Page 20 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Role of Hysterolaparoscopy in Evaluation of Subfertility

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Saraswati Ramesh , Harinath KS , Soumya Rajshekar Patil 3
AbstrAct
Introduction: Diagnosing and treating subfertility is a most rapidly evolving area in modern medicine. Advances in endoscopic surgery have
revolutionized the diagnostic and management approach to an infertile couple. Unlike USG and HSG, hysterolaparoscopy single-handedly
provides information regarding uterine, ovarian, tubal, as well as pelvic pathology.
Materials and methods: A prospective analysis was performed at BEST Institute and Research Centre, AV hospital, Bengaluru, over a period
of 2 years. Couples presenting to the infertility clinic were subjected for thorough history taking, general examination, and gynecological
examination. All necessary investigations were performed. Women who approached with fertility issues as a complaint and who could be
potentially benefited from hysterolaparoscopy were included in the study.
Results: A total of 102 patients were evaluated in the study, out of which 67 (65.7%) women had primary infertility and the rest (34.3%) had
secondary infertility. Ovarian pathologies such as ovarian cysts, endometriosis of the ovary, and PCOS were the most common abnormality
detected on laparoscopy followed by uterine pathologies. The most common hysteroscopic pathology was a polyp.
Conclusion: Combined hysterolaparoscopy is a safe, effective, and reliable tool in comprehensive evaluation of subfertility. It should be considered
as a definitive day-care procedure for evaluation and treatment of female subfertility.
Keywords: Diagnostic laparoscopy, Infertility, Hysterolaparoscopy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1519

IntroductIon 1,2 Department of MIS Gynecology, BEST Institute and Research Centre,
The World Health Organization (WHO) defines infertility as “inability AV Hospital, Bengaluru, Karnataka, India
of a sexually active, non-contracepting couple to achieve pregnancy 3 Department of Obstetrics and Gynecology, JSS Academy of Higher
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in one year”. The couple who have never conceived before are Education and Research, Mysuru, Karnataka, India
classified as primary infertility and who have had at least one prior Corresponding Author: Soumya Rajshekar Patil, Department of
conception, irrespective of the outcome, are classified as secondary Obstetrics and Gynecology, JSS Academy of Higher Education and
infertility. Subfertility describes any form of reduced fertility. The Research, Mysuru, Karnataka, India, Phone: +91 9739667595, e-mail:
desire for children is not universal, but childlessness is a tragedy to soumyarpatil999@gmail.com
many couples, even in developed countries. Relationships between How to cite this article: Ramesh S, Harinath KS, Patil SR. Role of
couples can become strained when children are not forthcoming, Hysterolaparoscopy in Evaluation of Subfertility. World J Lap Surg
and the onus of sub/infertility in most societies is placed on the 2022;15(2):116–119.
woman. Infertility in women was ranked the 5th highest serious Source of support: Nil
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global disability. World Health Organization estimates that 60–80 Conflict of interest: None
million couples worldwide currently suffer from infertility and the
overall prevalence of primary infertility in India to be between 3.9
and 16.8%. 2 significant pathologies that are missed by above all diagnostic
Diagnosing and treating subfertility is the most rapidly evolving modalities such as pelvic inflammatory disease, endometriosis,
area in modern medicine. Whenever a sub-/infertile couple visits adhesions, tubal pathology, and genital tuberculosis, and it is also
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a specialist, they undergo thorough examination and a battery proved effective in long-term unexplained subfertility. Pelvic
of tests to help pinpoint the cause of sub-/infertility. There are pathology is best identified by laparoscopy. Additionally, pathologies
a number of diagnostic assessment methods such as evaluation warranting surgical procedures and tubal patency testing can be
of the female hormonal system, semen analysis, ultrasound, done in the same sitting. Though hysterolaparoscopy is effective
hysterosalpingography (HSG), and hysterolaparoscopy. Ultrasound in managing infertile women, it cannot be used as a primary
is most frequently used in detection of uterine pathologies diagnostic tool as it is an invasive procedure. However, due to its lower
and adnexal masses. Fallopian tubes are not routinely seen on complication rates, minimal invasiveness, and a day-care facility,
ultrasound, unless if there is a hydrosalpinx. Hysterosalpingography it is widely accepted among gynecologists. One of the significant
has been a standard test in the workup of infertile couples for causes of infertility in India, genital tuberculosis, can be easily
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evaluating tubal patency. The sonohysterogram (SHG) is also an diagnosed with laparoscopy. The present study aims to highlight the
addition for intrauterine evaluation recently. 3 effectiveness of hysterolaparoscopy in evaluating female subfertility.
Advances in endoscopic surgery have revolutionized the
diagnostic and management approach to an infertile couple. MAterIAls And Methods
Unlike USG and HSG, hysterolaparoscopy single-handedly provides A prospective analysis was performed at BEST Institute and
information regarding uterine, ovarian, tubal, as well as pelvic Research Centre, AV hospital, Bengaluru, over a period of 2 years.
pathology. It is one of the most effective tools in diagnosing certain Couples presenting to the infertility clinic were subjected for

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