Hysterolaparoscopy (pan-endoscopy) in the management of female infertility in Nigeria: A report of 230 cases

Abstract

Background: Hysterolaparoscopy has emerged as a better evaluation tool than laparoscopy and dye test in cases of infertility because of the ability to evaluate intra uterine lesions. Objective: To examine the role of Hysterolaparoscopy in the management of infertile women who were seen in 2 Fertility/ Gynaecological Endoscopy units in Nigeria. Methods: A cross sectional descriptive survey of the first 230 infertile women who were managed in the fertility and Gynaecological endoscopy units of Nnamdi Azikiwe University Teaching Hospital Nnewi Anambra State, Nigeria and Holy Rosary Specialist Hospital & Maternity, Onitsha, Nigeria. Data were analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA). Result: The mean age of the women was 35.6+/- 5.9 years and the mean duration of infertility was 4.6+/- 2.7 years. More than half (53.9%. n=43) of the women had secondary infertility. Ninety -eight (42.61%) of the women had done a pelvic surgery in the past and pelvic ultrasound study was abnormal in 95(41.3%) of them. Abnormal hysteroscopy was found in 152 (66.1%) of the women and comprised mainly of intrauterine adhesions (41.%; n=95), endometrial polyps (20.%; n= 46), submucous fibroids (16.1%; n=37) and mullerian duct abnormalities (14.8%; n=34). Other findings were lost IUCD (6.1%'n=14), retained fetal bone (2.6%; n=6) and incarcerated omentum (2.2%; n=5). Abnormal laparoscopy findings were seen in 171 (74.4%) of the women. The main abnormal laparoscopy findings were tubal pathologies (161, n=70.0%), pelvic adhesions (39.6%, n=91), polycystic ovaries (33.0%; n=76), and endometriosis (8.8%, n=19). Tubal pathologies comprised mainly tubal occlusions (56.5%, n=130), hydrosalpinx (41.7%, n= 96) and plastered tubes (25.7%, n=59). Bilateral tubal occlusion was seen in 46 (20.0%). Conclusion: Hysterolaparoscopy is an effective tool for evaluating tuboperitoneal and intrauterine lesions among infertile women. There is a need to develop the capacity for this investigative modality.