Infertility is defined as a failure of a couple to conceive after having regular, unprotected sexual intercourse for one year. It affects about 10-15% of the couples. The ability to observe and treat pathology during laparoscopy has made it a gold standard to evaluate pelvic pathology. Similarly, visualizing uterine cavity and identifying the possible pathology has made hysteroscopy an essential part of infertility evaluation. The abnormalities of pelvic structures can be resolved in hysteron-laparoscopy at the same time. Thus, it becomes prognostic and therapeutic procedure rather than only diagnostic.
Hence the need for study in order to assess the role of combined hysteron-laparoscopy in female infertility and also to formulate the appropriate plan of management.
Combined hystero-laparoscopy is a safe, effective and reliable method in comprehensive evaluation of infertility. Hystero-laparoscopy can also be called as the ‘third eye’ of gynaecologists in the evaluation of female infertility. Correctable structural abnormalities in pelvic may be unfortunately missed by routine pelvic examination and imaging procedures. It is a very useful tool in detecting these missed pelvic abnormalities in patients with the normal ovulation and husband semen analysis. It can be considered as a definitive day care procedure for evaluation of female infertility. It may be even recommended as the first and final procedure for evaluation of female infertility. It will also help us to take decision regarding the need for ART (Assisted Reproductive Technology) in required patients, thus avoiding further emotional and financial trauma to the couples. So, it helps in formulating an appropriate plan of management in infertility.
In this prospective study of 50 patients of infertility, diagnostic hysterolaparoscopy was found to be useful in the following aspects.
- Presence of peritoneal factors, tubal and endometrial factors were diagnosed in the same sitting thereby improving the efficacy if infertility evaluation.
- It avoids unnecessary radiological evaluation in a majority of cases. (HSG)
- It decreases hospital stay and decreases costs and inconvenience
- Majority of patients with abnormalities as a probable cause of infertility were diagnosed in this study.
- This procedure is also helpful in carrying out further required therapeutic procedures in the same sitting.
Hence it can be concluded that diagnostic hysterolaparoscopy is invaluable in routine infertility work up.