Combined Hysterolaparoscopy for diagnosis and management of female infertility: A prospective study of 100 cases
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 6
Abstract
Background: Hysterolaparoscopy often brings to light the unexpected pathology in infertility. Often early and subtle causes of infertility are thus revealed and can be treated leading to rewarding results. The present study consisted of 100cases of infertility that were evaluated by Hysterolaparoscopy during a period of two yearsat a tertiary health care centre. Objectives: To assess role of combined Hysterolaparoscopy for evaluation and management of causes of female infertility. Materials and Methods: This prospective study was conducted at tertiary centre in Mumbai in 100 cases of reproductive age group were included. These couples were confirmed to have normal semen analysis reports. Diagnostic as well as therapeutic hysterolaparoscopy was performed to evaluate pelvic and intrauterine anatomy and pathology. Informed valid consent, both verbal and written was taken prior to the procedure after explaining the procedure, its risks and benefits in a language well understood by the patients. Necessary therapeutic interventions were done to detect tubal patency by chromopertubation. Endometrial biopsy was taken for all patients and sent for TB PCR and histology. In addition, hysteroscopic procedures like myomectomy, polypectomy, septal resection, adhesiolysis were also done. Therapeutic laparoscopic interventions in the form of PCO drilling, tubalcanulation, adhesiolysis, endometriotic cystectomy and endometriosis ablation were done. Observations and Results: Out of 100 cases, 76 patients had primay infertility and24 patients had secondary infertility. Most commonly they were in the age group of 30-34 years. (39% and 9% respectively). Hysteroscopy findings were normal in 80% in primary group and 54% in secondary group. In primary group, uterine septum, cervical stenosis and thickened endometrium were most common findings, while in secondary group, endometrial polyp, Ashermann’s syndrome and uterine septum were more common. Diagnostic laparoscopy revealed abnormalities in 61% of cases. PCOS was most common abnormality (29% and 25% respectively). Ovarian cysts, unilateral and bilateral tubal block, chocolate cyst, and peritubal adhesions were common in secondary infertility. Bicornuate uterus was more common in primary infertility group. Conclusions: Hysterolaparoscopy is a feasible, safe and acceptable procedure as a onetime approach in evaluation of female infertility due to pelvic pathology. It helps in diagnosing and management of certain factors causing infertility which can be missed by any other method such as by USG, HSG in the same sitting.
Authors and Affiliations
Alka Dani, Himgauri B Sabnis, Amarja A, Sriram Gopal
Keywords
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