ABSTRACT
Background: The inability to conceive is one of the most distressing conditions for a couple. It not only makes the female incomplete but also the social taboos attached are phenomenal. The problem of infertility as long as the recorded history of mankind. Fertility in our culture stands for reproductivity, growth and continuity. Reproduction is one of the basic essential for the survival of a species. Diagnostic laparoscopy & hysteroscopy have emerged as an accurate method of assessing, evaluating and treating infertility. Direct visualization of the abdominal and pelvic organs in laparohysteroscopy allows a definitive diagnosis to be made in many conditions where clinical examination and less invasive techniques such as ultrasound and hysterosalpingography fail to identify the problem.Methods: A prospective study was conducted in Department of Obstetrics and Gynaecology, AGMC& GBP Hospital Agartala. 50 infertile women suspected with pelvic (tubal, peritoneal, adnexal) and intrauterine (uterine polyp, septa, submucous fibroid, intrauterine adhesions) pathologies were included in the study for further evaluation and correlation of clinical findings with Laparohysteroscopy observations.Results: Out of 50 cases, 27 (54%) patients had primary infertility. While laparoscopy detected abnormalities in 60% of the cases, significant hysteroscopy findings were noted in 66% of cases. The most common laparoscopic abnormality was tubal (22%) ovarian and peritoneal (16%) in primary and secondary infertile patients respectively. On hysteroscopy, endometrial polyp (30%) was found as the commonest abnormality in both the groups.Conclusions: Laparoscopy and hysteroscopy are both diagnostic and therapeutic procedures. If pathology is discovered, it can often be treated simultaneously. Laparoscopy combined with hysteroscopy is the sole technique to have a direct view of the female reproductive tract and to find out the various causes of infertility.
ABSTRACT
A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.