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Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.
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Background: The prevalence of infertility ranges from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less developed nations, with an estimated overall median prevalence of 9%. The present study was aimed to evaluate the role of hysterolaparoscopy in the study of primary and secondary infertility, to identify the various pathological conditions in female reproductive tract leading to primary/ secondary infertility, to develop a plan for therapy and management at the same time.Methods: This is a one-year prospective study conducted in obstetrics and gynecology department at D. Y. Patil hospital, Navi Mumbai, Maharashtra, India. All infertility patients seen in outpatient department, who were medically fit, willing for surgery and willing to get enrolled for study were included in this study.Results: Out of total 120 cases for infertility evaluated, tubal factor is the most common cause (28.3%) in both primary (23.3%) and secondary (43.3%) infertility group as seen on laparoscopy. Followed by ovarian factors (28.3%), peritoneal (11.6%) and uterine factors (10.8%). In 27 cases (22%), there were no detectable pathology at laparoscopy. In this study, hysteroscopy findings show 5.8% cases to have submucous fibroid uterus, 3.3% submucous polyp, 1.6% subseptate uterus, 0.8% septate uterus, 0.8% intrauterine adhesions, 0.8% bicornuate uterus and cervical stenosis 1.6% of patients.Conclusions: From this study, it is concluded that the diagnostic hysteroscopy and laparoscopy is an effective and safe tool in evaluation of female infertility. It provides direct and magnified view of all pelvic organs.
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Background: Tubal factor is responsible for infertility and is found in one of three infertile women. The current research was undertaken to compare the efficacy of hysterosalpingo contrast sonography (HyCoSy) with laparoscopy and chromopertubation in infertile women.Methods: A cross-sectional study was conducted from August 2016 to March 2017 among the patients attending outpatient department with complaints of primary or secondary infertility after obtaining written and informed consent. Detailed history of the patient was taken; clinical examination and necessary investigations were done. Data analysis was carried out using SPSS version 22.Results: All the HyCoSy findings showed excellent specificity (84-100%) and the sensitivity ranged from 40-87%.Conclusions: Study conclude that HyCoSy is a good screening method for evaluating uterine cavity lesions and tubal block in infertile women being safe, sensitive, cost effective, non-invasive procedure giving additional information regarding ovarian, adnexal and peritoneal pathology.
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Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility.
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Background: Mullerian anomalies-developmental anomalies of the mullerian system might involve the uterus, cervix, fallopian tubes and vagina of which anomalies of the uterus are the most common. They are often regarded as a treatable form of infertility and have a prevalence of 0.5% in the general population. Though most of them remain asymptomatic, they contribute a good proportion of recurrent pregnancy losses, obstetric complications and infertility. Their timely diagnosis, management and evaluation of associated anomalies proves to be necessary.Methods: A prospective observational study was undertaken at KIMS, Hubli from 2014 to 2018. The study involved those women who were admitted in the department of obstetrics and gynecology at KIMS, Hubli for various reasons and were detected to have a mullerian anomaly. Their mode of presentation, method of detection, associated anomalies were analysed and statistical conclusions drawn from the same.Results: During the study period of 5 years, a total of 85 cases of mullerian anomalies were detected amounting to an incidence of 0.15%. 35% of them were asymptomatic, infertility (24%) being the next common mode of presentation. Septate/sub-septate uterus was found to have the poorest obstetric outcome. Mullerian anomalies were seen in combination in 14% of the cases and had an association with other anomalies like renal anomalies in 10% of the cases. Surgical correction was done for most of the cases of vaginal septum and septate/sub-septate uterus.Conclusions: Mullerian anomalies are often regarded as an uncommon but treatable form of infertility. Their timely detection, treatment and watchful obstetric management is in need.
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Background: Till date hysterosalpingography (HSG) remains the first-line method to detect tubal patency and to find out any uterine abnormalities in infertile female while diagnostic hysterolaparoscopy (DHL) is considered to be the gold standard method, it is during last decades only that saline infusion sonography (SIS)/ sonohysterography (SHG) has emerged as an efficacious method of checking tubal patency and uterine anatomy as well. The present study aims to compare all three methods viz- SIS, HSG and DHL and to evaluate the correlation between these methods.Methods: 98 infertile females of age group 18-35 years with normal Hormonal profile without any male factor infertility, were prospectively selected from the outpatient department of obstetrics and gynecology, GMH Rewa, Madhya Pradesh over one year from 1st August 2016 to 31st July 2017.Results: Diagnostic accuracy (sensitivity and specificity) of SIS was found to be more than HSG for both tubal patency and uterine abnormalities detection. SIS has less numbers of false positive and false negative rates as compared to HSG. DHL was found to be much superior to both SIS and HSG, also detected additional findings in multiple sites like pelvis, tubes and the uterus on the same setting which were missed on SIS and HSG.Conclusions: SIS may replace HSG as a first step screening method for tubal patency detection, as it has more diagnostic accuracy than HSG and better correlation with DHL and has many advantages and minimal disadvantages as compared to HSG.
