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Van Gestel H, Bafort C, Meuleman C, Tomassetti C, Vanhie A. The prevalence of endometriosis in unexplained infertility: a systematic review. Reprod Biomed Online 2024; 49:103848. [PMID: 38943813 DOI: 10.1016/j.rbmo.2024.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 07/01/2024]
Abstract
In 15-30% of couples with infertility, no abnormalities are found after the initial diagnostic work-up. The aim of this study was to investigate the prevalence of endometriosis in patients with unexplained infertility undergoing diagnostic laparoscopy in the current era of improved imaging and assisted reproductive technology. A systematic search of PubMed, Embase and Cochrane Central was conducted to identify all studies reporting on pelvic pathologies found by laparoscopy in couples diagnosed with unexplained infertility. Normal ovulatory cycles, normal semen analysis and an infertility period of ≥12 months were the minimum requirements for a study population to be included. The prevalence of endometriosis was 44%, and most lesions were classified as minimal or mild (74%). The prevalence rates of tubal factors and adhesions were 20% and 16%, respectively. The detection rate for pelvic abnormalities was higher in women with prior fertility treatment (75%) compared with women without prior fertility treatment (53%). Despite the significant improvements in imaging for the diagnosis of endometriosis and tubal factors over the last decades, the prevalence rates of endometriosis and tubal abnormalities remain high in patients with unexplained infertility. The high prevalence of endometriosis in this population is important for decision-making in patients who also suffer from pain symptoms suggestive of endometriosis.
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Affiliation(s)
- Hanne Van Gestel
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Celine Bafort
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Christel Meuleman
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Carla Tomassetti
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Arne Vanhie
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium.
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Varlas V, Rhazi Y, Cloțea E, Borș RG, Mirică RM, Bacalbașa N. Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology. J Clin Med 2021; 10:3749. [PMID: 34442042 PMCID: PMC8396885 DOI: 10.3390/jcm10163749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. AIM In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. METHOD We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. INCLUSION CRITERIA Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. EXCLUSION CRITERIA pre-puberty, menopause, couple with male infertility. CONCLUSION Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.
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Affiliation(s)
- Valentin Varlas
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (Y.R.); (E.C.); (R.G.B.)
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (R.M.M.); (N.B.)
| | - Yassin Rhazi
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (Y.R.); (E.C.); (R.G.B.)
| | - Eliza Cloțea
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (Y.R.); (E.C.); (R.G.B.)
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania; (Y.R.); (E.C.); (R.G.B.)
| | - Radu Mihail Mirică
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (R.M.M.); (N.B.)
- Department of General Surgery, Emergency Clinical Hospital “Saint John”, 014461 Bucharest, Romania
| | - Nicolae Bacalbașa
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania; (R.M.M.); (N.B.)
- Department of Obstetrics and Gynaecology, Cantacuzino Clinical Hospital, 030167 Bucharest, Romania
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Moreau J, Gatimel N, Simon C, Cohade C, Lesourd F, Parinaud J, Léandri R. Potential chances for natural fertility influence results of intrauterine inseminations. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100058. [PMID: 31673689 PMCID: PMC6817667 DOI: 10.1016/j.eurox.2019.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/26/2022] Open
Abstract
Objective Intra-uterine insemination (IUI) is widely used for different indications. The aim of the present study was to evaluate the efficiency of intra-uterine insemination as a function of indication and origin of the inseminated spermatozoa. Study design The retrospective study involved 827 first attempts of IUI in 827 couples between January 2011 and July 2017 in the Toulouse university hospital. Of these, 642 used fresh sperm from the husband, 40 frozen sperm from the husband and 145 frozen sperm from donors. The measured outcome parameter was live birth rate per attempt. Results When comparing couples lacking functional gametes (due to male or female causes), to couples who could potentially conceive spontaneously, i.e. subfertile, the latter were found to have a significantly lower live birth rate (18% vs 26%; P < 0.05). Even when adjusted for demographic parameters, which differed significantly between the 2 groups (female age, percentage of women suffering from primary infertility, BMI, number of inseminated motile spermatozoa and stimulation duration), this difference remained statistically significant (OR = 0.639 [0.425-0.961]; P = 0.0316). Conclusion When compared to couples lacking functional gametes, subfertile couples have poor IUI outcomes, suggesting a hidden cause of infertility, despite no apparent differences in ovarian reserve, tubal potency, results of ovarian stimulation and normal conventional sperm parameters. Further studies are required to better characterise and identify this subgroup of women with poor IUI outcomes.
