Diagnostic Hysterolaparoscopy Research Articles

Laparoscopic and hysteroscopic findings in women with sub-fertility and tuberculosis: A case series.

Evaluation of hysteroscopic and laparoscopic findings in subfertile women predictive of tuberculosis. Retrospective case series analysis. Tertiary hospital in India. A retrospective analysis of 16 784 subfertile women who had undergone diagnostic hysterolaparoscopy (DHL) was conducted between February 2014 and June 2021. Histopathological evidence, acid-fast bacilli (AFB), culture and GeneXpert MTB/RIF assay were used to diagnose female genital tuberculosis (FGTB). Various hysteroscopic and laparoscopic findings were analysed, and a binary logistic regression assessed associations between these findings and positive diagnostic outcomes. Various hysteroscopic and laparoscopic findings correspond to tubercular manifestation. Of the 16,784 patients, 1083 had hysteroscopy and laparoscopy findings suggestive of tuberculosis, and 309 were diagnosed with FGTB based on diagnostic tests. Logistic regression identified variables strongly predictive of positive status outcomes; tuberculous abdomino-pelvic adhesions of various grades, isthmo-ampullary block, tubercle, tubo-ovarian mass, tuberculous hydrosalpinx, complete tubal destruction, tubal diverticula and rigid tube emerged as strong predictors. Logistic regression-derived predictors, alongside specific laparoscopic and hysteroscopic findings, can enhance diagnostic accuracy and clinical decision-making to start antitubercular therapy in subfertile women.

To study the role of diagnostic hysterolaparoscopy in the evaluation of infertility

To study the role of diagnostic hysterolaparoscopy in the evaluation of infertility

Analysis of the Effect of Female Genital Tuberculosis on Ovarian Reserve Parameters.

Female genital tuberculosis (FGTB) is a known cause of female infertility. Worldwide incidence is 5%-10% and annual burden in India is around 4%-7%. It is known to cause tubal and endometrial damage. However, the effect on ovarian damage is poorly known. The availability of ovarian markers has contributed to an improved understanding of ovarian reserve in FGTB. The aim of this study was to assess ovarian reserve by measuring anti-Mullerian hormone (AMH) and antral follicle count (AFC) amongst infertile women and analyse the effect of GTB on ovarian reserve parameters. This was a prospective study at a tertiary referral centre for infertility for 18 months. A total of 133 infertile women who underwent diagnostic hysterolaparoscopy and cartridge-based nucleic acid amplification test testing of an endometrial biopsy were included in the study. AMH and AFC of all the infertile women were assessed and compared between cases with and without FGTB. Independent t-test was used to find the outcome differences in the distribution of values. P < 0.05 was considered statistically significant. Fifty-eight (43.6%) cases were diagnosed with FGTB (Group I), and 75 (56.3%) cases were without FGTB (Group II). The mean AMH level 1.88 ng/ml (±1.52) and mean AFC 9.0 (±5.50) were significantly lower (P < 0.001) in Group I than in Group II with AMH 3.57 ng/ml (±2.93) and AFC 12.50 (±6.0). In women with prolonged infertility and low ovarian reserve, FGTB should be ruled out. Early diagnosis and treatment of GTB may prevent further decline of ovarian reserve and improve the reproductive outcome.

Identification of Factors Contributing to Primary Female Subfertility by Diagnostic Hystero-Laparoscopy: An Experience of Private Hospital

