PDF herunterladen
Semin Reprod Med 2020; 38(01): 029-035
DOI: 10.1055/s-0040-1718942
Review Article

Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

Mohan S. Kamath
1   Department of Reproductive Medicine, Christian Medical College, Vellore, India
,
Judith F.W. Rikken
2   Center for Reproductive Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
,
Jan Bosteels
3   Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
4   Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
5   Department of Development and Regeneration, Gent University, Gent, Belgium
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

The standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.

Keywords

unexplained infertility - laparoscopy - hysteroscopy


Publikationsverlauf

Artikel online veröffentlicht:
20. Oktober 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ray A, Shah A, Gudi A, Homburg R. Unexplained infertility: an update and review of practice. Reprod Biomed Online 2012; 24 (06) 591-602
    CrossrefPubMedGoogle Scholar
  • 2 Collins JA, Rowe TC. Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study. Fertil Steril 1989; 52 (01) 15-20
    CrossrefPubMedGoogle Scholar
  • 3 Gleicher N, Barad D. Unexplained infertility: does it really exist?. Hum Reprod 2006; 21 (08) 1951-1955
    CrossrefPubMedGoogle Scholar
  • 4 Siristatidis C, Bhattacharya S. Unexplained infertility: does it really exist? Does it matter?. Hum Reprod 2007; 22 (08) 2084-2087
    CrossrefPubMedGoogle Scholar
  • 5 Kamath MS, Bhattacharya S. Demographics of infertility and management of unexplained infertility. Best Pract Res Clin Obstet Gynaecol 2012; 26 (06) 729-738
    CrossrefPubMedGoogle Scholar
  • 6 Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril 2020; 113 (02) 305-322
    CrossrefPubMedGoogle Scholar
  • 7 Practice Committee of American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2012; 98 (02) 302-307
    CrossrefPubMedGoogle Scholar
  • 8 National Institute of Health and Care Excellence. Fertility: assessment and treatment for people with fertility problems. NICE guidelines (CG156). Available at: www.nice.org.uk/guidance/cg156. Accessed September 30, 2020
    PubMedGoogle Scholar
  • 9 Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril 1995; 64 (03) 486-491
    CrossrefPubMedGoogle Scholar
  • 10 Broeze KA, Opmeer BC, Van Geloven N. et al. Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis. Hum Reprod Update 2011; 17 (03) 293-300
    CrossrefPubMedGoogle Scholar
  • 11 Mol BW, Collins JA, Burrows EA, van der Veen F, Bossuyt PM. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 1999; 14 (05) 1237-1242
    CrossrefPubMedGoogle Scholar
  • 12 Tanahatoe S, Hompes PGA, Lambalk CB. Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril 2003; 79 (02) 361-366
    CrossrefPubMedGoogle Scholar
  • 13 Mol BW, Swart P, Bossuyt PM, van Beurden M, van der Veen F. Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology. Hum Reprod 1996; 11 (06) 1204-1208
    CrossrefPubMedGoogle Scholar
  • 14 Karande VC, Pratt DE, Rao R, Balin M, Gleicher N. Elevated tubal perfusion pressures during selective salpingography are highly suggestive of tubal endometriosis. Fertil Steril 1995; 64 (06) 1070-1073
    CrossrefPubMedGoogle Scholar
  • 15 den Hartog JE, Lardenoije CMJG, Severens JL, Land JA, Evers JLH, Kessels AGH. Screening strategies for tubal factor subfertility. Hum Reprod 2008; 23 (08) 1840-1848
    CrossrefPubMedGoogle Scholar
  • 16 Giudice LC, Kao LC. Endometriosis. Lancet 2004; 364 (9447): 1789-1799
    CrossrefPubMedGoogle Scholar
  • 17 Marcoux S, Maheux R, Bérubé S. Canadian Collaborative Group on Endometriosis. Laparoscopic surgery in infertile women with minimal or mild endometriosis. N Engl J Med 1997; 337 (04) 217-222
    CrossrefPubMedGoogle Scholar
  • 18 Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi. Hum Reprod 1999; 14 (05) 1332-1334