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Affiliation(s)
- Jessika Moreau
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Nicolas Gatimel
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Cynthia Simon
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Clémentine Cohade
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Florence Lesourd
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Jean Parinaud
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
| | - Roger Léandri
- Department of Reproductive Medicine, Toulouse University Hospital, Toulouse, France.,EA 3694 Human Fertility Research Group, Paul Sabatier University, Toulouse, France
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Agrawal N, Fayyaz S. Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center. J Gynecol Obstet Hum Reprod 2018; 47:425-429. [PMID: 30153506 DOI: 10.1016/j.jogoh.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the success rate of endoscopic procedures in terms of achieving pregnancy at an interval of three months for 12 months or till achievement of fetal cardiac activity whichever is earlier. METHODS We prospectively evaluated 157 female patients (age range 19-35 years; mean age 27.75 years), who were diagnosed as infertile. During their diagnostic work, all underwent hysterolaparoscopy. The detected anatomical abnormalities on the hysterolaparoscopy were tackled at the same time during diagnostic work-up if possible. After hysterolaparoscopy, Patients were advised for regular sexual activity. The follow-up of all recruited patients was done at an interval of three months for 12 months or till achievement of fetal cardiac activity. RESULTS Of the 157 infertile female patients, 93 (59.2%) were of primary infertility and remaining 64 (41.74%) were secondary infertility patients. Hysterolaparoscopy revealed abnormalities in 125/157 patients. The detected hysterolaparoscopic anatomical abnormalities were distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertility patients. Of the 125 patients with abnormal hysterolaproscopic findings, 121 underwent active therapeutic interventions. All of the secondary infertility patients with hysterolaparoscopic abnormalities experienced active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 patients experienced active intervention. Out of the 125 abnormal hysterolaparoscopic patients, 121 underwent active intervention and 43 patients conceived during next 12 months. Among 32 patients with normal hysterolaparoscopic findings, 7 conceived within 12 months. Significantly higher conception was observed in hysterolaparoscopic intervention patients as compared to normal hysterolaparoscopy patients (p∼0.001). Independently in primary infertility patients, the conception rate in the patient with hysterolaparoscopic intervention was significantly higher than nonintervention group (p<0.0001). Similarly, conception rate was significantly higher in secondary infertility patients (p∼0.004). CONCLUSION We concluded that the conception rate was significantly high in infertility patients, who underwent hysterolaproscopic intervention. In short hysterolaparoscopy should be considered as a potential gold standard approach in the evaluation of female infertility.
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Affiliation(s)
- Namita Agrawal
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India.
| | - S Fayyaz
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India
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Yücel B, Demirel E, Kelekci S, Shawki O. Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility. J OBSTET GYNAECOL 2018; 38:511-515. [PMID: 29557219 DOI: 10.1080/01443615.2017.1303469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. The aim of this study was to examine the presence of tubal peristaltic dysfunction in unexplained infertility (UI). Hysteroscopy was performed in 35 women with UI and in 37 healthy fertile women. Bilateral tubal peristalses were assessed hysteroscopically by the observation of methylene blue injection and its transport to the Fallopian tubes. Tubal patency was evaluated with laparoscopic chromopertubation. Two women in control group (6.67%) and eight women in UI group (30.77%) had no tubal peristalsis, at least one tube with normal tubal patency. The difference was statistically significant (p = .019). Tubal peristaltic dysfunction may be a hidden cause of subfertility in women with bilateral patent Fallopian tubes. There is a definite need for larger trials to identify tubal peristaltic dysfunction as a cause of UI. Impact statement What is already known on this subject? Unexplained infertility has no identified pathophysiologic basis. It has been realised that rhythmic peristalsis of the ostia and tubes can be observed during hysteroscopy. What do the results of this study add? Tubal peristaltic dysfunction was detected in two tubes (3.70%) in a control group and nine tubes (19.57%) in women with unexplained infertility, when the tubes were patent. The difference was statistically significant (p = .012). What are the implications of these findings for clinical practice and/or further research? In cases of bilateral patent Fallopian tubes such as in unexplained infertility, tubal peristaltic dysfunction may be a hidden additional cause of subfertility.
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Affiliation(s)
- Burak Yücel
- a Clinic of Obstetrics and Gynaecology , Kanuni Sultan Suleyman Research and Training Hospital , Istanbul , Turkey
| | - Emine Demirel
- b Department of Obstetrics and Gynaecology , School of Medicine, Katip Celebi University , Izmir , Turkey
| | - Sefa Kelekci
- b Department of Obstetrics and Gynaecology , School of Medicine, Katip Celebi University , Izmir , Turkey
| | - Osama Shawki
- c Department of Obstetrics and Gyneacology , School of Medicine, Cairo University , Cairo , Egypt
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