Background: Management of subfertility is influenced by the diagnosis of its causative factor. Combined diagnostic hystero-laparoscopy has emerged as an effective procedure in identifying causative factors of female subfertility. Objectives: This study aimed to identify contributory factors to primary female subfertility by diagnostic hystero-laparoscopy. Methods: This descriptive study was conducted at the Department of Obstetrics and Gynecology of Hameed Latif hospital, Lahore, Pakistan from December 2021 to May 2022. Data was collected from 344 women with female primary subfertility, undergoing combined diagnostic hystero-laparascopy. All the demographic data along with identified causative factors (tubal blockade, cervical Os stenosis, endometrial polyp, uterine septum, uterine fibroid, endometriosis, peri tubal adhesions and polycystic ovaries) during the procedure were recorded in predesigned study proforma. Data were analyzed through SPSS software 23. Results: Mean age of the patients was 25±5.0 years and the mean duration of subfertility was 3.8+0.55 years. Two hundred and eighty-four (82.56%) patients had abnormal findings, while sixty (17.44%) had normal findings. Out of 284 patients, 94(34%) had one identified factor, while 190 (66%) patients had two or more identified factors for primary subfertility. Polycystic ovaries were seen in 128(37.21%) patients, followed by tubal blockade in 81(23.54%), peri tubal adhesions/hydrosalpinx in 58(16.86%) patients. Conclusions: Diagnostic hystero-laparoscopy is an effective diagnostic procedure for the evaluation of female factor subfertility and may be helpful to gynecologists in devising further management plans.

The role of combined diagnostic hysterolaparoscopy in unexplained infertility

Background: The two approaches for evaluating the female reproductive system are hysteroscopy and laparoscopy. Laparoscopy is becoming a standard component of infertility evaluation by virtue of its capability to visualize and manipulate the uterus, the ovaries and fallopian tubes. Hysteroscopy has become an important investigative tool for discovering possible causes of female infertility by examining the uterine cavity. The goal of this study was to examine the role of hystero-laparoscopy in diagnosis women with unexplained infertility.Methods: A total of 202 cases who were 20-35 years old women with 1ry or 2ry unexplained infertility were studied in this cross-sectional observational analytical study. All patients were subjected to: evaluation (physical, abdominal and bimanual), routine laboratory investigations, basic investigations (documentation of sound ovarian factor: hormonal assays and pelvic ultrasonography, normal hysterosalpingography, normal husband semen analysis) and hysterosalpingography (HSG) was reviewed or completed.Results: Abnormal laparoscopic was significantly higher in secondary cases compered to primary infertility (p=0.043). Abnormal combined hystero-laparoscopic was significantly higher in 2ry infertile cases compered to 1ry infertile cases (p=0.006). Pairwise comparison between 1ry and 2ry infertility was statistically significant difference (P=0.004).Conclusions: The percentage of abnormalities found during laparoscopy and hysteroscopy, are difficult to be visualized by the use of other noninvasive methods. While a thorough history, thorough examination, and early studies such as pelvic ultrasonography can all lead to the suspicion of numerous abnormalities, a considerable percentage of abnormalities may go undetected.

Diagnostic hysterolaparoscopy: An important tool in evaluation of female infertility, in beneficiaries of ESI scheme in Eastern India

Background: The WHO estimates that 60–80 million couples worldwide suffer from infertility and the overall prevalence of the primary infertility in India is 3.9–16.8%. As usual tests and examinations are unable to appreciate majority of pelvic pathology in infertile women, diagnostic laparoscopy has become an essential part of infertility evaluation. Diagnostic laparohysteroscopy (DHL) gives the opportunity to directly visualize and manipulate pelvic organs which allow accurate diagnosis and give an option to treat at the samesitting. Aims and Objectives: The aims of this study were to detect pelvic organ abnormalities by diagnostic hysteroscopy and laparoscopy in the evaluation of female infertility in a tertiary care hospital. Materials and Methods: This cross-sectional observational study recruited 50 patients who attended the infertility clinic during 1 year period as per inclusion and exclusion criteria. Those with male factor and endocrine abnormality were excluded from the study. The patients having abnormal hystero-salpingography (HSG) findings and those who in spite of having normal HSG finding, did not conceive even after three cycles of ovulation induction, underwent DHL. Results: Out of the 50 patients, 35 (70%) suffering from the primary and 15 (30%) suffering from the secondary infertility. The mean age of the study population was 29.5±5.3 years. Most of the cases presented with 3–6 years of infertility. The most common reported laparoscopic abnormality was ovarian in 58% cases, followed by 56% of pelvic and peritoneal abnormalities, 44% tubal factor abnormality, 36% having endometriosis at different stages, and 30% having uterine abnormality. Conclusions: Hystero -laparoscopy has good diagnostic accuracy in evaluating pelvic pathologies. The combination of hysteroscopy with laparoscopy done in a single setting improves the detection rate of abnormalities of uterus, fallopian tubes, ovaries, and pelvic peritoneum.

