Introduction: Diagnostic Laparoscopy is a minimally invasive technique that gives pelvic organs and provides information on the status of the fallopian tubes, ovaries and uterus. It is considered as gold standard for the diagnosis of various diseases e.g; pelvic inflammatory disease, endometriosis, cysts, pelvic congestion, fibroids and tuberculosis. Similarly, visualizing the uterine cavity and identifying the possible pathology has made hysteroscopy an essential part of infertility evaluation. Infertility accounts for 10-15 % of reproductive age couples. This study was undertaken with an aim to understand the role of diagnostic hysterolaparoscopy in cases of unexplained infertility.

Materials and Methods: This was a retrospective study of women with primary or secondary infertility presenting to our department. Patients between 20 and 45 years of age with infertility were included in this study on the basis of a predefined inclusion and exclusion criteria. Hormonal analysis (FSH, LH, Prolactin, and TSH) was done in indicated patients. Hysterolaparoscopy was done and corrective surgery was done if needed. Data was analyzed using SSPE 21.0 software. P value less than 0.05 was taken as statistically significant.

Results: A total of 24 infertile women were included in this study. 21 (87.5%) women had primary infertility and 3 (12.5%) had secondary infertility. The most common age group was found to be between 20-30 years (58.3%). 12 (50%) patients were married since more than 5 years. Most of the patients with infertility were asymptomatic (58.3%). 41.6% women were having some type of abnormal menstrual disorder. Abnormalities detected through laparoscopy were more in number than the abnormalities detected through hysteroscopy. In majority of the patients (79.1%) hysteroscopy was found to be normal. The most common pathology seen on hysteroscopy was uterine synechia (16.6%). On laparoscopy all patients were found to have some or the other pathology. The most common pathology found to be seen on laparoscopy was pelvic adhesion (33.33%) followed by endometriosis (29.16%) and polycystic ovaries (20.8%).

Conclusion: Hysterolaparoscopy is an effective, safe and minimally invasive procedure in the comprehensive evaluation of female infertility, as it could diagnose the pathologies such as endometriosis and periadnexal adhesions which otherwise could have been missed by other diagnostic modalities.

Keywords: Infertility, hysterolaparoscopy, Pelvic adhesions, endometriosis.

1. Datta J, Palmer MJ, Tanton C, et al. Prevalence of infertility and help seeking among 15 000 women and men. Hum Reprod. 2016;31(9):2108-18.
2. Gelbaya TA, Potdar N, Jeve YB, Nardo LG. Definition and epidemiology of unexplained infertility. ObstetGynecol Surg. 2014 Feb;69(2):109-15.
3. Buck Louis GM, Druschel C, Bell E, et al. Use of assisted reproductive technology treatment as reported by mothers in comparison with registry data: the Upstate KIDS Study. FertilSteril. 2015;103(6): 1461-8.
4. Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci. 2015;8(4):191-6.
5. Rastogi R. Role of imaging in female infertility [Dr. K.M. Rai Memorial Oration Award]. Indian J Radiol Imaging. 2010;20(3):168-73.
6. Bhoil R, Sood D, Sharma T, et al. Contrast Intravasation During Hysterosalpin-gography. Pol J Radiol. 2016;81:236-9. Published 2016 May 17.
7. Sadow CA, Sahni VA. Imaging female infertility. Abdom Imaging. 2014 Feb;39(1):92-107.
8. Zhang E, Zhang Y, Fang L, Li Q, Gu J. Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china. Mater Sociomed. 2014;26(3):156-7.
9. Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment Infect Dis Clin North Am. 2013;27(4):793-809.
10. Agrawal N, Fayyaz S. Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center. J GynecolObstet Hum Reprod. 2018 Nov;47(9):425-429.
11. Nayak PK, Mahapatra PC, Mallick J, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci. 2013;6(1):32-4.
12. Kabadi YM, Harsha B. Hysterolapa-roscopy in the Evaluation and Manag-ement of Female Infertility. J Obstet Gynaecol India. 2016;66(Suppl 1):478-81.
13. Wadhwa L, Rani P, Bhatia P. Comparative Prospective Study of Hysterosalping-ography and Hysteroscopy in Infertile Women. J Hum Reprod Sci. 2017;10(2):73-78.
14. Benksim A, Elkhoudri N, Addi RA, Baali A, Cherkaoui M. Difference between Primary and Secondary Infertility in Morocco: Frequencies and Associated Factors.Int J FertilSteril. 2018 Jul;12(2):142-146.
15. Davari Tanha F, Mohseni M, Ghajarzadeh M. Sexual function in women withprimary and secondary infertility in comparison with controls. Int J Impot Res.2014 Jul-Aug;26(4):132-4.
16. Masoumi SZ, Parsa P, Darvish N, Mokhtari S, Yavangi M, Roshanaei G. An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan. Iran J Reprod Med. 2015 Aug;13(8):513-6.
17. Antaratani RC, Harsha B. Hysterolaparoscopy in the evaluation and management of female infertility. Int J Reprod Contracept Obstet Gynecol 2017;6:4454-7.
18. Agrawal N, Fayyaz S. Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center. J GynecolObstet Hum Reprod. 2018 Nov;47(9):425-429.
19. Begum J, Samal S, Ghose S, Pallavee P, Samal R. Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients. Int J Reprod Contracept ObstetGynecol 2015;4:584-8.
20. Mehta AV, Modi AP, Raval BM, Munshi SP, Patel SB, Dedharotiya SM. Role of diagnostic hysterolaparoscopy in the evaluation of infertility. Int J Reprod Contracept Obstet Gynecol 2016;5:437-40.

Dr Ravikanth G O

Associate Professor, Department of Obstetrics and Gynaecology, KVG Medical College and Hospital, Sullia, D.K