopy and hysteroscopy in patients of infertility in a rural set up

Authors

  • Amogh Chimote Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), DMIMS (DU), Sawangi (Meghe),Wardha, Maharashtra,India
  • Swarnalata Samal Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), DMIMS (DU), Sawangi (Meghe),Wardha, Maharashtra,India
  • Chella Hariharan Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), DMIMS (DU), Sawangi (Meghe),Wardha, Maharashtra,India
  • Riju Angik Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital (AVBRH), DMIMS (DU), Sawangi (Meghe),Wardha, Maharashtra,India

Keywords:

Laparoscopy, Hysteroscopy, Infertility

Abstract

Background: Infertility is a life crisis. The number of couples seeking medical help for infertility is increasing dramatically. The incidence of infertility in any community varies between 5-15%.  This problem is compounded by the trend towards delayed child bearing to achieve socio-economic, educational and professional goals and the rapidly diminishing availability of adoptable infants. These couples are relatively well informed. Diagnostic laparoscopy & hysteroscopy have emerged as an accurate method of assessing, evaluating and treating infertility. Direct visualization of the abdominal and pelvic organs in laparoscopy allows a definitive diagnosis to be made in many conditions where clinical examination and less invasive techniques such as ultrasound and HSG fail to identify the problem.

Methods: A prospective study conducted in Department of Obstetrics and Gynaecology, JNMC, AVBRH, and DMIMS. 60 women with H/O infertility for ≥ 1 year were enrolled and subjected to diagnostic tests. Cases with diagnosed tubal blockage, active lower genital tract infection, suspected pregnancy, tuberculosis and high risk medical disorders were excluded.

Results: Endometriosis 32%, ovarian disorder (22%), Intra uterine synechiae and cervical stenosis together 14%, tubal block (6%) tubal pathology (delayed spill) (18%).

Conclusions: Laparoscopy and hysteroscopy detects pelvic pathology which can appear to be normal on other imaging modalities and provides direct visualization as well as treatment of the diseased condition. Laparoscopy and hysteroscopy combined together are valuable technique for complete assessment of female factors of infertility patient and should be used early in the diagnostic work up in cases of infertility.

References

Aral SO, Cates W Jr. The increasing concern with infertility. Why now? JAMA. 1983;250(17):2327-31.

Shaw W, Howkins J, Bourne GL. Shaw's textbook of gynaecology. Churchill Livingstone;1971.

International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009* F. Zegers-Hochschild,a G. D. Adamson,b J. de Mouzon,c O. Ishihara,d R. Mansour,e K. Nygren,f E. Sullivan,g and S. Vanderpoel,h for ICMART and WHO Fertility and Sterilit Vol. 92, No. 5, November 2009 0015-0282/09.

Laparoscopy and Hysteroscopy, A guide for Patients, ASRM, 2012.

Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertility and Sterility. 95(7):2171-9.

National Institute for Health and Clinical Excellence: Fertility: assessment and treatment for people with fertility problems. Nice clinical guideline 156 2013.

Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril. 2011;95(7):2171-9.

Mol BW, Collins JA, Burrows EA, van der Veen F, Bossuyt PM. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod. 1999;14(5):1237-42.

Sharma S, Mittal S, Aggarwal P. Management of infertility in low resource countries. Bjog. 2009;116 Suppl 1:77-83.

Widge A, Cleland J. The public sector's role in infertility management in India. Health Policy Plan. 2009;24(2):108-15.

Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-74.

Brusco GF, Arena S, Angelini A. The role of diagnostic hysteroscopy in infertile women. Minerva Ginecol. 2001;53(5):313-9.

Parveen S, Khanam M. Role of combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy for evaluation of female subfertility factors. Journal of surgery Pakistan (International) 2010;15(1):44-47.

Vaid K, Mehra S, Verma M, Jain S, Sharma A, Bhaskaran S. Pan endoscopic approach "hysterolaparoscopy" as an initial procedure in selected infertile women. J Clin Diagn Res. 2014;8(2):95-8.

Mettler L, Wendland EM, Patel P, Caballero R, Schollmeyer T. Hysteroscopy: an analysis of 2-years' experience. Jsls. 2002;6(3):195-7.

Talib W. Infertile female: laparoscopic evaluation. Professional Med J. 2007;14(4)562-6.

Wallace WH, Kelsey TW. Human ovarian reserve from conception to the menopause. PLoS One. 2010;5(1):e8772.

Menken J, Trussell J, Larsen U. Age and infertility. Science. 1986;233(4771):1389-94.

Templeton A, Morris JK, Parslow W. Factors that affect outcome of in-vitro fertilisation treatment. Lancet. 1996;348(9039):1402-6.

Botting B, Dunnell K. Trends in fertility and contraception in the last quarter of the 20th century. Popul Trends. 2000;(100):32-9.

Sharma R, Sharma V. The infertile women: a study of 120 cases. J Indian Med Assoc. 1991;89(2):31-2.

Gleicher N, Barad D. Unexplained infertility: does it really exist? Hum Reprod. 2006;21(8):1951-5.

Boricha Y.G., Sharma R.K. Laparoscopy in 50 infertile couples: Prospective study. International Journal Of Medical And Clinical Research. 2011;2(2):63-6.

Fuentes A, Devoto L. Infertility after 8 years of marriage: a pilot study. Hum Reprod. 1994;9(2):273-8.

Lasmar RB, Barrozo PR, Parente RC, Lasmar BP, da Rosa DB, Penna IA, et al. [Hysteroscopic evaluation in patients with infertility]. Rev Bras Ginecol Obstet. 2010;32(8):393-7.

Nayak P, Mahapatra P, Mallick J, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci 2013;6(1):32-4.

Haider G, Rani S, Talpur S, Zehra N, Munir A. Laparoscopic evaluation of female infertility J Ayub Med Coll Abbottabad. 2010;22(1):136-8.

Sharma R, Sharma V. The infertile women: a study of 120 cases. J Indian Med Assoc. 1991;89(2):31-2

Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol. 1999;181(4):952-7.

Goynume G, Yetim G, Gokcen O, Karaaslan I, Wetherilt L, Durukan B. Hysterosalpingography, Laparoscopy or both in the diagnosis of tubal disease In infertility. World Journal of Laproscopic Surgery. 2008;1(2):23-6.

Naz T, Hassan L, Gulmeen, Nighat F, Sultan S. Laparoscopic evaluation in infertility. J Coll Physicians Surg Pak. 2009;19(11):704-7.

Endometriosis: Does It Cause Infertility?, Factsheet. American Society for Reproductive Medicine. Revised 2012.

Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160(8):784-96.

Shokeir TA, Shalan HM, El-Shafei MM. Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients. J Obstet Gynaecol Res. 2004;30(1):9-14

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Published

2017-02-06

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Original Research Articles