WHO Definition of Infertility - “A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”

The prevalence of infertility is about 10%–15% of reproductive age couples.

Among the causes of infertility female factor (40%–55%) remains the foremost reason followed by male factor (30%–40%), combined factor (10%), whereas in 10% cases etiology remains unexplained.

Among female factor infertility, the most common cause is tuboperitoneal pathology accounting for 30%–35% cases followed by ovulatory dysfunction (20%–30% cases) and uterine pathology (15% cases).

Diagnostic hysterolaparoscopy (DHL) has emerged as the essential tool for the evaluation of female infertility and is the gold standard investigation for tubal patency.

The importance of DHL lies in the fact that it gives a detailed, direct visualization and analysis of the uterine cavity, endometrium, tubal morphology and patency, uterine, ovarian, and adnexal pathology.

These pathology findings are often missed in routine clinical examination and ultrasound scan. This study was undertaken to find out role of DHL in evaluation of female infertility.

OBJECTIVE

The objective of this study is to analyze the role of diagnostic hysterolaparoscopy (DHL) for evaluation of infertility and management in a tertiary care hospital.

STUDYDESIGN- Retrospective observational Study

STUDY PERIOD- MAY 2020 - FEB 2023

SAMPLESIZE-84

STUDYPLACE-DR B R Ambedkar medical college and Hospital

METHODOFCOLLECTION-data collected from bmedical record department

INCLUSIONCRITERIA

All patients between 20-40 years presented within fertility(primary and secondary) who has undergone DHL as a part of management.

EXCLUSIONCRITERIA

When cause of infertility is known either by USG, HSG, Hormone analysis.

STATISTICALANALYSIS

Statistical analysis was performed using SPSS (IBM Corp .SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) software version 16. Student’st-test and Chi-square test were performed for comparison of continuous variable and proportions, respectively.

RESULTS

A total number of 84 patients underwent DHL out of which 60 (73.2%) suffered from primary infertility and 22(26.8%) suffered from secondary infertility.

AGE

Majority of the patients belong to age group 25 to 29 years. The mean age of patients with infertility was 27.2 ± 2.6 years

DURATION

Majority of the cases of infertility belong to the duration of <5 yrs. The mean durationof infertility in primary and secondary infertility was 4.9 ±2.2 years and 4.8 ± 2.7 years, respectively. However it is statistically insignificant.

BMI

Among84 cases, 23 cases(28.1%) belongto normalBMI,and47(57.3%) belong to overweight category, and 12 cases (14.6%) belong to obese category. Statistically Significant association with BMI is seen.

PRIOR TREATMENT

Around43 cases(52.4%) prior treatment with ovulation induction and IUI. And majority of cases have been taken treatment for 3 years which was failed.

ABNORMALFINDINGS

In both primary and secondary infertility patients, laparoscopic abnormalities (37.6% and 49.2%) were more common thanthe hysteroscopic ones (7.3% and 14.2%). In both groups tubal factors was predominant, of which bilateral peritubal adhesions and hydrosalphinx found to be the most common cause.

Around2%ofpatientsendometrioticspotswasseeninlaparoscopyand ablation of them was done in the same sitting. The most common abnormality in hysteroscopy was uterine polyp.

CONCLUSION

From this study it is noted that primary infertility is more common than secondary infertility, in mean age group of 27 yrs. Incidence increases with rise in BMI. Peritubal adhesions due to PID was the most common cause and simultaneous a dhesiolysis was done.

DHL is helpful in identifying undetected treatable causes of infertility. It also gives advantage of providing simultaneous correction at the same instance and of course, it is a minimal invasive procedure.

Reversible causes of infertility such as a dnexaladhesions, tubal blockade, uterine synechiae, etc., can easily be diagnosed and treated by hysterolaparoscopy.

However, in the era of advanced ultrasound, in developing countries diagnostic hysterolaparosccopy may still offer some hope to the in fertile couple.

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