Publication:

Diagnostic and therapeutic yield of combined hysterolaparoscopy in female infertility: a prospective observational study from Central India

Background Combined diagnostic hysterolaparoscopy (DHL) permits evaluation of intra uterine and extrauterine causes of infertility and selected corrective procedures during the same sitting. This study evaluated its diagnostic and therapeutic yield in relation to preoperative transvaginal sonography (TVS) and hysterosalpingography (HSG).

Methods This prospective observational study included 250 consecutive consenting women with infertility who underwent hysteroscopy, laparoscopy, and chromopertubation at a tertiary-care hospital in Central India from 1 March 2024 to 28 February 2025. Direct endoscopic findings were compared with TVS and HSG findings. Appropriate paired and between-group statistical tests were applied.

Results Primary infertility was present in 159 women (63.6%) and secondary infertility in 91 (36.4%). Combined DHL detected at least one abnormality in 213 women (85.2%), compared with 138 (55.2%) on TVS and 112 (44.8%) on HSG (both p<0.001). Hysteroscopy detected intrauterine abnormalities sin 129 women (51.6%) versus 45 (18.0%) on TVS, while laparoscopy detected tubo-pelvic abnormalities in 110 (44.0%) versus 86 (34.4%) on HSG (both p<0.001). In unadjusted comparisons, polycystic ovarian morphology and endometriosis/endometrioma were more frequent in primary infertility, while synechiae, hydrosalpinx, tubal pathology, and bilateral tubal block were more frequent in secondary infertility. Same-sitting procedures were performed in 135 women (54.0%).

Conclusions Combined DHL had a high abnormality-detection yield and led to a same-sitting procedure in 54.0% of selected women. It is best used selectively after non-invasive evaluation, as a complementary, lesion-directed procedure at her than a replacement for first-line imaging.