Hysterolaparoscopy–‘See and Treat’ Infertility, is a Reality in Modern Gynaecological Practice

Abstract

Background: : The quest to improve diagnostic and therapeutic capabilities has led to the widespread acceptance of modern gynaecological endoscopy. Hysterolaparoscopy is a basic skill in the advanced scientific era and an effective and safe tool in comprehensive evaluation of infertility with an added advantage of treatment of some pathologies in same sitting. Methods: This clinical study is a prospective study of 100 selected cases of infertility. Patients who fulfills the inclusion and exclusion criteria were subjected to diagnostic laparoscopy and hysteroscopy in NIMS Infertility and Research centre, Jaipur over a period of one and half years from Jan 2014 -June 2015. Observation of pelvic and intrauterine cavity and chromopertubation test was done under general anaesthesia during hysterolaparoscopy. Surgical interventions were carried out whenever required and further treatment plan was decided. Results: A total of 100 women underwent hysterolaparoscopy. Age ranged from 21 to 40 years and mean age was 30.03 years. Prevalence of primary infertility was 64% and of secondary infertility was 36%. Among cases with primary infertility commonest pathology responsible were ovarian 20 (31.25%) followed by unexplained 19 (29.69%), uterine 11 (17.18%), tubal 8 (12.50%) and peritoneal 8 (12.50%) whereas in secondary infertility commonest pathology responsible were uterine 14 (38.88%), followed by tubal 13 (36.11%), peritoneal 9 (25%), ovarian 8 (22.22%) and unexplained being the least 2(5.55%). Therapeutic procedures were performed in the same sitting amongst 84.61% cases with primary infertility and 92% cases with secondary infertility.Conclusion: When done by experienced hands, with proper selection of patients, hysterolaparoscopy is an indispensable tool which can be considered as a definitive day care procedure for evaluation and treatment of female infertility.

Hysterolaparoscopy in assessment and management of female infertility

“…Concerning past obstetrics history in secondary infertility, previous miscarriage was reported by 50% (n = 5), vaginal delivery by 20% (n = 2), and LSCS by 30% (n = 3) subjects. These findings agreed with the studies of Sharma R et al [7] in 2016 and Mehta AV et al [8] in 2016 where 64% of subjects had primary infertility and 36% had secondary fertility. The present study showed that Laparoscopic abnormalities were seen in 35% (n = 140) subjects, Hysteroscopic abnormalities in 12.5% (n = 5) subjects, and combined in 15% (n = 6) subjects.…”

“…These findings coincided with the results of previous literature work by Puri S et al [11] in 2015 where ovarian drilling was a common procedure on hysterolaparoscopy performed in 11 subjects followed by cystectomy, adhesiolysis, and endometriosis. Similar results were also reported by Dawle S et al [7] in 2014 concerning interventional procedures by hysterolaparoscopy.…”

“…Hysteroscopy findings in study subjects were Submucos Fibroid (2.5%, n = 1), Complete Septum (2.5%, n = 1), polypoidal endometrium (15%, n = 6), Hypoplastic uterus (2.5%, n = 1), Bald endometrium (5%, n = 2), and Endometrial polyp (5%, n = 2). These findings were contrasting to the findings of Tomar S et al [9] in 2014 and Sharma R et al [7] in 2016 where the most common abnormality detected was endometrial polyp on hysteroscopy. Also, the study by Dawle S et al [10] in 2014 found a similar prevalence of abnormalities on hysteroscopy.…”

Role of endoscopy in the diagnosis and management of infertility

“…Boricha YG et al, (2011) which stated that primary infertility was present in 70% and secondary infertility was present in 30% of the study patients [11] and Kavitha G (2019) according to which primary infertility was found in 83% and secondary infertility in 17% of the patients [12] . Nagareshi et al, (2016) supported primary infertility in 70% and secondary infertility in 30% [13] . Female age is an important factor for infertility.…”

“…However, as per Wani Q et al, (2014), endometriosis was the most common uterine cause for infertility on laparoscopy (16%) followed by adhesions in 10% followed by fibroid in 7% [17] . Proposed mechanism by which myomas affect fertility include cornual fibroids which compress interstitial segment of the tube, contractility of the uterus is disturbed by myoma thus interfering with ovum/sperm transport or embryo implantation and poor regional blood flow resulting in focal endometrial ulceration (Vollenhoven BJ et al, 1990) [18] .There is no algorithm containing fibroid number, volume and location which predicts the need to remove them. Removing fibroids increase pregnancy rates and decreases pregnancy complications.…”