Reassessment of the laparoscopy role in the investigation of infertility and treatment plan determination

Abstract

To reassess the importance of laparoscopy in infertility investigation treatment plan determination. The study enrolled 237 patients with infertility duration > 1 year. A complete investigation was performed in all patients and male factor was evaluated by medical history and semen analysis. In the case of normal semen or mild-to-moderate oligozoospermia, the female evaluation included screening for infection diseases, transvaginal ultrasound, hormone parameter, hysterosalpingography, and laparoscopy. The final treatment plan was decided according to laparoscopy findings and any modification of the initial proposal was taken as treatment change. At laparoscopy, normal pelvic cavity was found in 5.5%, endometriosis in 76.4%, pelvic adhesion in 17.2%, ovarian adhesion in 24.8%, peritubal adhesion 15.2%, unilateral tubal occlusion in 21.1%, bilateral tubal occlusion in 5.5%, and tubal sacculation, kinking, constriction, or fibrosis in 46.3%. Operative interventions during laparoscopy were endometriosis ablation/excision (74.6%), adhesiolysis (27.4%), and endometrioma cystectomy (4.6%). Laparoscopy determined to switch the initial treatment plan in 85 (35.8%) patients. Pelvic cavity abnormalities, primarily endometriosis, have high prevalence in infertile Brazilian women. Laparoscopy provides a precise diagnosis of tuboperitoneal factor and may switch the initial treatment plan in at least one third of patients.