2011 Volume 27 Issue 1 Pages 296-299
Objective: The efficacy of diagnostic laparoscopy should be re-considered due to the improved success rate of assisted reproductive technologies (ART).
Methods: We retrospectively reviewed clinical records of 126 women who were examined by both hysterosalpingography (HSG) and diagnostic laparoscopy for unexplained and tubal infertility, and of 186 women undergoing in vitro fertilization and embryo transfer (IVF-ET) due to unexplained infertility, between January 2002 and December 2009 in the Department of Obstetrics and Gynecology, University of Tokyo.
Results: The mean age of patients undergoing laparoscopy was 33.2±3.7 years and the mean duration of infertility at first visit was 40.6±26.6 months. In assessing for tubal patency, laparoscopic findings differed from HSG findings in 45 women (35.7%). The cumulative pregnancy rate without ART after laparoscopic surgery was 42.4%. We compared the pregnancy rates between patients with normal tubes and those with abnormal tubes, who were treated during laparoscopy. The pregnancy rate of the patients with abnormal tubes was relatively high (64.3%) compared with that of the patients with normal tubes (36.5%) (P = 0.06). The cumulative pregnancy rate of patients undergoing IVF-ET was 52.7% (mean age: 37.4±3.7 years old) ; that of patients over 40 years old was 28.4%.
Conclusions: The evaluation of tubal pathology by HSG alone can be limited. Laparoscopic surgery can be a useful adjunct in accurate diagnosis of infertility and improvement of fecundity, especially for patients with tubal pathology that can be treated laparoscopically. However, older women may still require further IVF-ET treatments.
