DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150056

Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients

Jasmina Begum, Sunita Samal, Seetesh Ghose, Pallavee Palai, Rupal Samal

Abstract


Background: The aim of this study was to find out different causes of female infertility with diagnostic approach using laparoscopy and hysteroscopy.

Methods: This retrospective study was done in the Department of Obstetrics and Gynecology of MGMCRI, Puducherry. 135 infertile women aged 19-40 years were enrolled retrospectively for combined laparoscopy and hysteroscopy. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Patient with active genital tract infection and any contraindication to hysterolaparoscopy procedure were excluded. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Data was statistically analyzed using SPSS software version 15; a result of P <0.05 was considered as significant.

Results: Out of 135 cases, 65% patients had primary and 34.8% patients had secondary infertility. As a whole pelvic pathology were confirmed in 54.5% and intrauterine pathology in 20.7% patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was tubal pathology 40%, followed by pelvic inflammatory disease 18.5%, ovarian pathology 8.1% pelvic endometriosis 4.4%, and uterine pathology 4.4% in infertile patients. In hysteroscopy, the incidence of uterine anomaly was 9.6% and intrauterine septum is the most common anomaly with a mean incidence of approximately 84% in both the group of infertile patients.

Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable abnormalities in pelvis, tubes and the uterus which are usually missed by other imaging modalities.  


Keywords


Hysteroscopy, Laparoscopy, Infertility

Full Text:

PDF

References


Jahan S. Role of laparoscopy in infertility: review article. Birdem Med J. 2012;2:99-103.

Howkins, Bourine. The pathology of conception. In: Howkins, Bourine, eds. Shaw’s Text Book of Gynaecology. 13th ed. US: Elsevier; 2004.

Hucke J, De Bruyme T, Balan P. Hysteroscopy in infertility - diagnosis and treatment including falloscopy. Gynecol Obstet. 2000;20:13-20.

Wallach EE. The uterine factor in infertility. Fertil Steril. 1972;23:138-58.

Brown SE, Coddington C, Schnorr J, Toner JP, Gibbons W, Oehinger S. Evaluation of outpatient’s hysteroscopy, saline infusion hysterosonography and hysterosalpingography in infertile women: A prospective randomized study. Fertil Steril. 2000;74:1029-34.

Puri S, Jain D, Puri S, Kaushal S, Deol SK. Laparohysteroscopy in female infertility: a diagnostic cum therapeutic tool in Indian setting. Int J App Basic Med Res. 2015;5:46-8.

Mooney SD, Milki AA. Effect of hysteroscopy performed in the cycle preceding controlled ovarian hyperstimulation on the outcome of in vitro fertilization. Fertil Steril. 2003;76:637-8.

Grimbizis GF, Camns M, Tariazis BC, Bonits JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod. 2001;7:161-74.

Godinjak Z, Idrizbegovic E. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women? Bosnian J Basic Med. 2008;8:44-7.

Homer HA, Li TC, Cooke ID. The septate uterus a review of management and reproductive outcome. Fertil Steril. 2000;73:1-4.

Zhang E, Zhang Y, Fang L, Li Q, Gu J. Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china. Mater Sociomed. 2014 Jun;26(3):156-7.

Hourvitz A, Ledee H, Gervaizw A, Fernandez H, Frydman R, Olivenness F. Should diagnostic hysteroscopy in women with normal hysterosalpingography? Reprod Biomed. 2002;4:256-60.

Jansen FW, Vredevooged CB, Van Uzlen K, Hermans J, Trimbas JB, Trimbas Kemper TC. Complications of hysteroscopy: a prospective multicoated study. Obstet Gynecol. 2000;96:266-70.

Corson SL, Cheng A, Gotman JN. Laparoscopy in the normal infertile patient: a question revised. J Am Assoc Gynecol Laparosc. 2000;7:317-24.

Tanahatoe SJ, Hompes PG, Lambalk CB. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility workup programme in patients undergoing interuterine insemination? Hum Reprod. 2003;18:8-11.

Cundiff G, Car BR, Marshborn PB. Infertile couples with a normal hysterosalpingogram reproductive outcome and its relationship to clinical and laparoscopic finding. J Reprod Med. 1995;40:19-24.

Tsuji I, Ami K, Mujazaki A, Hujinami N, Hoshiai H. Benefit of diagnostic laparoscopy for patients with unexplained infertility and normal hysterosalphingography finding. Tohaku J Exp Med. 2009;219:239-42.

Nayak KP, Mahapatra P, Mallick JJ, Swain S, Mitra S, Sahoo J. Role of diagnostic hysterlaparoscopy in the evaluation of infertility: a retrospective study of 300 patients. J Hum Reprod Sci. 2013;6:32-4.

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.