The New Indian Journal of OBGYN. Epub Ahead of Print

Evaluation of place of early diagnostic laparoscopy and hysteroscopy in female infertility - right approach at right time for improved outcome

Shuchi Agrawal, Prof Urmila Singh, Amrita Shankar

ABSTRACT

Aim: To assess impact of early diagnostic laparoscopy and hysteroscopy in cases of primary and secondary infertility on fertility outcome. Methodology: This was a prospective study conducted in the Department of Obstetrics & Gynaecology at KGMU, 175 cases of primary and secondary infertility evaluated by hysteroscopy and laparoscopy, from January 2018 to December 2018 were enrolled. Thorough history and examination was done. Any positive findings per laparoscopy and hysteroscopy and any therapeutic intervention done noted. Results: Out of the total 175 cases of infertility 110 (62.8%) were of primary infertility, 65 (37.14%) were of secondary infertility. Majority patients of primary infertility were of age 25-30 years and secondary infertility were of age 30-35 years. In primary infertility group abnormal findings during laparoscopy seen in 71 cases out of 110 cases whereas 9 had abnormal findings per hysteroscopy. In secondary infertility group out of 65 patients 29 patients had abnormal findings per laparoscopy and 15 patients had abnormal hysteroscopic findings. Ovarian drilling done in 4 cases of primary infertility others required cystectomy, adhesiolysis, tubal clipping for hydrosalpinx. In secondary infertility group 5 had ovarian cystectomy and 4 underwent adhesiolysis whereas only one case required ovarian drilling. Hysteroscopic procedures done in cases of primary infertility, polypectomy in 6 cases followed by septal resection, adhesiolysis and tubal cannulation whereas in secondary infertility majority required adhesiolysis followed by other procedures. Post laparoscopy and hysteroscopy 87 patients given ovulation induction with IUI, 80 cases were explained for timed intercourse and 8 patients were taken up for IVF. Follow-up of these cases in first six months showed 4 cases of primary infertility had spontaneous conception, 2 conceived on IUI whereas in cases with secondary infertility 5 cases conceived on ovulation induction and IUI. Conclusion: Laparoscopy and hysteroscopy integrated together are beneficial technique for complete evaluation of female factors of infertility patient and should be used initial work up in cases of infertility without delay.