Evaluation and Management of Mechanical Infertility Using Minimal Access Surgery

Abstract

Introduction: Tubal and peritoneal pathologies are one of the most common causes responsible for female infertility corresponding to 30%–40% of cases. The use of combined hysteroscopy and laparoscopy (HL) has now become a gold standard in the diagnosis and subsequent treatment of these pathologies. Aim of the Study: (1) Evaluation of infertile females for tubal and uterine pathologies using combined HL as a diagnostic aid. (2) To find out the feasibility of providing therapeutic management concurrently. Materials and Methods: This study was conducted from 2018 to 2019 on 100 married females in the age group of 20–45 years with primary or secondary infertility of > 1-year duration after ruling out male causes and hormonal causes of infertility. Laparoscopy and hysteroscopy were performed in a single session; methylene blue dye testing was done. Any relevant positive findings on hysterolaparoscopy were noted, and the incidence of different lesions was calculated. Surgical procedures wherever possible were carried out and tabulated accordingly. Results: Out of all patients subjected to combined HL, positive findings were noted in 76% of the cases. The most common hysteroscopic pathology in our patients was intrauterine adhesions (9.2%), followed by polyp (7.9%) and septum (6.6%). Similarly, on laparoscopy, the common findings were adhesions (23.7%), endometriosis (21.1%), myomas (17.1%), and hydrosalpinx (13.2%). Unilateral tubal block was seen in 15.8% and bilateral tubal block in 13.2% of the patients. Hysteroscopic procedures were done in 40.8% of the patients and laparoscopic procedures in 60.5% of the patients. Conclusion: From our study, we concluded that combined HL serves as an important diagnostic as well as a therapeutic modality in female infertility. Direct visualization of the uterine cavity and the ability to manipulate uterus and adnexa and perform any procedure required l(cannulation, septal resection, adhesiolysis etc.) all in a single session makes combined HL a far more superior tool for evaluation and treatment of infertility.