Endoscopic surgery and diagnosis in infertility management and assisted reproductive techniques

Abstract

Objective To describe the role of diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, and diagnostic and surgical hysteroscopy in infertile patients, with special attention to techniques of assisted reproduction. Design A personal review. Setting The Regional Center for Ambulatory Surgery and Infertility, Florence, Italy. Subjects Infertile patients undergoing assisted reproduction procedures. Interventions Diagnostic laparoscopy, salpingoscopy, surgical laparoscopy, diagnostic and surgical hysteroscopy. Main outcome measures and results Diagnostic laparoscopy was considered mandatory in infertile patients when there was suspected tubal, ovarian or peritoneal disease interfering with the capacity to reproduce. The value of other methods as alternatives to laparoscopy and dye insufflation in the management of infertile patients was also evaluated. Salpingoscopy was also reviewed, with the conclusion that this technique is very important in the infertility work up because it allows a prognosis concerning the possibility of conception according to the status of the mucosal folds. Diagnostic hysteroscopy was evaluated. This technique is an extremely reliable outpatient procedure in infertility diagnosis and it allows savings in health costs, even though, unfortunately, it is not yet widely used. The indications for and results of hysteroscopic surgery were also reviewed. Hysteroscopic operations, compared with traditional surgery, involve reduced risk, shortened hospitalization, reduced costs and better results. Considering endoscopic techniques in relation to assisted reproduction, the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients was evaluated. However, the direct involvement of endoscopic techniques in gamete retrieval and transfer was considered to give inconsistent results. Conclusion There are clear advantages in using endoscopic surgical techniques, and many traditional surgical approaches can be replaced by operative laparoscopy and hysteroscopy. Considering assisted reproduction and endoscopic techniques, we should emphasize the importance of laparoscopy and hysteroscopy in the selection and preparation of infertile patients.