Evaluation of cases of infertility by diagnostic laparoscopy
Keywords:Diagnostic laparoscopy, Infertility, Tubal block
Background: Infertility affects nearly 10-15% of couples and is an important part of clinical practice. Leading causes of infertility include tubal disease, ovulatory disorders, uterine or cervical factors, endometriosis and male factor infertility. The objective of the study was to find out different causes of female infertility with diagnostic laparoscopy.
Methods: This was a descriptive study conducted from February 2012 to November 2013. 115 patients with infertility attending the infertility clinic in OPD of Obstetrics and Gynaecology were evaluated clinically with detailed history. The necessary investigations were carried out and the laparoscopic findings were documented.
Results: There were 91 cases (79.13%) with primary infertility and 24 (20.87%) with secondary infertility. Laparoscopy revealed normal findings in 14 cases (15.38%) of primary infertility and 1 case (4.17%) of secondary infertility. Pelvic abnormality was found in 100 cases (86.95%). Tubal block was the most common pathology found in 36 cases (31.30%) followed by polycystic ovaries in 32 (27.83%) and adhesions in 24 (20.87%). Uterine anomalies were found in 3 cases (3.30%).Conclusions: Diagnostic laparoscopy is a valuable technique and a mandatory investigation, which, though invasive, is more convenient and more precise for the diagnosis of infertility. Because of its potential diagnostic as well as therapeutic benefits, all patients with infertility should undergo diagnostic laparoscopy as part of their primary workup of infertility.
Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril.1991;56(2):192-3.
Padubidri VG, Shirish DN. The Pathology of conception. In: Shaw’s Text book of Gynaecology. 12th ed. New Delhi: BI Churchill Livingstone; 1983:154-68.
LuEsley D, Baker P. Female infertility. In: Obstetrics and Gynecology- An evidence based text for MRCOG. 1st ed. India; 2004:566-573.
Maroulis G. Effect of aging on fertility and pregnancy. Seminars Reprodn Endocrinol. 1991;9:165.
Kanal P, Sharma S. Study of primary infertility in females by diagnostic laproscopy. Internet J Med Update. 2006;1(2):7-9.
Boricha Y, Sharma R, Boricha B, Sabrina M, Archana C, Narshetty J. Laparoscopy in 50 infertile couples: prospective study. Int J Med Clin Res. 2011;2(2):63-6.
Mehreen B, Batool WS, Khawaja Tahir KM. Diagnostic significance of laparoscopy in infertility and identification of various unsuspected factors associated with infertility in females. J Pharm Sci. Res. 2010;2(8):499-505.
Dechanet C, Belaisch-Allart J, Hédon B. Prognosis criteria for the management of the infertile couple, J Gynecol Obstet Biol Reprod. 2010;39(8 Suppl 2):S9-26.
Wilkes S, Chinn DJ, Murdoch A, Rubin G. Epidemiology and management of infertility: a population-based study in UK primary care. Fam Pract. 2009;26(4):269-74.
Imani B, Eijkemans M, Velde E, Habbema J, Fauser B. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropicoligoamenorrheic infertility. J Clin Endocrinol Metab.1998;83:2361.
Wass P, Waldenstrom U, Rossner S, Hellberg D. An andoid body fat distribution in females impairs the pregnancy rate of in-vitro fertilization-embryo transfer. Hum Reprod. 1997;12(9):2057-60.
Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. Int J Obst Gynecol. 2006;113:1148-59.
Goldin A, Baker W. Tuberculosis of the female genital tract. J Ky Med Assoc. 1985;83:75-6.
Singh N, Gurunath S, Suneeta M. Genital tuberculosis a leading cause of infertility in women seeking assisted conception in North India. Archives Gynecol Obstet. 2008;278(4):325-7.
Shaheen R, Subhan F, Tahir F. Epidemiology of genital tuberculosis in infertile population. J Pak Med Assoc. 2006;56(7):306-9.
Sharma J, Roy K, Pushparaj M, Kumar S, Mittal S. Laparoscopic findings in female genital tuberculosis. Archives Gynecol Obstet. 2008;278(4):359-64.
McVeigh E. Polycystic ovarian syndrome. In: Baker P, Leusley D eds. Obstetrics and Gynaecology: an evidencebased text for MRCOG. London: Oxford University Press; 2004:588-593.
Raida M, Al-Wazzan, Entessar A. Diagnostic laparoscopy in female infertility. Ann Coll Med. 2009; 35(1):58-64.
Hoffman L, Chan K, Smith B, Okolo S. The value of saline salpingosonography as a surrogate test of tubal patency in a low resource setting. Int J Fertil women Med. 2005;50:135-9.
Otolorin EO, Ojengbede O, Falase AO. Laparoscopic evaluation of the tuboperitoneal factor in infertile Nigerian women. Int J Gynaecol Obstet. 1987;25(1):47-52.
Aflatoonian A, Hassani S, Tabibnejad N. The epidemiological and etiological aspects of infertility in Yazd province of Iran. Iranian J Reprod Med. 2009;7:117-2.
Yedidya H, Eliezer H, Miriam A, Chaim Y. Diagnostic laparoscopy in primary and secondary infertility. J Assist Reprod Genetics. 1998;15(9):535-7.
Farquhar C, Brown J, Marjoribanks J. Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database of Systematic Reviews. 2012 Jun;13(6):CD001122.
Mourali M, Kawali A, Fitouhi L, Bakri P, Hmila F, Binous N, et al. Ovarian drilling in treatment of infertility with dystrophic ovaries. Medicale Tunisia. 2012;90(2):122-8.
Abu H, Al-Inany H, De Vos M, Tournaye H. Laparoscopic ovarian drilling for treatment of PCOS. Arch Gynecol Obstet. 2013;288(2):409-22.
Lee H, Lee J, Choi Y. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. Clin Exp Reprod Med. 2013; 40(1):29-32.
Lavy Y, Lev-Sagie A, Holtzer H, Revel A, Hurwitz A. Should laparoscopy be a mandatory component of the infertility evaluation in infertile women with normal hysterosalpingogram or suspected unilateral distal tubal pathology? Eur J Obstet Gynaecol Reprod Biol. Eur J Obstet Gynecol Reprod Biol. 2004;114(1):64-8.
Mol B, Collins J, Burrow E, Veen F, Bossuyt. Comparison of hysterosalpingography and laparoscopy in predicting fertiliry outcome. Hum Reprod. 1999;14:1237-42.
Nordenskjold F, Ahlgren M. Laparoscopy in female infertility. Acta Obstetriciaet Gynecologica Scandinavica. 1983;62(6):609-15.