Role of diagnostic laparoscopy in infertility
Background: Use of diagnostic and therapeutic laparoscopy in infertility has been a focus of attention in recent years and demonstrated to be very effective method in evaluating these cases. The main objective of the study was to detect the diagnostic efficacy of laparoscopy in uterine, pelvic and ovarian pathologies.
Methods: This study was conducted from April 2017 to August2019.This prospective study included 50 infertile women and it was conducted at Vandana nursing home and IVF clinic. After thorough gynecological examination, necessary investigations were made and written consent form was taken from them before laparoscopy. The patients were kept fasting for 24 hours before the laparoscopy and the procedure was performed under general anaesthesia. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results.
Results: Among 50 patients, 36 were of primary infertility cases and 14 were of secondary infertility. In primary infertility maximum number of patients belonged to age group of 21-25 years where as secondary infertility was under the age group 26–30 years and above 31 years of age. Longest duration of infertility in primary was 16 years and that in secondary was 17 years. Out of 50 patients, 7 (14%) had absolutely normal laparoscopic findings. Among the various pathologies observed, tubal pathology contributed the most (44%), followed by ovarian (30%), pelvic (18%) and uterine (16%) pathologies.
Conclusions: Laparoscopy is safe and cost-effective method and should be considered as prime diagnostic tool for evaluating the etiology of infertility in women and for effective treatment decisions.
Hammond MG. Evaluation of the infertile couple. Obstet Gynecol Clin North Am. 1987;14(4):821-30.
Shaheen R. Infections & Infertility. Indian J Praise Doc. 2005;2(5):11-2.
Jose Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007;75(6):849-856.
Howkins, Bourne. The pathology of conception. In: Shaw’s textbook of Gynaecology. 13th edition. Elsevier; 2004.
Mehmood S. An audit of diagnostic laparoscopies for infertility. J Surg Pak. 2003;8:8.
Rehana R, Majid SS. Aetiological factors of infertility. J Postgrad Med Inst. 2004;18:166-171.
Moayeri SE, Lee HC, Lathi RB, Westphal LM, Milki AA, Garber AM. Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis. Fertil Steril. 2009;92(2):471-480. doi: https://doi.org/10.1016/j.fertnstert.2008.05.074
Wani QA, Ara R, Dangroo SA, Beig M. Diagnostic Laparoscopy in the Evaluation of Female Factors in Infertility in Kashmir Valley. Int J Women’s Health Reproduction Sci. 2014;2(2):48-57. doi: https://doi.org/10.15296/ijwhr.2014.08.
Panchal DN, Shah A. Role of diagnostic laparoscopy in infertility. Int J Reprod Contracept Obstet Gynecol. 2016;5(12):4180-4183. doi: http://dx.doi.org/10.18203/2320-1770.ijrcog20164002.
Rutstein SO, Macro ORC, Shah IH. Infecundity, infertility, and childlessness in developing countries. DHS Comparative Reports No 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization, 2004. Available at https://www.who.int/reproductivehealth/publications/infertility/DHS_9/en/.
Speroff L, Marc AF. Female infertility: Clinical Gynecologic Endocrinology and Infertility. 7th edition. Jaypee Brothers Medical Publishers; 2005;1013-1068.
Cohen SM. Operative Laparoscopy and Hysteroscopy. 2nd edition. Michigan: Churchill Livingstone; 1996.
Duignan NM, Jordan JA, Coughlan BM, Logan‐Edwards R. One thousand consecutive cases of diagnostic laparoscopy. BJOG:Int J Obstet Gynaecol. 1972;79(11):1016-1124. doi: https://doi.org/10.1111/j.1471-0528.1972.tb11880.x.
Templeton AA, Kerr MG. An assessment of laparoscopy as the primary investigation in the subfertile female. BJOG: Int J Obstet Gynaecol. 1977;84(10):760-762. doi: https://doi.org/10.1111/j.1471-0528.1977.tb12489.x.
Sharma R, Sharma V. The infertile woman; a study of 120 cases J Indian Med. Assoc.1991;82(2) 13-32.
Nakade KD, Deokar SS. Comparative evaluation of laparoscopy and hysterosalpingography in infertility. J Obstet Gynaecol India. 1993;43:784-787.
Sortey KD Dhurandhar J. Laparoscopic evaluation of infertility - J Obstet Gynaecol India. 1989;39:809-811.
Dor J, Homburg R, Rabau E. An evaluation of etiologic factors and therapy in 665 infertile couples. Fertil Steril 1977;28(7):718-722. doi: https://doi.org/10.1016/s0015-0282(16)42671-3.
Chakraborti DK, Kole SK, Diagnostic laparoscopy in gynaecologic disorders. J Obst Gynecol. 1990;40-262-265.
AG Bhide. Laparoscopic evaluation of the etiopathology of infertility. J Obstet Gynecol India. 1990;40:680-682.
Kumari C, Sinha S. Laparoscopic evaluation of tubal factors in cases of infertility. J Obstet Gynaecol India. 2000;50:67-70.
Merchant RN. Treatment of polycystic ovary disease with laparoscopic low-watt bipolar electrocoagulation of the ovaries. J Am Assoc Gynecol Laparoscop. 1996;3(4):503-508. doi: https://doi.org/10.1016/s1074-3804(05)80158-6.
Gowri BV, Chandravathi PL, Sindhu PS, Naidu KS. Correlation of skin changes with hormonal changes in polycystic ovarian syndrome: A cross-sectional study clinical study. Indian J Dermatol. 2015;60(4):419. doi: https://doi.org/10.4103/0019-5154.160505.
Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451-451. e1-11. doi: https://doi.org/10.1016/j.ajog.2013.02.040.
Hutchins CJ. Laparoscopy and hysterosalpingography in the assessment of tubal patency. Obstet Gynecol. 1977;49(3):325-327.