Role of laporoscopy-hysteroscopy in cases of infertility with pregnancy outcome. 2014

Neerja, and Kuldeep Jain

The study aims to analyse the role of hysteroscopy-laparoscopy in diagnosis and treatment of infertility with effect on pregnancy outcome. The study group comprised 200 patients of 20-30 years age (125 with primary and 75 with secondary infertility). Hysterosalpingography (HSG) was done in all. Diagnostic as well as operative hysteroscopy-laparoscopy if required were performed in the same sitting in cases who have already been treated for 6 months and did not conceive, with unexplained cause or with abnormal HSG findings. All cases were followed up till they conceived or up to 1 year. Fifty patients of unexplained infertility were used as control and given only folic acid 5 mg/day. HSG was normal in 102/200 (51%) and abnormal in 98/200 (49%) cases in form of fimbrial block in 48 (48.97%) out of 98, cornual block 25 (25.51%), peritubal adhesions 15 (15.31%), filling defect in uterus 10 cases (10.20%). Hysteroscopy was abnormal in 150/200 cases (75%) with uterine synechiae 58 (38.66%) out of 150, endometrial hypertrophy 22 (14.67%), endometrial polyps 20 (13.33%), submucus fibroids 20 (13.33%), atrophy 25 (16.66%) and malformations 5 (3.33%). Hysteroscopy surgery was performed in 70 (46.66%), alone in 14 and with laparoscopic procedures in 56 cases, with subsequent pregnancy rate of 35.71-42%. HSG missed the abnormalities in 58 cases (38.66%) which were diagnosed with hysteroscopy with difference in findings in 58 cases (38.66%). Operative laparoscopy was performed in 140 cases (70%), divided between adhesiolysis in 38(27.14%), tubal surgery in 53 (37.86%), electrocoagulation or excision of endometriotic nodule in 25(17.86%) and ovarian drilling for polycystic ovarian disease in 24(17.14%). The HSG missed 30(20%) abnormal tubal and peritubal findings which were diagnosed with laparoscopy. All cases were followed for one year. Subsequent pregnancy rate was 64 (45.71%) after laparoscopic surgery. The results were analysed by applying Chi-square test and calculating p-value at 1 df. Hysteroscopy-laparoscopy is diagnostic and therapeutic both for uterine, tubal infertility and ovarian abnormalities. They give an advantage in diagnosis and treatment of female infertility at the same sitting. As compared to HSG, it is more accurate in 25% cases and improves the rate of pregnancy to 35%-45% almost comparable to 56.52% in cases with normal hysteroscopy-laparoscopy findings.

UI MeSH Term Description Entries
D007047 Hysterosalpingography Radiography of the uterus and fallopian tubes after the injection of a contrast medium. Salpingography,Hysterosalpingographies,Salpingographies
D007247 Infertility, Female Diminished or absent ability of a female to achieve conception. Sterility, Female,Sterility, Postpartum,Sub-Fertility, Female,Subfertility, Female,Female Infertility,Female Sterility,Female Sub-Fertility,Female Subfertility,Postpartum Sterility,Sub Fertility, Female
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011256 Pregnancy Outcome Results of conception and ensuing pregnancy, including LIVE BIRTH; STILLBIRTH; or SPONTANEOUS ABORTION. The outcome may follow natural or artificial insemination or any of the various ASSISTED REPRODUCTIVE TECHNIQUES, such as EMBRYO TRANSFER or FERTILIZATION IN VITRO. Outcome, Pregnancy,Outcomes, Pregnancy,Pregnancy Outcomes
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D015907 Hysteroscopy Endoscopic examination, therapy or surgery of the interior of the uterus. Endoscopy, Uterine,Hysteroscopic Surgical Procedures,Surgical Procedures, Hysteroscopic,Uterine Endoscopy,Hysteroscopic Surgery,Surgery, Hysteroscopic,Uteroscopy,Endoscopies, Uterine,Hysteroscopic Surgeries,Hysteroscopic Surgical Procedure,Hysteroscopies,Procedure, Hysteroscopic Surgical,Procedures, Hysteroscopic Surgical,Surgeries, Hysteroscopic,Surgical Procedure, Hysteroscopic,Uterine Endoscopies,Uteroscopies

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