Diagnostic Laparoscopy to assess tubal and pelvic pathology in patients of subfertility: A retrospective analysis

Objective To assess the prevalence and varieties of pelvic pathology found during laparoscopic investigation of infertility in a large cohort of women. Study design Retrospective, descriptive study. Setting University Hospital. Materials and methods The medical records of women who underwent laparoscopy for the investigation of infertility between January 2001 and December 2010 were reviewed. Results 4103 cases were reviewed. 2980 (72.6%) were diagnosed with pelvic pathology while 1123 (27.4%) had a normal pelvis. Overall, the most common pathology was PCOS (25.5%), followed by pelvic adhesions (23.5%), tubal pathology (16.0%), endometriosis (7.9%), ovarian cyst(s) (7.0%), congenital anomalies (6.9%), and myoma (5.0%). Among 2944 (71.8%) women with primary infertility, 70.6% had pelvic pathology, the most common abnormality being PCOS (30.6%), followed by pelvic adhesions (16.5%), tubal pathology (14.4%), endometriosis (9.2%), ovarian cyst(s) (6.9%), congenital anomalies (7.9%), and myoma (5.6%). Among 1159 (28.2%) women with secondary infertility, 77.8% had pelvic pathology, the most common abnormality being pelvic adhesions (39.6%), followed by tubal pathology (19.8%), PCOS (13.7%), ovarian cyst(s) (7.2%), endometriosis (4.9%), congenital anomalies (4.8%), and myoma (3.9%). Conclusion The high prevalence of pelvic pathology found during laparoscopy confirms its role in the investigation and management of infertile women. While not all infertile women will need IVF, they will still benefit from laparoscopy either to assist natural conception, to direct them to IVF-ET, or to enhance IVF results.

Background: Infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,. This study was planned to compare the frequency of different causes of infertility undergoing diagnostic laparoscopy and chromopertubation. Objective: To compare the frequency of different causes of infertility in women with primary and secondary infertility undergoing diagnostic laparoscopy Material and Methods: This study was a five-year retrospective observational study conducted in Lady Reading Hospital from January 2017 to December 2021. Data record of all patients who underwent diagnostic laparoscopy and chromopertubation for infertility was retrieved. Basic demographic features like age, type of infertility (primary or secondary) and duration of infertility were noted in all patients. During the procedure, any abnormal features of the uterus, ovaries, and fallopian tubes including patency, uterosacral ligaments, Pouch of Douglas, and any adhesions or endometriosis were also noted. Findings were recorded on proforma.IBM SPSS Version 22.0 was used for data analysis Results: In this study, we got a record of 1945 patients, n=1427 (71.9%) patients had primary infertility while n=518 (26.1 %) had secondary infertility, mean age was 29.73± 4.37. Regarding causes of infertility, abnormal findings in fallopian tubes were more common in patients with secondary infertility (31.46% versus 23.05% of cases of primary infertility),an ovarian abnormality was observed in 16.88% in primary versus 22.58 in secondary infertility, endometriosis was seen in 27.99% of cases of secondary infertility in comparison to 22.42% in primary infertility, fibroid uterus was noted in 11.5% of primary infertility and 8.5 % of cases of secondary infertility. Conclusion: Tubal pathology and endometriosis are the most frequent abnormalities found in patients with secondary infertility, and uterine abnormalities are more common in patients with primary infertility.

Introduction: Infertility, one of the most common conditions confronting gynecologists, is defined as inability to conceive after 1 year of regular unprotected sexual intercourse. Infertility is a problem of global proportion. In recent years, laparoscopy has been considered as important tool in diagnosis and treatment of infertility. Objective: To detect the diagnostic efficacy of laparoscopy in uterine, tubal and ovarian pathologies. Material and Methods: This was a retrospective study carried out in Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from July to December 2022 in collaboration with Department of Radiodiagnosis & Department of Pathology. Study included sixty one cases of both primary and secondary infertility in women. We included only those infertile ladies whose husbands showed normal semen analysis. A detailed clinical history especially marital and obstetric history of the patients was taken. Through gynaecological examination was done and all necessary investigations (baseline endocrinal investigations, post coital study, cervical mucus study, ovulation study, post menstrual HSG) were done before laparoscopic examination. Written consent form was taken from all the patients. Results: Among 61 patients, 39 (63.9%) belonged to primary infertility and 22 (36.1%) were of secondary infertility. In primary (58.9%) and secondary infertility (59.1%) maximum number of patient belonged to age group of 21-25 years followed by 21-25 years age group in primary infertility and 31-36 years age group in secondary infertility. Peritubal or peri-ovarian adhesions were present in 15 cases of primary infertility and 5 cases of secondary infertility. Thirty four patients (56.67%) had normal ovaries. Conclusion: Due to safety and cost effectiveness, laparoscopy is considered as important diagnostic tool for evaluation of cause of infertility in women and for effective treatment decisions.