Evaluation of infertile women by diagnostic hysterolaparoscopy

Evaluation of infertile women by diagnostic hysterolaparoscopy

Role of diagnostic hysterolaparoscopy in the evaluation of infertility among the patients attending one of the tertiary care centers of Ahmedabad, Gujarat

Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.

Comparison of Treatment outcomes following Ovarian Stimulation with Intrauterine Insemination in Minimal or Mild Endometriosis versus Unexplained Infertility: A Retrospective Cohort Study.

Infertility is a global health issue. The variation in the prevalence of unexplained infertility is attributed to the choice of investigation. There remains a knowledge gap on the impact of minimal and mild endometriosis on treatment outcomes following intrauterine insemination (IUI). The aim of this study was to compare treatment outcomes following ovarian stimulation (OS) and intrauterine insemination (IUI) between minimal and mild endometriosis versus unexplained infertility. A retrospective analysis of women undergoing OS with intrauterine insemination during the year 20142020 in the Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, was considered for the study. Women with minimal and mild endometriosis or unexplained infertility diagnosed by diagnostic hysterolaparoscopy were included for the analysis. Univariate and multivariate analysis was done. The primary outcome was live birth rate (LBR) per cycle. The secondary outcomes measured were clinical pregnancy rate (CPR) , cumulative LBR (CLBR) per women, cumulative CPR (CCPR) per women and miscarriage rate. The baseline parameters were compared using a t-test for continuous data, and categorical data were compared using the Chi-square/Fisher's exact test as appropriate. The outcomes were assessed using logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI). There were no significant differences in CPR per cycle (14.28% vs. 18.8%, OR: 0.71; 95% CI: 0.401.28) and LBR per cycle (14.28% vs. 16.6%, OR: 0.84; 95% CI: 0.461.51) between the endometriosis and unexplained infertility groups. The cumulative LBR per woman and CCPR per woman also did not show any significant difference in between the two groups. The current study did not find any significant differences in cumulative LBR and CPR following OS-IUI in women with minimal or mild endometriosis and unexplained infertility.

The Role of Diagnostic Hysterolaparoscopy in the Evaluation of Infertility in Tertiary Care Centers

The Role of Diagnostic Hysterolaparoscopy in the Evaluation of Infertility in Tertiary Care Centers

English

BACKGROUND Infertility is a multidimensional health problem with social and economic consequences. Infertility affects about 10 - 15 % of reproductive age couples. 1 Hysterolaparoscopy is safe and effective method to diagnose infertility. The purpose of this study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in Chalmeda Anand Rao Institute of Medical Sciences. METHODS A prospective hospital-based study was carried out in Chalmeda Anand Rao Institute of Medical Sciences over a period of 1 year from August 2019 to July 2020. Hysterolaparoscopy was done in 100 patients. Women aged 20 - 40 years with normal hormone profile without male factor infertility were included. RESULTS 100 patients with infertility were undertaken, 70 (70 %) women had primary infertility and the remaining 30 (30 %) had secondary infertility. Ovarian pathology (30 %), endometriosis (23 %), tubal pathology (14 %) and pelvic adhesion (14 %) were the most well-known anomalies recognized in laparoscopy in both primary and secondary infertility. Uterine septum was major intrauterine pathology seen in two gatherings. Out of 12 patients having uterine malformations, most regular uterine malformation in both the gatherings was 9 uterine septum and 2 unicornuate and 1 was hypoplastic uterus. CONCLUSIONS Combined hysterolaparoscopy is a safe, effective, and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which is missed by routine pelvic examinations and basic investigations done for evaluation of infertility. Hysterolaparoscopy gives the added advantage of doing a therapeutic procedure in the same sitting. Thus, hysterolaparoscopy may be considered as gold standard and definitive investigative day-care procedure for evaluation of female infertility. KEY WORDS Hysteroscopy, Infertility, Laparoscopy

