Experience with combined use of laparoscopy and hysteroscopy for the investigation of infertility

Abstract

Objective To present our experience with the combined use of laparoscopy and hysteroscopy as the primary investigation for tubal and uterine factors in infertility. Design This is a prospective study of patients investigated for infertility using hysterolaparoscopy for evaluation of infertility. Setting Assisted Conception and Infertility Unit at Newham General Hospital, London. Subjects These were 117 consecutive patients, of whom 53 (45.3%) had primary and 64 (54.7%) had secondary infertility. Results Laparoscopic examination revealed at least one abnormal finding in 77 (66.3%) patients and 29 (26.6%) patients had abnormal findings at hysteroscopy. Concurrent laparoscopy and hysteroscopy were completed in 108 patients in whom eight (7.4%) had abnormal hysteroscopic findings but normal laparoscopic findings. Five out of six (83.3%) patients who had intrauterine adhesions had a history of previous uterine surgery. Out of 67 patients with abnormal laparoscopy, 21 (31.3%) had abnormal findings at hysteroscopy compared with eight out of 41 (20.0%) with normal laparoscopy (χ2 = 1.678; P > 0.05). There was no significant difference in the prevalence of intrauterine abnormality detected hysteroscopically between the patients with primary and secondary infertility (χ2 = 2.899; P > 0.05). Conclusions The findings of this study suggest that routine use of hysteroscopy adds little information to the management of infertile patients and its concomitant use should be based on the history or physical examination findings. However, certain intrauterine abnormalities do not have warning signs. Until the significance of these intrauterine abnormalities in infertility is proven, routine use of hysterolaparoscopy for infertility investigation will remain a controversial issue.