Objective:To nd out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. Study Design:Acase series. Place and Duration of Study: Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, August 2018 to July 2019. Methodology:All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic ndings regarding primary and secondary infertility. Results: Fifty infertile women underwent laparoscopy during the study period, 32 (64%) had primary infertility while 18 (36%) secondary infertility. Eight (25.0%) patients with primary and 2 (11.1%) patients with secondary infertility had no visible abnormality. The common nding was tubal blockage in 7 (21.9%) and 6 (33.3%) cases of primary and secondary infertility respectively. Five (15.6%) cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 4 (12.5%) cases with primary infertility and 2 (11.1%) cases with secondary infertility. Pelvic inammatory disease (PID) was found in 1 (3.1%) and 2 (16.7%) cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 (6.3%) cases with primary infertility and 4 (22.2%) cases with secondary infertility. Fibriod was found in 2 (6.3%) and 1 (5.6%) cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 (6.3%) cases with primary infertility while none was found in cases of secondary infertility. Conclusion: Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only

Infertility is a public health problem in developed and developing countries. Diagnostic laparoscopy is a generally accepted procedure to detect pelvic organ pathologies affecting fertility. This study was undertaken to find out the tubal pathology contributing to primary and secondary infertility by laparoscopic examination. The study was carried out in the department of Gynaecology and Obstetrics, BIRDEM during the period of January 2001 to December 2001. The study group comprised of 100 cases of infertile patients of age between 20 to 40 years. Sixty seven percent patients had primary infertility and 33% patients had secondary infertility. Size and shape of the uterus was normal in 69% cases and bicornuate uterus was found in 2% cases. Out of total cases, 71% and 69% had normal right and left fallopian tubes respectively. Patency of right and left fallopian tube was normal in 90% and 89% cases respectively while 11% and 10% had peritubal adhesions. Laparoscopy examination is an important tool for evaluation of tubal pathology contributing to infertility and might play a major role in infertility management. DOI: http://dx.doi.org/10.3329/imcj.v7i2.20110 Ibrahim Med. Coll. J. 2013; 7(2): 38-40

Should a semen analysis be ordered in a man with history of previous fertility?

Background: Infertility affects approximately 10% of the population.One third (30%) of infertility can be attributed to male factors, and about one third (30%) can be attributed to female factors. In about 20% of cases infertility is unexplained, and the remaining 10% of infertility is caused by a combination of problems in both partners. Diagnostic laparoscopy is the gold standard in diagnosing tubal pathology and other intra‐abdominal causes of infertility. Objective: To evaluate the role of laparoscopy in the diagnosis of infertility. Study design: Retrospective study. Setting: Department of Obstetrics and Gynaecology, K.S. Hegde Charitable hospital, Mangalore from July 2006 to December 2007. Methods: Fifty infertile women underwent diagnostic laparoscopy during the study period. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Laparoscopy was scheduled in the proliferative phase of the menstrual cycle. Results: Of thefifty women studied, 34 (64%) had primary infertility while 16 (36%) secondary infertility. Laparoscopy revealed normal findings in 8 (23.5%) with primary infertility and 2 (12.5%) with secondary infertility. The common finding was tubal blockage in 9 (26.5%) and 4 (25%) of primary and secondary infertility respectively. Polycystic ovaries were detected in 4 (11.7%) of primary infertility and 1 (6.25%) in secondary infertility. Endometriosis was found in 5 (14.7%) with primary infertility and 1 (6.25%) in secondary infertility group. Pelvic inflammatory disease (PID) was found in 1 (2.9%) and 3 (18.7%) of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 3 (8.8%) with primary infertility and 3 (18.7%) in secondary infertility. Fibroids were found in 3 (8.8%) and 1 (6.25%) in primary and secondary infertility respectively. Ovarian cyst detected in 1 (2.9%) in primary infertility and 1(6.25%) in secondary infertility. Conclusion: The most common cause responsible for infertility was tubal occlusion in both primary and secondary infertility group. Laparoscopy is necessary in establishing diagnosis of female infertility.

