Abstract
Introduction: Infertility can be defined as failure to conceive despite unprotected sexual intercourse for 1 year regardless of the cause of such a failure. The infertility may be caused due to male or female factors. In some instances, both male and female factors may be responsible. In approximately 15% cases no responsible factor can be identified despite extensive investigations and such infertility is then labelled as “unexplained infertility”. Role of diagnostic laparoscopy in evaluation of infertility is important in diagnosis of uterine, tubular and peritoneal causes of infertility.
Materials and Methods: This was a prospective study of women attending the infertility center of our tertiary care obstetric hospital situated in an urban area. Total 60 women with infertility were included in this study on the basis of a predefined inclusion and exclusion criteria. A detailed history, Clinical examination, per speculum and per vaginal examination was done in all the cases. Investigations such as ultrasound and hysterosalpingography was also done. Laparoscopic evaluation was done in 22 (36.67%) selected patients. Data was analyzed using Minitab 17 version. For statistical purpose P value less than 0.005 was taken as significant.
Results: Mean Age of the studied cases was found to be 29.38+/- 4.49 years. Primary and secondary infertility was seen in 71.67%and 28.33% patients respectively. 20 patients (33.33%) had menstrual irregularities in addition to infertility, while chronic abdominal pain and vaginal discharge was present in 4 (6.66%). 4 (6.66%) patients had dyspareunia in addition to infertility. Out of the 22 (36.67%) cases in whom laparoscopy was done the most common cause of infertility was found to be endometriosis which was seen in 12 (20%) cases. Peritubal blockages, hydrosalpinx and other tubal abnormalities were found in 8 (13.33%) cases. In remaining 2 (3.33%) patients no abnormality was detected on laparoscopy.
Conclusion: Laparoscopic evaluation of the women presenting with primary as well as secondary infertility may be helpful in identifying uterine, peritubal and peritoneal causes of infertility and should be done before labelling the infertility to be “unexplained”.
Keywords: Infertility, evaluation, Diagnostic laparoscopy, Endometriosis.
References
- Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018 Mar 16. pii: S0009-9120(18)30220-0
- Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of Human Reproductive Sciences. 2015;8(4):191-196.
- Westrom L. Effect of pelvic inflammatory disease on fertility. Venereology.1995 Nov;8(4):219-22.
- Mueller BA, Daling JR, Weiss NS, Moore DE. Recreational drug use and the risk of primary infertility. Epidemiology. 1990 May;1(3):195-200.
- Collins JA, Rand CA, Wilson EH, Wrixon W, Casper RF. The better prognosis insecondary infertility is associated with a higher proportion of ovulationdisorders. Fertil Steril. 1986 May;45(5):611-6.
- Al-Homaidan HT. Depression among Women with Primary Infertility attending an Infertility Clinic in Riyadh, Kingdom of Saudi Arabia: Rate, Severity, and Contributing Factors. International Journal of Health Sciences. 2011;5(2):108-115.
- Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: A review of recent literature. Sociology of health & illness. 2010;32(1):140-162. doi:10.1111/j.1467-9566.2009.01213.x.
- Hrometz SL, Gates VA. Review of available infertility treatments. Drugs Today (Barc). 2009 Apr;45(4):275-91.
- Sadow CA, Sahni VA. Imaging female infertility. Abdom Imaging. 2014Feb; 39(1):92-107.
- Farquhar C. Endometriosis. BMJ : British Medical Journal. 2007;334 (7587):249-253.
- Stephen EH, Chandra A Updated projections of infertility in the United States: 1995-2025.Fertil Steril. 1998 Jul; 70(1):30-4.
- Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer SBirths: final data for 2004.Natl Vital Stat Rep. 2006 Sep 29; 55(1):1-101
- Calverton, Maryland, USA: ORC Macro and the World Health Organization; 2004. World Health Organization. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No 9.
- 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 Iranian Journal of Reproductive Medicine. 2015;13(8):513-516.
- Ashok Kumar K, Priyanka Jogi Y, Bharathi A. Diagnostic laparoscopy in the evaluation of female factor infertility. Int J Reprod Contracept Obstet Gynecol 2017;6:383-7.
- Naz T, Hassan L, Gulmeen, Nighat F, Sultan S. Laparoscopic evaluation ininfertility. J Coll Physicians Surg Pak. 2009 Nov;19(11):704-7.
- Bosteels J, Van Herendael B, Weyers S, D'Hooghe T. The position of diagnostic laparoscopy in current fertility practice. Hum Reprod Update. 2007Sep-Oct;13 (5):477-85. Epub 2007 Jun 11. Review.
- Aziz N. Laparoscopic evaluation of female factors in infertility. J CollPhysicians Surg Pak. 2010 Oct;20(10):649-52.
- National Collaborating Centre for Women’s and Children’s Health (UK). Fertility: Assessment and Treatment for People with Fertility Problems. London: Royal College of Obstetricians & Gynaecologists; 2013 Feb. (NICE Clinical Guidelines, No. 156.) 11, Unexplained infertility.Available from: https://www.ncbi.nlm.nih.gov/books/NBK327760
- Sadeghi MR. Unexplained Infertility, the Controversial Matter in Management of Infertile Couples. Journal of Reproduction & Infertility. 2015;16(1):1-2.
Corresponding Author
Chetana A Gopchade
Consultant Obstetrician and Gynecologist, Amrutpath Maternity and Children’s Hospital Nanded (MS)- India