Title: Laparoscopic Evaluation of Tubal Factor in Infertility

Authors: Dr Anitha M, Dr Sheila Balakrishnan, Dr Dolly John Rose

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.50

Abstract

Background: Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The evaluation of the fallopian tube is necessary to determine the management plan for infertility. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. The aim of this study was to determine the role of laparoscopy in the evaluation of tubal factor in infertile women.

Methods: A prospective study was performed on 158 consecutive patients who underwent laparoscopy as part of infertility evaluation. The laparoscopic findings were documented.

Results: Of the 158 patients who underwent laparoscopy, 95 (60.1 %) patients had evidence of tubal disease as evidenced by unilateral or bilateral tubal block, peritubal adhesions, hydrosalpinx, beading of the tube and unhealthy shaggy appearance. Of the patients with tubal disease in our study, 64% had block in one or both tubes, 70% had peritubal adhesions, 13.7% had hydrosalpinx and 62.1% had unhealthy looking tubes. Of the 95 patients with tubal disease 48.4% (n=46) had evidence of endometriosis. Tubal disease was predominant in the age group 26 - 35 years, almost 75 %. Of the 95 patients with tubal disease, 61 patients (64%) had primary infertility. 77% of the patients with tubal disease were married for a period of less than 10 years.

Conclusion: Laparoscopy is an effective diagnostic tool for evaluation of tubal pathology. Laparoscopy and chromopertubation test should be recommended for all infertile patients with tubal factor. Further it enables correction , in possible cases.

Keywords: Chromopertubation, Infertility, Laparoscopy, Tubal factor.

References

  1. Dun EC, Nezhat CH. Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin North Am. 2012 Dec;39(4):551-66.
  2. Muzii L, Sereni MI, Battista C, Zullo MA, Tambone V, Angioli R. Tubo-peritoneal factor of infertility: diagnosis and treatment. Clin Ter. 2010; 161(1):77- 85.
  3. Confino E, Radwanska E. Tubal factors in infertility. Curr Opin Obstet Gynecol. 1992 Apr;4(2):197-202
  4. Mondal SK, Dutta TK. A ten year clinicopathological study of female genital tuberculosis and impact on fertility. JNMA J Nepal Med Assoc. 2009 Jan-Mar; 48(173):52-7.
  5. Tsuji I, Ami K, Fujinami N, Hoshiai H. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingo-graphy. Tohoku J Exp Med. 2012; 227(2):105-8.
  6. National Institute for Clinical Excellence, NHS. Fertility: Assessment and Treatment for People with Fertility Problems- Full Guideline. London: RCOG Press, 2004
  7. Shetty SK, Shetty H, Rai S. Laparoscopic evaluation of tubal factor in cases of infertility. Int J Reprod Contracept Obstet Gynecol 2013;2:410-3.
  8. Chaudhari AD, Baria AM, Chaudhari UR, Dixit GT, Thakor N. Diagnostic laparoscopy in the evaluation of tubal factor in cases of infertility. Int J Reprod Contracept Obstet Gynecol 2017;6:1275
  9. Kanal P, Sharma S. Study of Primary Infertility in females by Diagnostic Laparoscopy. Internet Journal of Medical Update 2006 Jul-Dec;1(2):7-9.
  10. Aziz N. Laparoscopic evaluation of female factors in infertility. J Coll Physicians Surg Pak. 2010 Oct; 20(10):649-52.

Corresponding Author

Dr Anitha M

Addl. Professor, Dept. of O and G, SATH, Govt. Medical College, Trivandrum