DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174423

Hysterolaparoscopy in the evaluation and management of female infertility

Ramalingappa C. Antaratani, Harsha B.

Abstract


Background: To study the role of hysterolaparoscopy in the evaluation and management of female infertility.

Methods: A retrospective study of the 677 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2011 to December 2016 at Karnataka Institute of Medical Sciences, Hubli and Sushruta Multispeciality hospital, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interven-tions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized.

Results: Out of 677 cases, 74% patients had primary, 26% patients had secondary infertility. As a whole pelvic pathology was confirmed in 59.5% and intrauterine pathology in 22.3% patients by hysteroscopy. The most common laparoscopic abnormality detected was Polycystic ovaries (27.1%), followed by pelvic adhesions (18.7%). Tubal block comprised 8.1% whereas distorted uterus by fibroid in 6.2% and pelvic endometriosis in 8.7%. In hysteroscopy, the incidence of uterine anomaly was 54 (7.9%). Septate uterus is the most common with a mean incidence of approximately 37 (67.8%).

Conclusions: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities.


Keywords


Hysteroscopy, Infertility, Laparoscopy

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References


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

Howkins J, Bourine GL. The pathology of conception. In: Howkins J, Bourine GL, editors. Shaw’s text book of gynaecol-ogy. 13th ed. New York: Elsevier; 2004.

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

Begum J, Samal S, Ghose S. Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients. Int J Reprod Contracept Obstet Gynecol. 2015;4:584-8.

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

Brown SE, Coddington C, Schnorr J. Evaluation of outpa-tient’s hysteroscopy, saline infusion hysterosonography and hysterosalpingography in infertile women: a prospective ran-domized study. Fertil Steril. 2000;74:1029-34.

Puri S, Jain D, Puri S. 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 out-come of in vitro fertilization. Fertil Steril. 2003;76:637-8.

Godinjak Z, Idrizbegovic E. Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in infertile women? Bosn 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. Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china. Mater Sociomed. 2014;26(3):156-7.

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

Jansen FW, Vredevooged CB, Van Uzlen K. Complications of hysteroscopy: a prospective multicoated study. Obstet Gyne-col. 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 rela-tionship to clinical and laparoscopic finding. J Reprod Med. 1995;40:19-24.

Tsuji I, Ami K, Mujazaki A. Benefit of diagnostic laparo-scopy for patients with unexplained infertility and normal hys-terosalphingography finding. Tohaku J Exp Med. 2009;219:239-42.

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