Published: 2018-12-26

Combined hysteroscopy and laparoscopy in evaluation of female infertility

Nikita Gandotra, Syed Masuma Rizvi, Preeti Sharma


Background: Infertility has always been one of the most elusive symptom complexes that perplex the best gynecologists and affects about 10-15% of reproductive age couples.

Methods: This descriptive study was conducted in the Postgraduate Department of Obstetrics and Gynaecology at Government Medical College, Jammu  for a period of 18 months in which 100 infertile females attending  OPD for infertility workup were subjected to detailed relevant history taking followed by physical examination. Diagnostic hysteroscopy and laparoscopy along with laparoscopic chromopertubation was carried out after written informed consent including minimal therapeutic interventions if required.

Results: Out of 100 patients included in the study, 67 (67%) presented with primary infertility and 33 (33%) presented with secondary infertility. Combined laparoscopy and hysteroscopy was normal in 13% (13) of cases. Out of 100 patients, abnormal laparoscopic findings were noted in 73% of patients: Endometriosis ( 13%),Polycystic ovaries (12%), Unilateral tubal block (11%), Pelvic inflammatory disease (9%).Abnormal hysteroscopic findings were noted in 47% of patients: Submucous myoma (8%),unilateral ostial block (8%),Endometrial polyp (7%), Hyperplasic endometrium (7%), Cervical stenois (6%).Most common cause of infertility in present study on Combined hysteroscopy and laparoscopy was Endometriosis (13%) followed by Polycystic ovaries (12%),Uterine myoma (12%) out of which 5% myomas were diagnosed on laparoscopy and 8% on hysteroscopy and 1%  had myoma diagnosed on both hysteroscopy and laparoscopy. In the primary infertility group most, common finding was Polycystic ovaries (16.4%)  followed by Endometriosis (14.9%) and uterine myoma (14.9%) while in patients suffering from secondary infertility, most patients had Bilateral tubal block (18.2%), Pelvic inflammatory disease (12.1%), Unilateral tubal block (12.1%), intrauterine adhesions (12.1%).

Conclusions: Combined Hysteroscopy and Laparoscopy is a quintessential tool that provides cost-effective, comprehensive and single set-up diagnostic aid in infertile patients.


Hysteroscopy, Infertility, Laparoscopy

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WHO-ICMART revised glossary. Fertility and Sterility and Human Reproduction 2009

Richard O. Burney, Daniel J. Schust Mylene W.M. Yao INFERTILITY Chapter 30: BEREK and Novak’s Gynaecology 14th ed.

National, Regional, Global trends in Infertility Prevalence since 1990 WHO study: A systematic study of 277 health surveys: 2012.

Marc A. Fritz and Leon Speroff. Female infertility Chapter 27:Clininical Gynecologic Endocrinology and Infertility 8th Edition

Parveen S, Khanam M. Role of combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy for evaluation of female sub fertility factors. J Surg Pak. 2010;15(1):44-7.

Abdelazim IA, Elezz AA. Complimentary roles of hysteroscopy and saline infusion hysterosonography in uterine cavity assessment before in vitro fertilization. Asian Pac J Reprod. 2012;1(1):1316.

Nayak KP, Mahapatra CP, Mallick JJ, Swain S, Mitra S, Sahoo J. Role of diagnostic hysterolaparoscopy in the evaluation of infertility: A retrospective study of 300 patients J Hum Reprod Sci.2012;6(1):32-34.

Shetty KS, Shetty H, Rai S. Laparoscopic evaluation of tubal factor in cases of infertility. Int J Reprod Contracept Obstet Gynecol.2013;2(3):410-3

Singh R, Singh S, Yadav P, Goyal M. Role of diagnostic laparohysteroscopy in the management of infertile females. J Evolution Med Dental Sci. 2013;2(12):1792-8.

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 Clinic Diagnos Res. 2014;Vol 8(2):95-8.

Shah SJ, Shah AC, Trivedi YN. Study of combined Laparoscopic and Hysteroscopic findings in 100 cases of Infertility. NHL J Med Sci. 2014;3(2).

Wani Q, Ara R, Dangroo AS, Beig M. Diagnostic laparoscopy in the evaluation of female factors in infertility in Kashmir Valley. Int J Women’s Health Reproduct Sci.2014;2(3).

Chimote A, Samal S, Hariharan C, Angik R. Laparoscopy and hysteroscopy in patients of infertility in a rural set up. Int J Reprod Contracept Obstet Gynecol. 2015;4(2):322-8.

Mondal SK, Dutta TK. A ten-year clinicopathological study of female genital tuberculosis and impact on fertility. JNMA J Nepal Med Assoc. 2009;48(173)52-7.