Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study

OBJECTIVE

To evaluate the efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in the treatment of female infertility.

MATERIALS AND METHODS

This study includes 174 female patients with a history of long-standing female infertility. We retrospectively reviewed 41 patients who underwent hysterolaparoscopy (HL) via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and 133 patients who underwent laparoendoscopic single-site surgery (LESS). Demographic data, operation records, and pregnancy outcomes were collected and analyzed. The deadline for postoperative follow-up was June 2022. All the included patients were followed up for at least 18 months after surgery.

RESULTS

Compared with the LESS group, the vNOTES group had a shorter postoperative bowel movement time and less pain at 4 and 12 h (p = 0.004 vs. 0.008); no differences were found in other perioperative indicators. The clinical pregnancy rates of the vNOTES and LESS groups were 87.80% and 74.43% (p = 0.073), respectively.

CONCLUSIONS

vNOTES represents a new, less invasive approach for infertility diagnosis and treatment that is particularly suitable for women who have special esthetic requirements. vNOTES is safe and practical and may be an ideal choice for scarless infertility surgery.

Sonographic Evaluation of Various Causes of Female Infertility: A Literature Review

Objective:

Female infertility may be a commonly encountered problem that presently accounts for a great percentage of women seeking gynecologic services. A systematic review was preformed to evaluate the most common cause of infertility, using sonography.

Materials and Methods:

A search was executed with Google Scholar, PubMed, NCBI, and Medscape databases, from 2001 to 2020. Two investigators independently reviewed and assessed those studies for eligibility. The data were tabulated in a Microsoft Excel sheet. The Statistical Package for the Social Sciences (SPSS), version 24 software was used to evaluate the data.

Results:

Out of 70 studies, the contributing factors, detected with sonography, for infertility were as follows: polycystic ovarian syndrome (PCOS), 44.9%; fibroids, 43.6%; endometriosis, 33.3%; polyps, 29.5%; adhesions, 29.5%; pelvic inflammatory disease, 23.1%; ovarian cysts, 23.1%; congenital anomalies, 20.5%; and adenomyosis, 11.5%.

Conclusion:

The most common cause of infertility, detected with sonography, was PCOS, and the least contributor to infertility was adenomyosis.

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

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.

The Diagnostic Value of Hysterosalpingography and Hysterolaparoscopy for Evaluating Uterine Cavity and Tubal Patency in Infertile Patients

Background and objective Hysterosalpingography (HSG) is a common radiologic modality employed for the initial workup of female infertile patients to evaluate for tubal patency or any gross intrauterine pathology. HSG is a relatively cheap and easily available outpatient procedure but bears the risk of radiation exposure. The purpose of the study was to compare the diagnostic value of HSG with that of diagnostic hysterolaparoscopy in infertile women and to evaluate their role in the diagnosis and management of infertility. Methodology This study was carried out from February 2018 to January 2019. All women attending our outpatient department (OPD) for the treatment of infertility who were aged between 20-40 years were included in the study. Those with acute vaginal and cervical infection and those having an allergic reaction to the dye used in HSG were excluded from the study. Known cases of pelvic inflammatory disease and those who achieved pregnancy before the performance of hysteroscopy were also excluded from the study. Results A total of 172 women with primary or secondary infertility were enrolled in the study. Out of these, 13 women became pregnant, and two were lost to follow-up and were excluded from our study. Thus, a total of 157 infertile women were analysed. The agreement between HSG and hysteroscopy was 71.3% for the evaluation of the uterine cavity, and this was considered a fair strength of agreement between the procedures (k value=0.302). Conclusion Compared to HSG, the incidental findings detected by hysteroscopy amounted to 19.14%. Our study results depict the advantage of hysterolaparoscopy over HSG. Although the sensitivity of HSG is as good as that of diagnostic hysterolaparoscopy for the detection of tubal patency, a significant number of important incidental findings can be missed by it. Hence, diagnostic hysterolaparoscopy should be offered as the first-line modality for the evaluation of infertility wherever the procedure is available.