Background: Infertility prevails in good number in our society, causing social disharmony and distress. Laparoscopy is now a very effective tool for diagnosis and evaluation of female infertility.
 Method: This cross sectional study was conducted in Infertility Unit of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, from July, 2012 to June 2014. The aim of the study is to identify common pelvic pathologies of female factor infertility by laparoscopy so that early detection and treatment modalities can be instituted. Total 230 sub fertile patients attending OPD were selected for this study. Patients with DM, HTN, known case of hypothyroidism and male factor infertility was excluded from study. Detailed clinical history of every patient was recorded on a pre-set questionnaire and physical examination was performed. Laparoscopy was scheduled in proliferative phase of menstrual cycle.
 Results: Among the study subjects, 130 (56.5%) had primary infertility while 100 (43.5%) secondary infertility. On laparoscopy, 64.4% patient had normal sized uterus, 31 % had bulky uterus. Two patients had bicornuate uterus in secondary infertility cases. Uterus was restricted in mobility in 41% of patients due to endometriosis, pelvic inflammatory disease (PID) or previous pelvic surgery. Fibroid uterus was detected in 30(13%) and 10(4.3%) cases of primary and secondary infertility cases respectively. Bilateral tubal blockage was present in 16(6.9%) and 17 (7.4%) cases of primary and secondary infertility respectively. Forty (17.4%) cases of primary infertility were detected as polycystic ovaries (PCO) which was 30(13%) in cases of secondary infertility. Endometriosis was found in total 9(3.9%) patient in both the groups. Pelvic adhesion was found in 22(9.5%) and 21 (9.1%) cases of primary and secondary infertility respectively.
 Conclusion: Laparoscopy could diagnose a substantial number of portion pelvic pathology. In a developing country like Bangladesh, earlier and justified intervention with laparoscopy can save time and expense of infertility treatment by diagnosing pelvic factor responsible for infertility.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 29-35

Aim: To evaluate the factors behind primary and secondary infertility in females through diagnostic laparoscopy. Study design: Cross sectional study Place and duration: This study was conducted at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020 Methodology: The present study is a cross sectional study conducted at at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020. A total of 115 females were included in the study and they all underwent diagnostic laparoscopy after setting strict inclusion criteria. Data was recorded on proforma and analyzed on IBM SPSS version 22. Primary and secondary infertility frequency was calculated and analyzed. Result: A total of 115 infertile women were considered in the study and results were recorded after performing diagnostic laparoscopy on all of the participants. Total 74 (64.35%) had primary infertility and 41 (35.65%) reported secondary infertility. Total 19 (25.67%) participants of primary infertility and 5 (12.19%) participants with secondary infertility showed no abnormality. The most common abnormality found was tubal blockage in 17 (22.97%) women of primary infertility and 13 (31.70%) women of secondary infertility. Total 11 (14.86%) patients of primary infertility were diagnosed with polycystic ovaries (PCO). PCO was absent in patients with secondary infertility. Total 9 (12.16%) cases of primary infertility and 5 (12.19%) cases of secondary infertility were diagnosed with Endometriosis. Total 2 (2.7%) cases of primary infertility and 7 (17.07%) participants with secondary infertility presented with Pelvic Inflammatory disease (PID). A total of 6 (8.10%) cases having primary infertility were observed with periovarian adhesions and Peritubal adhesions, whereas, 9 (21.95%) cases of secondary infertility were seen with these issues. Conclusion: Tubal occlusion, periovarian adhesions, peritubular adhesions, and endometriosis were the most common factors behind infertility in both primary and secondary infertility. Ovarian cyst and polycystic ovarian disease were only present in patients with primary infertility. Keywords: Diagnostic Laparoscopy, Primary infertility tubal occlusion, Secondary infertility

Objective To observe the different manifestations and differences of pelvic laparoscopy in primary and secondary infertility patients, and to clarify the application of hysteroscopy combined with laparoscopy in the diagnosis and treatment of infertility. Methods A total of 120 infertile women were enrolled in Yiwu Central Hospital from January 2015 to January 2017, of which 66 cases were primary infertility and 54 cases were secondary infertility. The infertility group was divided into 1 time, 2 times, 3 times and above according to previous maternity. Hysteroscopy combined with laparoscopy was used for pelvic exploration in infertility patients. The detection of the type of disease, pelvic adhesions, tubal fluid and treatment were analyzed. Results (1)Infertile patients were complicated with endometriosis, pelvic tuberculosis, polycystic ovary, uterine fibroids, ovarian tumors, endometrial polyps and other diseases. (2)There were 94 cases of pelvic adhesions(78.3%), 50 cases of primary infertility(75.8%), and 44 cases in Secondary infertility group(81.5%). (3) Primary infertility adhesion ratio of 75.8%, secondary infertility adhesion ratio of 81.5%, the proportion of adhesions in maternal 1 time patients was 80.6%, the proportion of adhesions in pregnant women with 2 times was 83.3%, the proportion of adhesions in pregnant women with more than three times was 90.0%, and the median adhesion rate was 36.4% in the secondary infertility cases, the proportion of severe adhesion was 45.5%. (4) Intraoperative treatment of tubal fluid examination conducted in 240 strips.The probability of recanalization of the primary infertility group was 17.78%, and the probability of recanalization was 18.75%. Conclusion (1) Pelvic adhesion is an important factor in causing infertility, primary infertility patients also have a greater proportion of pelvic, fallopian tube disease.(2) Repeated maternal history significantly increased pelvic, fallopian tube disease, which is an important factor caused the increased incidence of secondary infertility. Key words: Infertility, female; Hysteroscopy; Laparoscopy; Tissue adhesions; Pelvic inflammatory disease; Fallopian tube diseases

