Does Diagnostic Laparoscopy Have Value in Unexplained Infertile Couple? A Review of the Current Literature

Abstract

Context: Correct timing of diagnostic laparoscopy for unexplained infertility management remains as a debate for clinicians. A cost-effective strategy of diagnostic laparoscopy utilization for unexplained infertile patients is much needed. Evidence Acquisition: Detailed evaluation of the articles extracted from a Pubmed and Cochrane database search using unexplained infertility and diagnostic laparoscopy word group between 1993 and 2012 was the preparation style of this review. Results: Diagnostic laparoscopy should be considered when there are abnormal hysterosalpingography results, a past history of pelvic infection, pelvic surgery and/or unexplained secondary infertility during management of an unexplained infertile couple. Currently, omitting diagnostic laparoscopy following a normal hysterosalpingography in couples suspected to have unexplained infertility and proceeding with ovulation induction for several cycles before referring to assisted reproductive techniques are recommended. The additional value of diagnostic laparoscopy after a normal hysterosalpingography was found to be very low prior several attempts of intrauterine insemination. In the absence of pathological ?ndings precluding fertility during an unexplained infertility evaluation, routine diagnostic laparoscopy for infertility evaluation is not necessary because 77% of these patients become pregnant following ovulation induction and/or assisted reproductive techniques treatment. Conclusions: Omitting diagnostic laparoscopy after a normal hysterosalpingography in infertile patients with unexplained infertility and without risk factors for pelvic pathologies related to infertility is reasonable because the majority became pregnant after several cycles of ovulation induction, and/or assisted reproductive techniques treatment while diagnostic laparoscopy is indicated when pelvic endometriosis and/ or tubal pathology is strongly suspected.