Laparoscopic evaluation of primary and secondary subfertility

Abstract

Background: Prevalence of subfertility in industrialized countries has been quoted as 20%, and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure and tubal patency was hysterosalphingography but it is now been largely superseded by laparoscopy and hysteroscopy. With the objective of this study was to highlight the role of laparoscopy in establishing the diagnosis of primary and secondary female subfertility and different therapeutic procedure done. Method: This cross sectional study was conducted in the Subfertility and Reproductive Medicine Unit of Gynae and Obstetrics department of Dhaka Medical College Hospital, Dhaka from January 2015 to June 2018. Total 4256 sub fertile patients attended the Infertility OPD. Out of these 215 patients were selected for laparoscopy. Those patients who had contraindication for laparoscopy were excluded from study. Detailed laparoscopic findings were recorded. Results: Out of 125 selected sub fertile patients 136 (63.26%) patients were in primary subfertility group while 79 (36.74%) patients were in secondary subfertility group. In primary subfertility group(n=136), most common laparoscopic finding was PCO in 44 (32.34%) patients followed by peritubal and periovarian adhesions in 24 (17.65%) patients, Bilateral tubal block in 23(16.91%) patients, Endometriosis in 15(11.03%), Unusual tortuous and lengthy tube in 15(11.03%) patients, fibroid in 11(8.09%) patients, Mullerian agenesis and hypoplasia in 3(2.21%) cases. No visible abnormality found in 22(16.18%) cases. The commonest finding by laparoscopy in patients with secondary infertility were PCO in 18 (22.78%) patients and peritubal and periovarian adhesions in 18 (22.78%) patients, followed by Bilateral tubal block in 12(15.19%) patients, fibroid uterus in 12(15.19%) patients, Endometriosis in 10(12.66%), Genital tuberculosis in 3(1.40%) cases. No visible abnormality found in 12(15.19%) cases. Various laparoscopic procedure like Ovarian drilling. Adhesiolysis, ovarian cystectomy, cyst puncture, salphingostomy, Myomectomy. Conclusion: Laparoscopy helped us to detect and treat important clinical condition in bath primary & secondary sub fertility.