Predictive value of bubble sign for tubal patency during office hysteroscopy

OBJECTIVE

Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures.

METHODS

In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed.

RESULTS

Mean age of patients was 33.45 ± 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %).

CONCLUSIONS

A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.

Incidence of intrauterine abnormalities in Pakistani women with unexplained infertility diagnosed via saline infusion sonography

To determine the frequency of intrauterine abnormalities in women with unexplained infertility using saline infusion sonography. This was a retrospective cohort study conducted at Aziz medical centre, Karachi, Pakistan between January and December 2015. The study population comprised of women with unexplained infertility who underwent saline infusion sonography as a part of their diagnostic workup. The frequency of uterine abnormalities in these women was determined and the relationship between these pathologies and patient age and body mass index was assessed. Of the 769 women included, 202 (26.3%) had uterine abnormalities. Endometrial polyp (118 cases, 15.3%) was the most common abnormality, followed by submucous fibroids (54, 7%), intrauterine adhesions (20, 2.6%), and septae (10, 5%). Intrauterine pathologies were more common in women with primary infertility (71.8% versus 28.2%, p = 0.002). Uterine abnormalities were most common in the age group 30-34 years ( n = 80, 39.6%) and in overweight patients ( n = 95, 47%). The distribution of abnormalities differed significantly in various age groups ( p = 0.009) and among women with different BMI ( p = 0.029). A significant number of women with unexplained infertility present with unsuspected uterine abnormalities; therefore an assessment of the uterine cavity should be performed in all cases.

Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center

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.

Can hysterolaparoscopic mediated chromopertubation obviate the need for hysterosalpingography for proximal tubal blockage?: An experience at a single tertiary care center

OBJECTIVES

To compare the diagnostic performance for tubal patency by chromopertubation and hysterosalpingography in the female infertile patients.

METHODS

We prospectively evaluated 103 female patients (age range 19-35 years; mean age 27.60 years) diagnosed as infertile, underwent hysterosalpingography (HSG) for tubal patency and uterine pathology during initial diagnostic work-up. All the enlisted patients fulfilled the criteria of infertility and these also underwent hysterolaparoscopic chromopertubation (CPT). The results of HSG were compared with the reference standard using CPT.

RESULTS

Out of 103 female infertile patients, 60 (58.2%) were of primary and rest of them 43 (41.8%) secondary infertile patients. HSG showed abnormalities in tubal patency in 69/103 (∼67%) patients. The detected abnormalities were distributed in 40/60 (66.6%) primary and 29/43 (67.4%) secondary infertile patients. On comparison to HSG with CPT (reference standard) for tubal blockage detection, it was found that HSG was true positive (TP) in 38 patients, true negative in 34 patients, false positive in 31 patients and FN in 0 patients. We found that for detection of tubal blockage, the sensitivity, specificity, PPV, NPV and accuracy of HSG was 100.00%, 52.31%, 36.89%, 57.07% and 67% respectively. Tubal occlusion detected on HSG and CPT showed a moderate agreement (weighted kappa - 0.447; 95% CI -0.312 to 0.583). In present study, no patient shows tubal blockage in CPT while HSG was normal.

CONCLUSION

We concluded that hysterolaparoscopic mediated chromopertubation not only diagnostic but also therapeutic, so it can obviate the need of hysterosalpingography.

Comparative Prospective Study of Hysterosalpingography and Hysteroscopy in Infertile Women

Aim:

To compare the findings and diagnostic accuracy of Hysterosalpingography (HSG) and hysteroscopy in infertile women.

Setting and Design:

Prospective comparative study in a tertiary care Centre.

Material and Methods:

108 women with primary or secondary infertility were recruited. In all women after basic infertility workup, both HSG and hysteroscopy were performed.

