This study assessed infertility using hystero-laparoscopy in 504 patients over 3 years. Key findings include:
Tubal factors were the leading cause of infertility (35%). Hysteroscopy found endometrial polyps in 5% and adhesions in 4%. Laparoscopy found endometriosis in 20% and thickened tubes in 13%. Hystero-laparoscopy allowed diagnosis of factors missed by other tests and endoscopic management such as adhesiolysis, myomectomy, or polycystic ovarian drilling. The study concluded hystero-laparoscopy is a feasible one-time approach for infertility assessment and treatment.
3. INTRODUCTION
• Failure to conceive a desired pregnancy after
12 months of unprotected sexual intercourse
• Male and female are equally affected
4. INDIAN PERSPECTIVE
• “Barrenness amid plenty”
– Increased incidence in countries with high fertility rates
• Developing countries- 6.9-9.3%*
– Primary infertility: 1/3
– Secondary infertility: 2/3
• Developed countries- 3.5-16.7%*
*Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and
treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007;
22(6):1506-12.
5.
6. CAUSES OF INFERTILITY
Tubal and
pelvic
pathology-
35%
Male
problems
35%
Ovulatory
dysfunction-
15%
Unexplain
ed
infertility
10%
Unusual
problems
5%
8. AIMS & OBJECTIVES
• Assess the etiopathology of infertility
– Uterine factors
– Tubal factors
– Ovulatory factors
– Cervical factors
• Study the distribution of infertility in the population
• Use hystero-laparoscopy as a tool in the diagnosis and
management of infertility
9. MATERIALS AND METHODS
• Study Design
• Prospective Study
• Institute
• L.T.M.M.C. and L.T.M.G.H
• Cases Studied
• 504
• Study Period
• 3 years
10. INCLUSION CRITERIA
• Women aged 20-40 years
• Duration of marriage>1 year
• Couples who had undgergone complete
infertility assessment
• Male factor ruled out
11. EXCLUSION CRITERIA
• Active generalised infection
• Bowel obstruction
• Abdominal wall hernia
• Tubercular peritonitis with adhesions
• Large pelvic masses
• Cardiorespiratory diseases
12. PARAMETERS STUDIED
• Age
• Married life
• Regularity of menstrual cycles
• Duration of infertility
• Hystero-laparoscopic findings
• Operative intervention
13. METHODOLOGY
• Hysteroscopy
– Panoramic view of the
uterus, ostia, endocervical
canal
• Laparoscopy
– Abdominal cavity
– Uterus
– Fallopian tubes
– Ovaries
– Pouch of Douglas
– Uterovesical Pouch
– Tubal Patency Test
18. RESULTS
• Normal per speculum examination: 77%
• Normal per vaginal examination: 83%
• Regular menstrual cycles- 67%
• Past history
– Tuberculosis- 7%
– Curettage- 3%
26. CONCLUSION
• Hystero-laparoscopy- Third eye of the Gynaecologist
• Feasible and acceptable procedure- "one time
approach”
– Diagnosis of factors missed by any other method such as
by ultrasound or hysterosalpingography
– Endoscopic management (cystectomy, myomectomy,
septum resection or polycystic ovarian drilling) in the
same sitting