Laparoscopy in Infertility: A Retrospective Analysis of 200 Cases

Abstract

Study objective:The aim of this study is to analyze the findings in females on whom laparoscopy was performed for the evaluation and management of infertility.Design: Retrospective study in a Multispecialty Hospital.Participants: Two hundred patients who underwent diagnostic and Operative Laparoscopy for evaluation and management of infertility in the age group 20-49 years were selected. Materials and methods:In this retrospective observational study we evaluated 200 patients on whom laparoscopy was performed for evaluation of primary or secondary infertility, and simultaneous management of the cause was done in a gynae-endoscopy unit in Delhi. The study included 120 females of primary Infertility and 80 women with secondary Infertility for 18 months. Laparoscopic findings, patient's age, nature of pathology and their distribution, the most common factor involved in infertility, chromopertubation, and results were analyzed from the data collected from these available case records.Results: Total 200 women on whom laparoscopy was performed for evaluation of infertility, it was observed that there were 120 cases were of primary infertility, Out of 120, 8 cases had no abnormal finding. A most common finding was endometriosis in 6/120 (57.5%) cases including endometrioma in 38 (31.7%) cases. Tubal factor 24 cases (20%), ovarian factor 14 cases (11.7%), bowel and Omental adhesions28 cases (23.33%), PCOD 32 cases (26.7%), and myoma 34 cases (28.33%), similarly Out of 80 cases of secondary infertility in 11 cases no abnormal finding was there. Strangely, even in cases of secondary infertility, we found endometriosis to be the most common cause in about 53/80 (66.3%) cases which is a significant number. This may be the possible reason for adhesions (Bowel, mental and other) also which account to42 cases (52.5%). Tubal factor 13 cases (16.25), ovarian factor 9 cases (11.25%), endometriosis 24 cases (30%), PCOD 4 cases (5%), Myoma17 cases (21.25%).In both primary and secondary infertility, filmy dense adhesions were seen distorting the normal anatomy. These findings were not significant according to age groups 20-30 years and >30 years. Conclusion:In this study, endometriosis was found to be the most significant factor contributing to both primary and secondary infertility and also giving an explanation to increased finding Bowel/Omental and pelvic adhesions. Sometimes, more than one factor is present in overlapping fashion making management more difficult. Laparoscopy has a key role in delineating and managing such cases. It is the minimally invasive method, reaching new horizons with better technique. Simultaneous chromopertubation can be done for evaluation of tubal patency. Now in this era, it is impossible to consider workup for infertility without the aid of laparoscopy.Clinical significance: This study demonstrates the benefits of laparoscopy in the evaluation of infertility patients and the advantages of the minimally invasive technique. Statistical analysis:Fischer's exact test for calculation of p value. A p value...