LAPAROSCOPIC EVALUATION OF FEMALE INFERTILITY
AbstractBackground: Sub-fertility is inability to ensure child bearing when it is wanted. Prevalence ofsub-fertility in industrialised countries has been quoted as 20%, and seems to be on the rise.Traditional way to assess the uterine cavity, tubal structure and tubal patency washysterosalpingography but it has now been largely superseded by laparoscopy and hysteroscopy.The objective of this study was to highlight the role of laparoscopy in establishing diagnosis offemale infertility. Methods: This descriptive study was conducted in Gynaecology Unit of LiaquatUniversity of Medical Health Sciences, Hyderabad, Pakistan from 28th August 2000 to 1st July2001. Total 200 sub-fertile patients attended the gynaecology OPD. Out of these 30 patients wereselected for laparoscopy and dye test who were suspected cases of endometriosis, abnormal HSGand unexplained infertility. Those patients who had medical disorders and contraindication forlaparoscopy were excluded from study. Detailed history of every patient was recorded on aproforma and physical examination was performed. Laparoscopy was scheduled in proliferativephase of menstrual cycle. Data were analysed using SPSS 11. Frequency and percentages werecalculated to describe the results. Results: Out of 200 sub-fertile patients total 30 patients wereselected for laparoscopy. Twenty (66%) patients were in primary infertility group while 10 (33%)patients were in secondary infertility group. Eleven (55%) patients of primary infertility belong toage group of 18-25 years while 6(60%) patients of secondary infertility belong to age group of 26-33 years (TABLE 1). Mean duration of sub fertility at time of presentation in primary infertilitygroup was 1.95 years while in secondary infertility was 2.70 years (Table 2). In primary infertilitygroup main associated symptoms were dysmenorrhoeal in 8 (40%), irregular cycles 5 (25%), anddyspareunia in 4 (20%). In secondary infertility group 3 (30%) patients had dysmenorrhoeal anddyspareunia while 2 (20%) had irregular cycles. The commonest cause observed in patients withprimary infertility was endometriosis spots which accounted for 11 (55%). In secondary infertilitytubal occlusion was more common which accounted for 3 (30%). Conclusion: Laparoscopicprocedures are less invasive, more convenient and more precise for diagnosis of sub-fertility inwomen.Keywords: Laparoscopy, Primary infertility, Secondary infertility, Complications
Penzias AS. Infertility. Contemporary office-based evaluation
and treatment. Current. Obstet Gynecol Clin N Am
WHO. Life in 21st century- A vision for all. Geneva: WHO
Report 1998. p. 121.
Hammond MG. Evaluation of the infertile couple. Obstet
Gynecol Clin North Am 1987;14:821–30.
Taylor A. ABC of subfertility: Making a diagnosis. BMJ
Fathalla MF. Reproductive health: A global overview. Early
Human Develop 1992;29:35–42.
Omu AE, Ismail AA, Al-Qattan F. Infertility in Kuwait Int J
Gynaecol Obstet 1999;67:113–4.
al-Badawi IA, Fluker MR, Bebbington MW. Diagnostic
laparoscopy in infertile women with normal
hysterosalpingograms. J Repord Med 1999; 44:953–7.
Usmani AT, Shaheen F, Waheed N. Laparoscopic evaluation of
female infertility. Pak Armed Forces Med J 1995;45(2): 63–5.
von der Meden Alarcón W, Matute Labrador A, García Leon
JF. Laparoscopic findings in patients with pelvic pain,
dysmenorrhoea and sterility. Ginecol Obstet Mex
Shagufta S, Saad R, Prevalence of infertility factors in Pakistan.
Pak J Obstet Gynecol 1993;6:17–31.
Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M.
Epidemiologic and etiologic aspects of primary infertility in the
Kashmir region of India. Fertility Sterlity 1997;68:637–43.
Rana T. Role of laparoscopy in gynaecologic diagnosis. Pak J
Obstet Gynecol 1992;5(2):31.
sNajmi RS. Study on endometriosis diagnosis at Sir Ganga Ram
hospital Lahore. J Coll Physicians Surg Pak 1995;59(4):201–4.
Garry R, Clayton R, Hawe J. The effect of endomtriosis and its
radical laparoscopic excision on quality of life indicators. Br J
Obstet Gynaecol 2000;107:44–5.
Malinowski A, Nowak M, Podeiechowski L, Kaminski I,
Szpakowski M. The cost of laparoscopy in the diagnosis of
female infertility. Ginekol Pol 1998;69:1192–1202.
Semely S, Strickler RC. Laparoscopy: Is it replacing clinical
acumen? Obstet Gynaecol 1976;48:615–8.
Marcoux S, , Maheux R, Bérubé S. Laparoscopic surgery in
infertile women with minimal or mild endometriosis. N Eng J
Cahill DJ, Wardle PG. Management of infertility. BMJ.
Popovic J, Sulovic V, Vucetic D. Laparoscopy treatment of
adnexal sterlity. Clin Exp Obstet Gynecol 2005;32:31–4.