PREVALENCE AND DIAGNOSIS OF MULLERIAN ANOMALIES IN INFERTILE WOMEN USING DIFFERENT MODALITIES

Objective: To diagnose the various types of Mullerian abnormalities using different modalities and to nd out its prevalence among infertile women. Method: A prospective study was conducted on 200 infertile women attending the outpatient and inpatient department of Obstetrics and Gynaecology in Swaroop Rani Nehru hospital and kamla Nehru Hospital of MLN medical College,Prayagraj during the year 2019-2020. Hysterosalpingography, 3 D ultrasonography and hysterolaparoscopy was used as diagnostic modalities to nd the prevalence of mullerian anomalies among infertile women of age group of 20 to 40 years. A total of 18 cases (9%) Results: were diagnosed to have mullerian anomalies which included 7 cases of partial septate uterus(3.5%), 2 cases (1%) each of complete septate,partial bicornuate and arcuate uterus respectively, 1 case(0.5%) each of agenesis, didelphys, complete bicornuate,unicornuate-non communicant and unicornuate without horn respectively. Conclusion: Prevalence of Mullerian anomalies in our study was 9% among infertile women, partial septate being the most common. Diagnostic hysterolaparoscopy was best investigation(sensitivity=100%, specicity=100%,PPV=100%,NPV=100%). 3D ultrasonography ,being non-invasive and more convenient was stongly comparable to hysterolaparoscopy( kappa value=0.906) than to hysterosalpingography( kappa value=0.660).

The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients.

Background and objectiveHysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility.MethodologyThis study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study.ResultsA total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302).ConclusionCompared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Assessment of Tubal Patency with Selective Chromopertubation at Office Hysteroscopy versus Modified Minilaparoscopy in Infertile Women.

Objectives:Tubal factor is the leading cause of female infertility. Diagnostic hysterolaparoscopy with chromopertubation plays a pivotal role in its evaluation. Office hysteroscopy (OH) has gained popularity as the outpatient procedure for diagnostic purposes. OH being a less invasive approach, the current study was undertaken to compare the accuracy of assessment of tubal patency with chromopertubation at OH with modified minilaparoscopy in infertile patients.Materials and Methods:The present study was a pilot study conducted from March 2017 to August 2018. Eighty patients were recruited. OH was done without anesthesia. Diluted methylene blue dye was injected. The eddy current of blue dye, “Visualizable flow” at ostium, and disappearance of blue dye from the uterine cavity through ostium was documented as evidence of patent tubal ostium. In case of tubal occlusion, uterine cavity became blue due to backflow of dye. After OH, minilaparoscopy with chromopertubation was performed under general anesthesia. Both tubes were assessed separately for tubal patency.Results:All patients underwent OH followed by minilaparoscopy in the same sitting. OH was 87.5% sensitive with positive predictive value of 95.2%. Compared to minilaparoscopy, OH is 85.6% accurate in predicting tubal patency. The area under receiver operating curve was 0.96 (SE is 0.15 with 95% confidence interval of 0.93–0.99, P < 0.001). It implies that, OH should correctly identify all laparoscopic cases with probability of 0.96.Conclusion:OH chromopertubation can be used as an alternative to laparoscopy for assessing tubal patency with added advantages of lack of requirement of anesthesia, minimal cost, and better patient acceptance. Moreover, the procedure is less time-consuming and less invasive with high sensitivity and moderate specificity.

