Publication:

Role of diagnostic hysterolaparoscopy in the evaluation of infertility

Background Infertility has become nowadays not only a medical, but a social problem as well. None of the laboratory findings alone is conclusive in diagnosing infertility. Diagnostic hysterolaparoscopy is an accurate method of assessing and treating infertility. Direct visualization of abdominal and pelvic organs in hysteroscopy and laparoscopy allows a definite diagnosis where clinical examination and less invasive techniques such as ultrasound, SSG and HSG fail to identify the problem. The main objective of study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centers.

Methods A prospective hospital based study was carried out in two tertiary care centers (Sheth V.S. General Hospital and Smt. S.C.L. Municipal Hospital) over a period of 2 years from July 2013 to June 2015. Hysterolaparoscopy was done in 300 patients. Women aged 20-40 years with normal hormone profile without male factor infertility were included.

Results Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 35% of the cases, significant hysteroscopy findings were noted in 17% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesions (12%) in primary and secondary infertile patients respectively, on hysteroscopy, intrauterine septum was found as the commonest abnormality in both the groups.

Conclusions Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions and subseptate uterus, which are usually missed by other imaging modalities.