Publication:

The role of combined diagnostic hysterolaparoscopy in unexplained infertility

Background The two approaches for evaluating the female reproductive system are hysteroscopy and laparoscopy. Laparoscopy is becoming a standard component of infertility evaluation by virtue of its capability to visualize and manipulate the uterus, the ovaries and fallopian tubes. Hysteroscopy has become an important investigative tool for discovering possible causes of female infertility by examining the uterine cavity. The goal of this study was to examine the role of hystero-laparoscopy in diagnosis women with unexplained infertility.

Methods A total of 202 cases who were 20-35 years old women with 1ry or 2ry unexplained infertility were studied in this cross-sectional observational analytical study. All patients were subjected to: evaluation (physical, abdominal and bimanual), routine laboratory investigations, basic investigations (documentation of sound ovarian factor: hormonal assays and pelvic ultrasonography, normal hysterosalpingography, normal husband semen analysis) and hysterosalpingography (HSG) was reviewed or completed.

Results Abnormal laparoscopic was significantly higher in secondary cases compered to primary infertility (p=0.043). Abnormal combined hystero-laparoscopic was significantly higher in 2ry infertile cases compered to 1ry infertile cases (p=0.006). Pairwise comparison between 1ry and 2ry infertility was statistically significant difference (P=0.004).

Conclusions The percentage of abnormalities found during laparoscopy and hysteroscopy, are difficult to be visualized by the use of other noninvasive methods. While a thorough history, thorough examination, and early studies such as pelvic ultrasonography can all lead to the suspicion of numerous abnormalities, a considerable percentage of abnormalities may go undetected.