Diagnostic Hysterolaparoscopy in the Evaluation of Female Factor Infertility: A Cross-sectional Study at a Tertiary Care Hospital in Central India

ABSTRACT Background Infertility is a worldwide problem affecting people of all geographical location and socioeconomic status. It is estimated that globally 60–80 million couples suffer from infertility every year. The main objective of the study is to detect the diagnostic efficacy of hysterolaparoscopy in evaluating the tubal, uterine, ovarian, and pelvic pathologies causing infertility and also compare the findings of a hysterosalpingogram with diagnostic laparoscopy in evaluating the tubal factor infertility. Materials and methods This hospital-based cross-sectional study included an evaluation of 1,456 couples presenting with complaints of infertility at the Outpatient Department of Government Medical College, Nagpur during the period of February 2016 to September 2018. After thorough gynecological examination and investigations, 130 infertile women were posted for diagnostic hysterolaparoscopy. All the data were collected on predesigned proforma and the results were tabulated and raw percentages calculated to describe the results. Results Among the 130 infertile women, 102 women (78.46%) had primary and 28 (21.53%) had secondary infertility. The maximum number of patients belonged to the age group of 26–30 years (39.23%). About 56% of patients were in the active marriage life of 3–5 years duration. Most of them had multiple factors affecting their fertility. Out of the 130 infertile women, 32 patients (24.62%) had uterine factors, 44 patients (33.84%) had peritoneal factors, 67 patients (51.5%) had ovarian factors, and 89 patients (68.46%) had tubal factors. Only eight patients (6.15%) had normal findings in laparoscopy. Out of the 130 patients, 122 (93.84%) had more than one factor causing infertility. About 26.15% of patients had positive findings in diagnostic hysteroscopy. Conclusion Hysterolaparoscopy provides both a panoramic view of the pelvic reproductive anatomy and also a magnified view of the pelvic organs and peritoneal surfaces. It is generally regarded as the most reliable tool in the diagnosis of tubal pathology and other intra-abdominal causes of infertility because of the correctable abnormalities like endometriosis, adnexal adhesions, and septate uterus which are usually missed, are usually identified that helps in formulating a specific plan of management. How to cite this article Selvaraj P, Parpillewar M, Fidvi J. Diagnostic Hysterolaparoscopy in the Evaluation of Female Factor Infertility: A Cross-sectional Study at a Tertiary Care Hospital in Central India. Int J Infertil Fetal Med 2020;11(2):37–41.

English

BACKGROUND About 10 - 15 % of reproductive age couples are affected by infertility.1 According to WHO 60 - 80 million couples currently suffer from infertility.2 Prevalence of infertility is rapidly increasing globally.3 Uterine factors of infertility include uterine anomalies, fibroid uterus, synechiae, Asherman’s syndrome, and failure of implantation without any known primary causes. Congenital uterine malformations are seen in 10 % cases of infertile women. We wanted to evaluate the anomalies of uterus in case of primary and secondary infertility by DHL (diagnostic hysterolaperoscopy). METHODS This is a hospital-based, observational study, conducted in the Department of Obstetrics and Gynaecology, VIMSAR, Burla, from November 2017 to October 2019. Diagnostic hysterolaparoscopy was done in 100 infertility cases. RESULTS In our study, uterine anomaly i.e. septate uterus was the most common hysteroscopic abnormaly found in 23 cases followed by submucous fibroid, polyp, synechiae and bicornuate uterus. CONCLUSIONS With proper selection of cases, and when done by skilled surgeon, can be considered as standard day care procedure for female infertility evaluation. KEYWORDS Infertility, Uterine Anomalies, Diagnostic Hysterolaparoscopy

Role of Hysterolaparoscopy in The Evaluation and Management of Female Infertility

Background: The definition of infertility is one year of unprotected intercourse with no pregnancy among married couples. Objective: The aim of the study is to assess the efficacy and safeness of combined hysterolaproscopy on evaluation and management of female infertility. Patients and Methods: A prospective clinical triad study was carried on 416 patients infertile women aged between 18 and 42 years with either primary or secondary infertility with normal hormone profile and without male factor infertility at the Cytogenetics and Endoscopy Unit, at Zagazig University. Those females underwent both hysteroscopy and laparoscopy through the period from August 2017 to July 2018. Results: This study showed that 42.7% of primary infertility and 59.5% of secondary infertility cases did not have any abnormality detected on laparoscopy. Endometriosis was the most common abnormality found in primary infertility followed by peritoneal adhesions, which was(12.2%) the most common abnormality found in second infertility followed by endometriosis. Abnormality in cases of primary infertility was intrauterine septum, and in secondary infertility was intrauterine synechia. Conclusions: Diagnostic hysterolaparoscopy is a very safe and effective tool for the evaluation of infertility particularly for detection of conditions like endometriosis, tubal adhesions, and intrauterine septum