BACKGROUND Infertility is a multidimensional health problem with social and economic consequences. Infertility affects about 10 - 15 % of reproductive age couples. 1 Hysterolaparoscopy is safe and effective method to diagnose infertility. The purpose of this study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in Chalmeda Anand Rao Institute of Medical Sciences. METHODS A prospective hospital-based study was carried out in Chalmeda Anand Rao Institute of Medical Sciences over a period of 1 year from August 2019 to July 2020. Hysterolaparoscopy was done in 100 patients. Women aged 20 - 40 years with normal hormone profile without male factor infertility were included. RESULTS 100 patients with infertility were undertaken, 70 (70 %) women had primary infertility and the remaining 30 (30 %) had secondary infertility. Ovarian pathology (30 %), endometriosis (23 %), tubal pathology (14 %) and pelvic adhesion (14 %) were the most well-known anomalies recognized in laparoscopy in both primary and secondary infertility. Uterine septum was major intrauterine pathology seen in two gatherings. Out of 12 patients having uterine malformations, most regular uterine malformation in both the gatherings was 9 uterine septum and 2 unicornuate and 1 was hypoplastic uterus. CONCLUSIONS Combined hysterolaparoscopy is a safe, effective, and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which is missed by routine pelvic examinations and basic investigations done for evaluation of infertility. Hysterolaparoscopy gives the added advantage of doing a therapeutic procedure in the same sitting. Thus, hysterolaparoscopy may be considered as gold standard and definitive investigative day-care procedure for evaluation of female infertility. KEY WORDS Hysteroscopy, Infertility, Laparoscopy

  Infertility is a common public health problem especially in sub-Saharan Africa. Hysterosalpingography (HSG) has for many years been employed in the evaluation of infertility for assessment of tubal patency and tubal or intrauterine lesions. The objective of this paper is to evaluate the structural abnormality of the fallopian tubes in infertile women with hysterosalpingography in Tikur Anbessa Hospital (TAH). Retrospective analysis of clinical records of 331 women with infertility problem who underwent HSG in TAH from March 1, 2003 to March 31, 2006 was done. Infertility unit in the Obstetrics and Gynecology Department in collaboration with Radiology Department compiled the data. Primary infertility is more common (60%) than secondary infertility (40%). Tubal pathologies accounted for 261 (78.9%) of the total sample. The age group of 23 to 27 years and 33 to 37 years accounted for the majority of cases of primary and secondary infertility respectively. Tubal pathology accounted for 78.9% of infertility in this study. HSG should continue serving as a valuable means of investigation (imaging modality) in infertile women of reproductive age group related to tubal pathology.   Key words: Infertility, hysterosalpingography, tubal pathologies

To find out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A case series. Department of Obstetric and Gynaecology, Liaquat University Hospital (LUH), Hyderabad, rom January 2006 to December 2007. All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic findings regarding primary and secondary infertility. Fifty infertile women underwent laparoscopy during the study period, 32 (64%) had primary infertility while 18 (36%) secondary infertility. Eight (25.0%) patients with primary and 2 (11.1%) patients with secondary infertility had no visible abnormality. The common finding was tubal blockage in 7 (21.9%) and 6 (33.3%) cases of primary and secondary infertility respectively. Five (15.6%) cases of primary infertility were detected as polycystic ovaries (PCO) which was not found in cases of secondary infertility. Endometriosis was found in 4 (12.5%) cases with primary infertility and 2 (11.1%) cases with secondary infertility. Pelvic inflammatory disease (PID) was found in 1 (3.1%) and 2 (16.7%) cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 (6.3%) cases with primary infertility and 4 (22.2%) cases with secondary infertility. Fibriod was found in 2 (6.3%) and 1 (5.6%) cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 (6.3%) cases with primary infertility while none was found in cases of secondary infertility. Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only.

72: Office Hysteroscopy Followed By Transvaginal Ultrasound: A Comprehensive Test for Infertility in the Office Setting

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.