Publication:

Evaluation of various factors in secondary infertility by diagnostic laparoscopy

Background Infertility is defined as one year of unprotected conception. It affects approximately 10-15% of couples in reproductive age group. Secondary infertility implies that at least one previous pregnancy has occurred, regardless of the outcome. Of the various factors responsible, the brunt of the problem in secondary infertility is born by tuboperitoneal factor, ovulation factor, uterine factor and past obstetric outcomes. This lead to the emergence of diagnostic laparoscopy for evaluation of pelvic pathology in secondary infertility. The objective of the study was to secondary infertility by diagnostic laparoscopy is undertaken for following purpose. Evaluation of different causes using laparoscopy. Detecting the commonest cause of secondary infertility in our place of study.

Methods This study was conducted in the Department of Obstetrics and Gynaecology at 50 married women who presented with secondary infertility at the outpatient department Sri Adichunchanagiri Hospital and Research Centre, B.G nagar, Mandya district were recruited in this study. Study was done for 2 years. Detailed clinical history with respect to duration and nature of infertility, detailed menstrual history, past obstetric history, a complete medical, surgical and gynaecological history, medications, sexual history, personal history and habits, details of previous tests and therapy for infertility if any taken. Patients were subjected to a general physical, abdominal and pelvic examination to detect any obvious pathology. The laparoscopic procedure was planned in the premenstrual period. With the help of the laparoscope, the pelvic organs are visualized and studied. Chromopertubation done with methylene blue. Later dilatation and currettage done and endometrium sent for HPE.

Results Most common age group was 25-29 years. There were 27 Cases (54%) of secondary infertility. In our study, the cases recruited for diagnostic laparoscopy had to be infertile for a minimum period of 12 months, following their recent past obstetric outcome. 23 cases (50%) of secondary infertility had a duration between 7-9 years. Of the 50 cases of secondary infertility, 24 cases (48%) had definite tubal involvement. Of the 50 cases of secondary infertility, 8 cases (16%) had ovarian involvement. In our study, tubal factors contributed largely to infertility as evidenced by the fact that it was present in 24 cases (48%). This is followed by peritoneal factor in 10 cases (20%). Ovarian factor in 8 cases (16%) and uterine factor in 5 cases (10%).

Conclusions Diagnostic Laparoscopy is now a universally accepted procedure for evaluating the intraperitoneal and peritubal causes of infertility in the female. The work up of every secondary infertile female must involve a laparoscopic evaluation after meticulously excluding the male factor.