Results:

Out of 108 women, in 3 women HSG couldn’t be done and in one woman there was uterine perforation on hysteroscopy. HSG showed normal uterine cavity in 77.8% (81/105) women and abnormal in 22.85% (24/105). Hysteroscopy findings were normal in 70.09% (75/107) and abnormal in 29.91% (32/107). Hysteroscopy detected incidental findings in 15.38% (16/104) cases. HSG showed irregular uterine cavity in 14.15% (15/105) women but on hysteroscopy; normal cavity was present in 6 (40%) women and abnormality was detected in 9 (60%) women. The sensitivity, specificity, positive predictive and negative predictive value of HSG in evaluating uterine cavity abnormalities were 44.83% (95% confidence interval (CI); 0.26–0.64), 86.67% (95% CI; 0.76–0.93), 56.52% (95% CI; 0.34–0.76) and 80.25% (95%CI; 0.69–0.88). Positive likelihood ratio and negative likelihood ratio of HSG in detecting uterine cavity abnormality was 3.36 and 0.64 respectively. The agreement between HSG and hysteroscopy was 75%. This was statistically significant (P value = 0.001) with fair strength of agreement between HSG and hysteroscopy. (k value= 0.336).

Conclusion:

Hysteroscopy should be performed in all infertile patients as it can detect significant number of incidental findings missed by HSG.

Comparison between findings of saline infusion sonohysterography and office hysteroscopy in patients with recurrent implantation failure

AIM:

This study aims to determine the accuracy of saline infusion sonohysterography (SIS) in the diagnosis of intrauterine pathologies in women with recurrent implantation failure (RIF).

SETTINGS AND DESIGN:

This is a prospective cross-over study which was carried out during the period between December 2013 and July 2014.

MATERIALS AND METHODS:

The study involved sixty subfertile women with a history of RIF. All cases underwent a transvaginal ultrasonography, SIS and then an office hysteroscopy (1 day after SIS) during early follicular phase. SIS was carried out by same sonographer, and then hysteroscopy was carried out by same gynecologist who was kept blind to findings at SIS.

STATISTICAL ANALYSIS:

Was done using IBM^© SPSS^© Statistics version 22. The sensitivity of SIS was calculated as it equals: True positive by SIS/all positive (true cases by hysteroscopy) and specificity was calculated as it equals: True negative by SIS/all negatives (normal by hysteroscopy).

RESULTS:

Overall uterine abnormalities were significantly less likely to be identified with SIS compared to hysteroscopy (P = 0.002), but analysis of each finding separately demonstrated a comparable difference between SIS and hysteroscopy (P > 0.05). We found that the sensitivity, specificity, positive predictive value, and negative predictive value of SIS to detect intrauterine pathology is 41.2%, 100%, 100%, and 81.1%, respectively.

CONCLUSION:

Our findings suggest a good role of SIS in the workup for RIF saving more invasive procedure for selected cases.

Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china

Objectives:

To evaluate the effects and safeness of combined hysterolaparoscopy on evaluation the causes of infertility.

Methods:

This retrospective study was conducted at the Department of Gynecology (The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China) from January 2011 to April 2014. Patients aged 21–43 years with infertility were included in this study. The prevalence of different lesions was collected to analyze.

Results:

132 infertile patients were included, 71 (53.8%) women had primary infertility and the rest 61 (46.2%) had secondary infertility. Laparoscopic abnormalites were more common than hysteroscopy abnormalites both in primary infertility group and secondary infertility group. Pelvic inflammatory disease (59.09 %) and endometriosis (29.55%) were the most common abnormalities in two groups. The most common intrauterine pathology was uterine polyps and the most common uterine malformation was uterine septum in two groups. Out of 12 patients having malformation uterus, only one was double uterus and double cervical with double vagina. There was no major surgical or anesthetic complication in any of our patients, other than mild abdominal pain.

Conclusion:

Hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility to diagnosis and treat the lesions of pelvic and uterus in the same time. Hysterolaparoscopy may be recommended as the first and final procedure for evaluation of female infertility.