Role of diagnostic laparoscopy in patients with apparent infertility unexplained

Abstract

Study question: Is it useful to perform a diagnostic laparoscopy in patients with apparent unexplained infertility? Summary response: Performing diagnostic laparoscopies in this group of patients diagnosed pelvic pathologies (endometriosis and chronic pelvic inflammatory disease) unnoticed in previous imaging studies and achieved a very satisfactory pregnancy rate per patient post laparoscopy (50%) with expectant treatment (ET), ovulation induction (OI) or intrauterine insemination (IUI). What is already known: The indication of a diagnostic laparoscopy in patients with normal basic infertility studies (ovulatory, normal hysterosalpingography and normal or mild male factor) considered as carriers of unexplained infertility is controversial. Study design: Retrospective descriptive study. Materials and Methods: We studied 92 ovulatory patients, with normal hysterosalpingography and normal or mild male factor during the period from January 2015 to December 2018. All of them underwent a diagnostic laparoscopy under general anesthesia and outpatient hospitalization. Expectant treatment (ET) or ovulation induction (IO) was indicated after the study for 4 to 6 months and if pregnancy is not achieved, a maximum of 3 cycles of intrauterine insemination (IUI) and finally IVF or ICSI. Results: Ninety-two patients were included in the study, the mean age was 33.2 years (range 24-38) and the laparoscopic findings were: normal in 10 cases (10.9%), minimal endometriosis in 25 cases (27.1%), mild in 37 (40.2%), moderate in 6 (6.6%), severe in 2 cases (2.2%) and adhesions secondary to chronic pelvic inflammatory disease (PID) in 12 cases (13%). After laparoscopy, 60 pregnancies were obtained, 46 of them without using highly complex assisted reproduction techniques (16 with ET, 18 with OI and 12 with IUI), that is, a pregnancy rate per patient of 50% (46/92) without IVF or ICSI. Study limitations: It is a retrospective study and lacks a control group to compare these results with other strategies such as indicating highly complex assisted fertilization treatments (IVF / ICSI) directly, after performing the basic studies of infertility and cataloging them as unexplained infertility.