Role of combined hystero-laparoscopy in the evaluation of female infertility as one step procedure: a retrospective analytical study of 250 patients

Background: Infertility is defined as a failure of a couple to conceive after having regular, unprotected sexual intercourse for one year. To determine the role of combined hystero-laparoscopy in the evaluation of female infertility patients with no significant clinical/ ultrasonography findings and to calculate the incidence of various pathological conditions in the female reproductive tract leading to infertility.Methods: This retrospective analytical study was done in 250 patients with primary and secondary infertility. It was conducted at our hospital from December 2014 to November 2015. We assessed the role of combined hystero-laparoscopy female infertility patients with no significant clinical/ ultrasonography findings and calculated the incidence of various pathological conditions in the female reproductive tract leading to infertility.Results: Out of 250 patients, 165 had primary and 85 had secondary infertility. The patients in secondary infertility group were older compared to primary group. The most common intrauterine pathology in both the groups was uterine septum. Next most common intrauterine lesion was endometrial polyp. Adnexal adhesions and endometriosis were the most common abnormalities detected in laparoscopy in both groups. The prevalence of unilateral and bilateral tubal block was almost equal in both groups. The operative interventions, both hysteroscopic and laparoscopic were also noted.Conclusions: Combined hystero-laparoscopy is a safe, effective and reliable method in comprehensive evaluation of female infertility. It is a very useful tool in detecting the correctable missed pelvic abnormalities in patients with the normal ovulation and semen analysis. It will also help us to take decision regarding the need for ART in required patients, thus avoiding further emotional and financial trauma to the couples

Hysterolaparoscopy as a comprehensive diagnostic and therapeutic tool in modern art

Background: Infertility affects about 10-15% of reproductive age couple and is increasing globally. None of the laboratory findings alone are conclusive in diagnosing infertility. The ability to visualize and simultaneously treat the identified pathology makes hysterolaparoscopy an essential part of infertility management. Aim of the study was to evaluate hysterolaparoscopy as a comprehensive diagnostic and therapeutic tool in female infertility management. Objective of the study was to evaluate various etiological factors in infertility and the therapeutic interventions done during hysterolaparoscopy. Methods: A cross-sectional study of 250 cases over one year from October 2021 to September 2022 at a teritiary care hospital. Women with primary or secondary infertility aged between 20-40 years were included. Patients with contraindications for general anaesthesia and active pelvic infection were excluded. Results: Out of 250 patients, 195(78%) had primary infertility and 55(22%) had secondary infertility. In primary infertility group 69% and in secondary infertility group 87.7% had abnormal laparoscopy findings. The most common laparoscopic abnormality is tubal factor both in primary infertility (58%) and secondary infertility (58%) group and on hysteroscopy, endometritis is the commonest abnormality in both. Conclusions: In experienced hands, hysterolaparoscopy is a very safe operation. The abnormalities of pelvic and uterus can be diagnosed and also resolved in hysterolaparoscopy at the same time. Also, the future plan of management can be taken in time after the evaluation

Role of hysterolaparoscopy in management of infertility a retrospective clinical analysis

Background: Diagnosis and treatment of infertility is an elaborate process. The goal of treating clinician is to decide upon the plan of management best suited to the couple by selecting relevant investigations and procedures from available options. Objective was to determine the role of hysterolaparoscopy in the management of infertility.  Methods: This retrospective study was conducted at a tertiary canter (Department of reproductive medicine and surgery) over a period of 12 months-January 2019 to December 2019. Women aged 20-40 years with primary or secondary infertility, except male factor infertility, undergoing hysterolaparoscopy were included. Results: Out of 41 cases, 71.84% patients had primary infertility. Common laparoscopic abnormalities were adhesions (36.5%) and endometriosis (17.07%) Hysteroscopy revealed polyps (9.7%) and intrauterine synechia (4.8%) as common pathologies. The diagnosed pathologies were dealt surgically in the same sitting. Plan of infertility treatment could be outlined in all patients based on intraoperative findings. Conclusion: Hysterolaparoscopy serves both diagnostic and therapeutic purpose. Various pelvic, peritoneal, tubal, endometrial and uterine factors can be diagnosed and treated at the same time. The clinician has to be well versed and skilled in selecting and performing the appropriate surgery. Clinical information gained from hysterolaparoscopy helps in decision making and designing individualized, evidence-based treatment plan can for the patients

Role of diagnostic hysterolaparoscopy in the evaluation of female infertility

Background: Infertility is defined by WHO as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. The prevalence of infertility is about 10%-15% of reproductive age couples. Female factor is responsible for 40-45% of etiology of infertility. Aim of the study was to evaluate the role of diagnostic hysterolaparoscopy in female infertility at a tertiary care centre.Methods: This is a retrospective hospital based study done at a tertiary care hospital attached to JSS Medical College, Mysuru between January 2017 and December 2018. Infertile women with primary or secondary infertility in the 18-40 years age group, with normal hormonal profile and no known male factor were included.Results: In our study, primary infertility was found in 77% of the 96 patients and secondary infertility was found in 23% of patients. In primary infertility, ovarian pathology was the most common finding while Endometriosis was the most common finding in secondary infertility group. 77 % patients were found to have bilaterally patent tubes while remaining had unilateral or bilateral blockage. On hysteroscopy, endometrial polyps were the commonest hysteroscopic finding in both groups.Conclusions: Combined hystero-laparoscopy is a safe, effective and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which may have been missed by routine examination and thereby helps in optimal management of female infertility

Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients

Background: The aim of this study was to find out different causes of female infertility with diagnostic approach using laparoscopy and hysteroscopy.Methods: This retrospective study was done in the Department of Obstetrics and Gynecology of MGMCRI, Puducherry. 135 infertile women aged 19-40 years were enrolled retrospectively for combined laparoscopy and hysteroscopy. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Patient with active genital tract infection and any contraindication to hysterolaparoscopy procedure were excluded. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Data was statistically analyzed using SPSS software version 15; a result of P <0.05 was considered as significant.Results: Out of 135 cases, 65% patients had primary and 34.8% patients had secondary infertility. As a whole pelvic pathology were confirmed in 54.5% and intrauterine pathology in 20.7% patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was tubal pathology 40%, followed by pelvic inflammatory disease 18.5%, ovarian pathology 8.1% pelvic endometriosis 4.4%, and uterine pathology 4.4% in infertile patients. In hysteroscopy, the incidence of uterine anomaly was 9.6% and intrauterine septum is the most common anomaly with a mean incidence of approximately 84% in both the group of infertile patients.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable abnormalities in pelvis, tubes and the uterus which are usually missed by other imaging modalities.

A prospective study on the role of Hysterolaparoscopy in the evaluation of infertility

Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important

Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

Background: Infertility is one of the most common problem for which couple seeks medical attention. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients.Methods: For this retrospective study, patient with the diagnosis of primary infertility were recruited. Patients admitted between the periods 2014 to 2016 were included. Pertinent data related to infertility were collected from the case records and entered in predesigned performa.Results: Patients with primary infertility 246 (82%) diagnosed to have pelvic pathology. The most common cause of infertility was ovarian 122 (36.63%), Uterine 66 (19.82%), tubal 84 (25.22%) and unexplained infertility in 103 (30.93%) women. Patients with PCOS 76 (22.82%) and endometriosis 46 (13.81%) treated with drilling and endometriotic cystectomy. In 32 (9.60%) of patients hysteroscopic cannulation was done. For distal tubal blockage fimbrioplasty was performed in 38 (11.41%) of women. Pelvic adhesions diagnosed in 26 (7.80%) women. patients diagnosed with uterine septum 42 (12.61%) required hysteroscopic septal resection. During the evaluation of infertility 70 (21%) of women diagnosed to have incidental pelvic pathology treated according to pathology.Conclusions: Hysterolaparoscopy is emerging as a valuable technique for complete assessment of female infertility and also helps in treatment according to the cause

Reproductive surgery in infertility

Background: With recent improvements in the assisted reproductive technology (ART), there has been a growing tendency that bypasses diagnostic laparohysteroscopy and proceeds directly to ART. Therefore, the value of diagnostic laparohysteroscopy in current fertility practice is under debate. In the present study, we evaluated the usefulness of diagnostic laparoscopy and hysteroscopy for patients with infertility.Methods: This retrospective study was conducted at Safal Hospital, Nagpur from January 2017 to July 2017. 80 patients were selected for this study who had undergone diagnostic laparohysteroscopy for infertility.Results: In present study, out of 80 patients studied, 66.25% patients had normal hysteroscopy findings, in 10% of patients, tubal cannulation was done for cornual block, in 6.25% of patients, resection of uterine septum was done, adhesiolysis for asherman’s syndrome was done in 5% of patients, endometrial polyp was removed in 5% of patients, 2.5% patients had resection of submucous fibroid. In 5% patients, cervical dilatation for fibrosis was done in 5% of patients. 68.75% had normal laparoscopy findings, in 8.75% of patients, ovarian drilling for PCOS was done, adhesiolysis for peritubal adhesions was done in 6.25% patients, fulguration of endometriosis was done in 6.25% patients, salpingectomy for hydrosalpinx was done in 5% patients, aspiration of ovarian cyst was done in 2.5% patients.Conclusions: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities

Role of hysterolaparoscopy in the diagnosis and management of infertility

Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility

Is hysterolaparoscopy a real theranostic approach for anatomical barriers in female fertility? A future argument

Background: Hysterolaparoscopy is a modality that provides the real time abdomino-pelvic view during diagnosis in infertile female patients and any pathology is noticed can be tackled at the same time. So we investigate the theranostic application of hysterolaparoscopy in structural causes of female infertility in present study.Methods: Authors prospectively evaluate 157 female patients (mean age 27.7 years) diagnosed as infertile, underwent hysterolaparoscopy during diagnostic work-up.  All the enlisted patients fulfilled the criteria of infertility. The noticed anatomical abnormalities in the hysterolaparoscopy were tackled at the same time if possible.Results: Of the 157 infertile female patients, 93 (~59.2%) were of primary infertility and remaining 64 (~41.8%) were secondary infertility patients. Hysterolaparoscopy showed abnormalities in 125/157 (~85.0%) patients. The detected hysterolaparoscopic abnormalities were distributed in 77/93 (~82.8%) primary and 48/64 (~75.0%) secondary infertility patients. Of the 125 patients with abnormal hysterolaparoscopic findings, 121 (~96.8%) experienced for active therapeutic interventions. All of the 48 secondary infertility patients with hysterolaparoscopic abnormalities experienced for active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 (~94.8%) experienced active intervention. Only four patients with streak ovaries and hypoplastic uterus, few tiny fibroids and adenomyosis did not undergo for active hysterolaparoscopic intervention.Conclusions: Authors concluded that hysterolaparoscopy has a better theranostic approach for the anatomical barriers of female fertility so it can be performed in the initial phases of the infertility diagnostic work-up