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Background: Infertility is one of the commonest problems encountered in gynecology. Infertility appears to be a problem in 10-15% of Indian population. Tubal factors account for (20-40%) of infertility. The objective of the study was to demonstrate the role of hystero-salpingography and hystero-laparoscopy in evaluation of tubal factors for female infertility.Methods: Present study was carried out on 70 women attending the gynaecology OPD for investigation of infertility admitted between March 2014 to December 2014 in Gynecology ward, SSG Hospital attached to Government Medical College, Vadodara, Gujarat.Results: Out of 70 patients who underwent HSG tubal block was detected in 34 cases. Out of these 34 cases tubal block was detected only in 17 cases by laparoscopy and chromopertubation. One case which showed patent tubes on HSG had unilateral tubal block on chromopertubation test. Accordingly, sensitivity of HSG for tubal patency comes out to be 0.72, specificity of 0.94, positive predictive value of 97.43%, negative predictive value of 51.61%, positive likelihood ratio of 12.28 and negative likelihood ratio of 0.30.Conclusions: HSG being simple and less invasive technique along with higher specificity and lesser complications. Hystero-laparoscopy is a valuable technique for the complete assessment of female infertility.
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Background: The worldwide incidence of GTB is approximately 5- 10% in infertile women. It varies from as low as 0.69% in some developed countries to as high as 19% in India. It is diagnosed by culture of the tubercle bacillus from tissue sampled from the genital tract is the yardstick for diagnosis and remains the gold standard.Methods: A prospective study was carried out between January 2012 and January 2015 on 100 women presenting with infertility.Results: A total (27%) women were diagnosed as genital tuberculosis by combination of hystero laparoscopic findings, histopathological and endometrial DNA-PCR technique confirmation. Of these (40.62%) had secondary infertility and remaining (59.38%) had primary infertility. (15.62%) were previously diagnosed with pulmonary or extra pulmonary tuberculosis and had completed a full course of Anti-tubercular treatment as per WHO CAT 1 regime.Conclusions: Therefore, in countries where TB is endemic, early and aggressive strategies should be pursued to diagnose and treat TB.
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Background: In modern era, endoscopic methods are commonly used in evaluation of female infertility. Hysterolaparoscopy is such a real time theranostic modality for anatomical causes of the infertility. The objective of this study was to evaluate the effect of accessory parameters (Age, Body mass index, duration of infertility, Rhesus factor, menstruation history and hemoglobin) on success rate of endoscopic procedures in terms of achieving pregnancy.Methods: A total 157 female infertile patients (Mean± standard deviation 27.72±3.82 years) were recruited in present study. During initial assessment detailed history was taken and hysterolaparoscopy was performed. The observed structural abnormalities on hysterolaparoscopy during diagnostic work up were tackled at same time if possible. After procedure, patients were counselled for regular sexual activity. The follow-up of all patients was done for 12 months.Results: A total 157 female infertile patients were recruited and divided into primary 93 (59.2%) and secondary infertile 64 (41.74%) patients on basis of obstetric history. The average age, BMI, hemoglobin and duration of infertility were 27.7years, 21.8 kg/m2, 12.3 gm and 3.9 years respectively. Out of 157 patients, anatomical abnormalities were detected in 125 patients during Hysterolaparoscopy and distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertile patients. Of 125 patients with abnormal hysterolaparoscopic findings, 121 underwent active intervention and on follow up, 43 patients were conceived. We found that age; BMI, Rhesus factor, menstruation history and duration of the infertility were not correlated with fertility outcome while hemoglobin level was significantly correlated with conception rate.Conclusions: Authors concluded that outcome of the hysterolaparoscopy in female infertile patients is significantly depends upon hemoglobin levels, however outcome is irrelevant to age, duration of infertility, Rhesus factor and body mass index.
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Background: To compare the types of hysterolaparoscopic interventions in female infertile patients and evaluate the outcome in terms of achieving pregnancy at follow up of 12 months.Methods: We prospectively evaluated 157 female-infertile-patients (age range 19-35 years; mean age 27.75 years). During their workup, all underwent hysterolaparoscopy. The detected anatomical abnormalities on hysterolaparoscopy were also tackled at same time if possible. After hysterolaparoscopy, Patients were advised for regular sexual activity. Follow-up of all recruited patients was done for 12 months or till achievement of fetal cardiac activity.Results: Of the 157 female-infertile-patients, 93 (59.2%) were of primary infertility and remaining 64 (41.74%) were secondary infertility patients. Hysterolaparoscopy revealed abnormalities in 125/157 patients. Of the 125 patients with abnormal hysterolaparoscopic findings, 121 underwent active therapeutic interventions. Out of 121 underwent active intervention and 43 patients conceived during next 12 months. Of 121 patients, 81 (66.9%) experienced single type intervention and remaining 40 (33.1%) experienced multiple type of the intervention. Among 81 patients with single type intervention, 28 conceived while 33 patients with multiple type of intervention 15 conceived. There was no statistically significant difference in pregnancy outcome in both groups. When we analyzed independently in primary and secondary infertility patients, similarly there was no significant difference in the pregnancy outcome.Conclusions: We concluded the conception rate was not significantly difference in infertile female patients, who underwent either single or multiple type hysterolaparoscopic intervention. So hysterolaparoscopy interventions should be performed in infertile female patients irrespective of type and extent of pelvic pathologies.