Received: December 12, 2005
Accepted: February 03, 2006
Ref: Kanal P, Sharma S. Study of Primary Infertility in females by Diagnostic Laproscopy. Internet Journal of Medical Update 2006 Jul-Dec;1(2):7-9.

STUDY OF PRIMARY INFERTILITY IN FEMALES BY DIAGNOSTIC LAPROSCOPY

Dr. Preeti Kanal MS and Dr. Sanjaya Sharma MD

Department of Obstetrics and Gynecology, M L B Medical College, Jhansi (U P), India

(Corresponding Author: Dr. (Mrs.) Preeti Kanal, Senior Resident, Department of Obstetrics and Gynecology, MLB Medical College, Jhansi (UP), India, Email: preeti_dr@rediffmail.com)

INTRODUCTION

Primary infertility is defined as inability of a couple to achieve pregnancy within one year of defined time of unprotected intercourse with adequate coitus. The incidence of infertility in any community varies between 5% and 15%. Both partners in relationship contribute to potential fertility and both may be sub fertile. The female factors contribute most (i.e. 40-55%) in the etiologies of infertility followed by male factors (30-40%), both partners (10%) and unexplained (10%). [1] Infertility in female is caused by various factors. To determine the causes of sterility or impaired fertility, one must visualize the process of reproduction from gametogenesis to nidation.

Diagnostic laparoscopy provides a direct visual access to inner pelvic anatomy without restoring to major abdominal surgery so that physiology of the ovaries, fallopian tubes and uterus can now be studied in more details. Our aim of study is to find out the causes of infertility in otherwise tested normal women, to evaluate tubal morphology and patency by dye testing so as to avoid unnecessary laparotomy.

MATERIALS AND METHODS

The patients of the age group 20-40 years were selected from gynecology out patients department and admitted in inpatients department of obstetrics and gynecology of MLB Medical College and Hospital Jhansi (UP), India. The study was conducted from January 2001 to December 2002. The females were selected who could not achieve pregnancy within one year of defined time of unprotected intercourse with adequate coitus.

Initially, the infertile couples were examined by taking detailed history, physical examination, basic endocrinological investigations and semen analysis. After that, general examination, systemic examination and local genital examination were carried out on the patients selected for this study.

Diagnostic laparoscopy was performed in post menstrual phase under general anesthesia. All the patients undergoing this procedure were investigated properly for full blood count, blood urea, blood sugar, urine examination, ECG, chest x-ray, husband’s seminogram, basal body temperature, luteinizing hormone monitoring, endometrial biopsy and ultrasonography. The chromotubation was carried out in all cases of infertility to test the patency of tubes under laparoscopic vision by using 10-15 ml of 0.5% autoclaved methylene blue dye. All the cases under the study went for HSG first and after HSG they went for laparoscopy.

RESULTS

The present study showed maximum cases of infertility (45%) in the age group of 21-25 years followed by 35% cases of infertility in the age group of 26-30 years (Table 1).

Table 1: Distribution of cases of primary infertility according to age

As per the period of infertility after marriage is concerned, majority of cases (18 out of 40 cases) were brought to hospital within 1-5 years of infertility (Table 2).

Table 2: Distribution of cases according to duration of infertility

On laparoscopy, twenty eight out of 40 patients (70%) revealed abnormal findings and rest had normal pelvic findings. The tubal blockage without adhesions was found to be most important abnormality and was seen in 22.5% cases followed by tubal blockage with adhesions (15%). Out of 17 cases of tubal blocks, bilateral tubal block was found in 13 cases of primary infertility.(Table 3)

Table 3: Laparoscopic findings

Laparoscopy with HSG (Hysterosalpingography) revealed 20 cases of tubal blockage (16 bilateral and 4 unilateral) as compared to laparoscopy alone, which showed 17 cases of tubal blockage (13 bilateral and 4 unilateral) (Table 4).

Table 4: Comparison of tubal block by Laparoscopy HSG and Laparoscopy

DISCUSSION

Tubal factor, which accounts for 15-30% of infertility in all women, is common in developing countries with high rates of pelvic inflammatory disease but limited resources. [2]

The present study shows abnormal pelvic findings in 70% cases of primary infertility. The mean age of women is 26.8 years. This is consistent with the observation of Jedrzejczak el al [3], who found mean age of primary infertility 28.5 years. Maximum number of patients (46.67%) presented with less than 6 years of infertility. Tubal blockage was found to be the most common cause of infertility i.e. 42.5% followed by pelvic adhesions. Cystic ovaries, endometriosis, uterine myoma, genital tuberculosis and hypo-plastic uterus were also seen. These findings were similar to the study conducted in Thailand by Sinawat et al [4] Laparoscopy combined with Hysterosalpingography (HSG) is more effective method to reveal tubal blocks. However recent studies [5-8] show, that hysterosalpingo-cantrast sonography (HyCoSy) is a cost effective screening test as compared to diagnostic laparoscopy with HSG in the assessment of tubal patency for the investigations of infertility patients.

CONCLUSION

Tubal abnormalities are detected in about half of the infertile females brought to hospital for treatment. Laparoscopy along with HSG is very effective method in evaluating cases of primary infertility especially tubal blockage. Further studies are needed to investigate the etiologies of these abnormalities at the earliest this could be a measure to bring down the occurrence of such conditions.

It should be appreciated that HSG and Laparoscopy are complimentary rather that competitive procedures. The accuracy of diagnosis is enhanced when two procedures are combined especially in those cases where the result of one of the tests is doubtful. In the days of modern gynecology, salpingoscopy and falloscopy via hysteroscope are the alternatives available for assessment of tubal patency.

REFERENCES

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