Response to Marik

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To the Editor: I read Dr. Marik’s letter with interest. There is no debate on the issue of the efficancy of laparoscopy in the investigation of infertility in women, although the question when to perform it is controversial. The difference in the percentages of pathological findings can be explained not only by the different stages at which the procedure is performed, but also by the population on which it is performed. In our population, the percentage of sexually transmitted diseases and endometriosis is quite low. We suggest that centers tailor their laparoscopy rate to the specific populations they serve. Population at high risk for tubal disease should likely have a higher rate of diagnostic laparoscopies performed. Similarly, populations at low risk for tubal disease may not require a high rate of diagnostic laparoscopies. Along with the many advantages of diagnostic laparoscopy as Dr. Marik described, there are a few complications associated with this procedure. These include injury to abdominal organs and to major blood vessels and complications due to the anesthesia (1–3). It can be assumed that these complications occur more often than are reported. One must remember that laparoscopy can reveal the anatomical state of the fallopian tubes but cannot give any information on their functional state (i.e., there may be a problem getting the ovum to or through the tubes). On the other hand, it is a known fact that there have been spontaneous pregnancies in women who have been diagnosed, using laparoscopy, as suffering from bilateral adhesions. Today, with the option of in vitro fertilization (IVF), it is often hard to persuade a woman with a normal human serum gonadotropin to undergo an invasive procedure such as laparoscopy. These women often prefer to have IVF, with a good chance for a pregnancy. The efficiency of laparoscopy should not be measured according to the number of pathologies it discovers, but according to the improvement of the outcome from performing the procedure.