Laparoscopy in the “Normal” Infertile Patient: A Question Revisited

Corson, Stephen L.; Cheng, Anne; Jacqueline, Norma

doi:10.1016/s1074-3804(05)60473-2

Cited by 90 publications

(72 citation statements)

References 13 publications

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“…Similarly when patients with unexplained infertility following standard infertility screening tests underwent diagnostic laparoscopy, 21-68 % of these patients was found to have pathologic abnormalities which included endometriosis and tubal disease [14,16,17]. Our results at laparoscopy and dye studies had shown bilateral tubal patency in 87 (92.5 %), bilateral tubal block in 4 (4.3 %) and unilateral tubal block in 3 (3.2 %) of infertile patients, excluding those who had come for recanalization.…”

Section: Discussionmentioning

confidence: 99%

Hysterolaparoscopy in the Evaluation and Management of Female Infertility

Kabadi¹,

Harsha

2016

J Obstet Gynecol India

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Objective To study the role of hysterolaparoscopy in the evaluation and management of female infertility.Materials and Methods A retrospective study of the 94 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2014 to June 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Results Out of 94 cases, 53.1 % patients had primary, 17.1 % patients had secondary infertility, and 29.8 % came for tubal recanalization. As a whole pelvic pathology was confirmed in 51.7 % and intrauterine pathology in 18.1 % patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was ovarian pathology (20.8 %), followed by pelvic inflammatory disease 123(17.5 %). Tubal block comprised 7.7 % whereas distorted uterus by fibroid in 6.6 % and pelvic endometriosis in 5.4 %. In hysteroscopy, the incidence of uterine anomaly was 13 (13.8 %). Septate uterus is the most common with a mean incidence of approximately 7 (53.8 %). Conclusion Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities.

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Section: Discussionmentioning

confidence: 99%

Hysterolaparoscopy in the Evaluation and Management of Female Infertility

Kabadi¹,

Harsha

2016

J Obstet Gynecol India

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“…They suggested that laparoscopy is mandatory after abnormal HSG findings in work-up prior to intrauterine insemination to prevent overtreatment with ART. Even when laparoscopy was performed for infertile patients with normal HSG findings, tubal pathology was detected in 6.0~34.0% (Al-Badawi et al 1999;Corson et al 2000;Capelo et al 2003;Tanahatoe et al 2003;Tsuji et al 2009). The management plan was switched to ART in 1.6~14.0% of patients (Tanahatoe et al 2003;Tsuji et al 2009).…”

Section: Discussionmentioning

confidence: 99%

The Significance of Laparoscopy in Determining the Optimal Management Plan for Infertile Patients with Suspected Tubal Pathology Revealed by Hysterosalpingography

Tsuji

Ami

Fujinami

et al. 2012

Tohoku J. Exp. Med.

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The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of infertility. Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance. The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the impact on fertility. Bilateral tubal pathology affects the prospect of spontaneous fertility, whereas unilateral tubal pathology affects the prospect of spontaneous fertility less severely (Nordenskjold et al. 1983;Mol et al. 1999). The pregnancy rates after adhesiolysis for peritubal adhesions were 75% in mild adhesions and 33% in severe adhesions (Carey et al. 1987). The intrauterine pregnancy rate after salpingostomy for hydrosalpinx was 0~44% (Taylor et al. 2001). In cases that include over half normal tubal mucosa without adhesions, size of hydrosalpinx < 1 cm, and thin thickness of the fallopian tubal wall, salpingostomy will allow postoperative spontaneous pregnancy (Vasquez et al. 1995). Salpingectomy should be recommended if the fallopian tube has severely damaged mucosa (Strandell et al. 2000). In this manner, determination of the management plan is associated with the degree of tubal pathology.Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions (Helmerhorst et al. 1995;Mol et al. 2001). A meta-analysi...

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“…The main aim of diagnostic tests is to prove pathology. Today, laparoscopy with dye (LS) is considered the best available diagnostic test for tubal factor infertility (6)(7)(8). It is used as a reference standard in most clinical studies.…”

Section: Introductionmentioning

confidence: 99%