Diagnostic laparoscopy in female infertility

Entessar Abdel Jabbar,Raida M Al-Wazzan

doi:10.33899/mmed.2009.8898

Abstract

Objective: To highlight the importance of laparoscopic evaluation in the etiology of infertility and to evaluate the etiology in primary and secondary infertility. Methods: This retrospective study included 1233 patients complaining of infertility, 919 patients had primary infertility and 314 patients had secondary infertility. All had been subjected to diagnostic laparoscopy at the Infertility Center in Al-Batool Teaching Hospital, Mosul. Results: Laparoscopy diagnosed pelvic abnormality in 87.27% of infertile patients which was statistically significant difference comparing to no abnormality detected in 12.73%. The ratio of positive findings in secondary infertility was significant in comparison with the positive findings in primary infertility. Single pelvic abnormality detected during laparoscopy among infertility patients was seen in 75.09% of cases and it was statistically different from multiple pelvic abnormality: 24.91%, and it was highly significant among primary infertility patients (77.24%) and among secondary infertility patients (30.87%). Among all infertile patients, ovarian factor was the most common (66.83%) followed by tubal factor (22.03%), endometriosis (4.46%), pelvic inflammatory disease (2.85%), pelvic adhesion (2.10%) and uterine fibroid (1.73%). Ovarian factor was highly significant in primary infertility while tubal factor and pelvic inflammatory disease were the highly significant in secondary infertility. Multiple pelvic pathology identified by laparoscopy showed the tubal factors associated with poly cystic ovary in 29.49% of cases (31.66% in primary infertility and 25% in secondary infertility with no significant statistical difference). Pelvic inflammatory disease associated with other pelvic abnormality 34.09% was highly significant among secondary infertility patients. Congenital uterine abnormalities was not seen alone, it was seen associated with other causes among primary infertility patients (9 cases 0.72%). Conclusion: Diagnostic laparoscopy is a valuable technique and is a mandatory invasive investigation for complete assessment of female infertility before the couple progresses to infertility treatment especially where assisted reproductive techniques were not available.

Highlights

MethodsThis 5 years retrospective study was done at the Infertility Center in Al-Batool Teaching Hospital where files of infertile women who have undergone diagnostic laparoscopy from January 2001 to January 2005 were recorded and included in the study
Diagnostic laparoscopy is not recommended as a first line screening test, it should be considered in patients with a history suggestive of endometriosis, previous pelvic inflammatory disease or previous pelvic surgery
Diagnostic laparoscopy was decided to the infertile patient who had one or more of the following: history suggestive of endometriosis, previous pelvic inflammatory disease, previous pelvic surgery, abnormal hysterosalpingography or there was greater than 36 months period of infertility

Summary

Methods

This 5 years retrospective study was done at the Infertility Center in Al-Batool Teaching Hospital where files of infertile women who have undergone diagnostic laparoscopy from January 2001 to January 2005 were recorded and included in the study. All infertile patients underwent evaluation with history from male and female and clinical examination, as well as evaluation of ovulation, tubal patency (most cases) and male factor by seminal fluid analysis. Diagnostic laparoscopy was decided to the infertile patient who had one or more of the following: history suggestive of endometriosis, previous pelvic inflammatory disease, previous pelvic surgery, abnormal hysterosalpingography or there was greater than 36 months period of infertility. The tubes were visualized and any abnormalities were noted. Both ovaries were examined regarding their size, shape, evidence of ovulation.

Results

Discussion

Conclusion