Role of Hysterolaparoscopy in The Evaluation and Management of Female Infertility

Background: The definition of infertility is one year of unprotected intercourse with no pregnancy among married couples. Objective: The aim of the study is to assess the efficacy and safeness of combined hysterolaproscopy on evaluation and management of female infertility. Patients and Methods: A prospective clinical triad study was carried on 416 patients infertile women aged between 18 and 42 years with either primary or secondary infertility with normal hormone profile and without male factor infertility at the Cytogenetics and Endoscopy Unit, at Zagazig University. Those females underwent both hysteroscopy and laparoscopy through the period from August 2017 to July 2018. Results: This study showed that 42.7% of primary infertility and 59.5% of secondary infertility cases did not have any abnormality detected on laparoscopy. Endometriosis was the most common abnormality found in primary infertility followed by peritoneal adhesions, which was(12.2%) the most common abnormality found in second infertility followed by endometriosis. Abnormality in cases of primary infertility was intrauterine septum, and in secondary infertility was intrauterine synechia. Conclusions: Diagnostic hysterolaparoscopy is a very safe and effective tool for the evaluation of infertility particularly for detection of conditions like endometriosis, tubal adhesions, and intrauterine septum

A two-third majority of infertile women exhibit endometriosis in pre-ART diagnostic hysteroscopy and laparoscopic chromopertubation: only one-third have a tubal obstruction.

This study was undertaken to evaluate the prevalence of endometriosis in infertile women of couples with non-male factor infertility. A retrospective validation analysis was carried out of consecutive women of infertile couples with non-male factor infertility who received combined diagnostic hysteroscopy and laparoscopy, in the period from January 2017 to August 2019 in the Department for Gynecology and Reproductive Medicine (n = 300). Type, stage and site of endometriosis were assessed and matched with the occurrence of tubal stenosis. Binary regression analysis was used to estimate the prevalence of endometriosis. Endometriosis was diagnosed in 67% (n = 201). Primary infertility (OR 1.76; p = 0.036), dysmenorrhea (OR 2.47; p = 0.002), and a shorter cycle length (OR 0.972; p = 0.036) were independent risk factors for detection of endometriosis in diagnostic hystero-laparoscopy. The most frequent endometriosis sites were pelvic side wall (53.2%) and uterosacral ligaments (41.8%). Patients with endometriosis showed less often a tubal occlusion (34.32% vs. 41.4%; p = 0.205) and presented a lower rate of bilateral obstruction (9.5% vs. 18.8.%, p = 0.024). Women with endometriosis of a Fallopian tube showed a higher rate of tubal occlusion on the same side (right side p = 0.002; left side p = 0.001). Patients with rASRM score III showed the highest rate of tubal obstruction. The prevalence of endometriosis in infertile women was higher than expected. The indication for operative infertility diagnostics by minimal invasive techniques should be made much more generous as well as the complete clarification of the causes of female infertility.

Acute Temporomandibular Joint Dislocation during General Anesthesia Using LMA Supreme

Temporomandibular joint (TMJ) dislocation has been described in literature as a rare complication of LMA use. In this report, we describe the case of acute TMJ dislocation that occurred after LMA Supreme use in a 29 year old lady who underwent diagnostic hysterolaparoscopy under general anesthesia. The patient had an unremarkable airway and no history of TMJ subluxation or dislocation in the past. After induction of anesthesia, a size 3 LMA Supreme was successfully inserted in a single attempt after giving jaw thrust. After an uneventful surgical procedure the patient was reversed and the LMA Supreme was removed. After LMA removal, the patient was unable to close her mouth. The bony swelling palpable in the region anterior to bilateral TMJ confirmed the diagnosis of TMJ dislocation. A dental surgeon performed manual reduction of the same and the reduced position was secured using a bandage.