    CrossrefPubMedGoogle Scholar
  • 19 Duffy JMN, Arambage K, Correa FJS. et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2014; (04) CD011031
    PubMedGoogle Scholar
  • 20 Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 2006; 21 (10) 2679-2685
    CrossrefPubMedGoogle Scholar
  • 21 Olive DL, Stohs GF, Metzger DA, Franklin RR. Expectant management and hydrotubations in the treatment of endometriosis-associated infertility. Fertil Steril 1985; 44 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 22 Dunselman GAJ, Vermeulen N, Becker C. et al. European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (03) 400-412
    CrossrefPubMedGoogle Scholar
  • 23 Chua SJ, Akande VA, Mol BWJ. Surgery for tubal infertility. Cochrane Database Syst Rev 2017; 1 (01) CD006415
    PubMedGoogle Scholar
  • 24 Tran DK. Can open tubal microsurgery still be helpful in tubal infertility treatment?. Gynecol Surg 2010; 7: 385-400
    CrossrefPubMedGoogle Scholar
  • 25 Chu J, Harb HM, Gallos ID. et al. Salpingostomy in the treatment of hydrosalpinx: a systematic review and meta-analysis. Hum Reprod 2015; 30 (08) 1882-1895
    CrossrefPubMedGoogle Scholar
  • 26 Honoré GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril 1999; 71 (05) 785-795
    CrossrefPubMedGoogle Scholar
  • 27 Mol BW, Collins JA, Van Der Veen F, Bossuyt PM. Cost-effectiveness of hysterosalpingography, laparoscopy, and Chlamydia antibody testing in subfertile couples. Fertil Steril 2001; 75 (03) 571-580
    CrossrefPubMedGoogle Scholar
  • 28 Verhoeve HR, Moolenaar LM, Hompes P, van der Veen F, Mol BW. Cost-effectiveness of tubal patency tests. BJOG 2013; 120 (05) 583-593
    CrossrefPubMedGoogle Scholar
  • 29 Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?. Hum Reprod 2002; 17 (01) 1-3
    CrossrefPubMedGoogle Scholar
  • 30 Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet 2018; 391 (10119): 441-450
    CrossrefPubMedGoogle Scholar
  • 31 Diamond MP, Legro RS, Coutifaris C. et al. NICHD Reproductive Medicine Network. Letrozole, gonadotropin, or clomiphene for unexplained infertility. N Engl J Med 2015; 373 (13) 1230-1240
    CrossrefPubMedGoogle Scholar
  • 32 Lucas ES, Salker MS, Brosens JJ. Reprint of: Uterine plasticity and reproductive fitness. Reprod Biomed Online 2013; 27 (06) 664-672
    CrossrefPubMedGoogle Scholar
  • 33 Golan A, Eilat E, Ron-El R, Herman A, Soffer Y, Bukovsky I. Hysteroscopy is superior to hysterosalpingography in infertility investigation. Acta Obstet Gynecol Scand 1996; 75 (07) 654-656
    CrossrefPubMedGoogle Scholar
  • 34 Kamath MS, Bosteels J, D'Hooghe TM. et al. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev 2019; 4 (04) CD012856
    PubMedGoogle Scholar
  • 35 Seyam EM, Hassan MM, Mohamed Sayed Gad MT, Mahmoud HS, Ibrahim MG. Pregnancy outcome after office microhysteroscopy in women with unexplained infertility. Int J Fertil Steril 2015; 9 (02) 168-175
    PubMedGoogle Scholar
  • 36 Aghahosseini M, Ebrahimi N, Mahdavi A, Aleyasin A, Safdarian L, Sina S. Hysteroscopy prior to assisted reproductive technique in women with recurrent implantation failure improves pregnancy likelihood. Fertil Steril 2012; 98 (Suppl. 03) S4
    CrossrefPubMedGoogle Scholar
  • 37 Alleyassin A, Abiri A, Agha-Hosseini M, Sarvi F. The value of routine hysteroscopy before the first intracytoplasmic sperm injection treatment cycle. Gynecol Obstet Invest 2017; 82 (02) 125-130
    CrossrefPubMedGoogle Scholar
  • 38 Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online 2004; 8 (05) 590-594
    CrossrefPubMedGoogle Scholar
  • 39 El-Nashar IH, Nasr A. The role of hysteroscopy before intracytoplasmic sperm injection (ICSI): a randomized controlled trial. Fertil Steril 2011; 96 (Suppl. 03) S266
    CrossrefPubMedGoogle Scholar
  • 40 Elsetohy KA, Askalany AH, Hassan M, Dawood Z. Routine office hysteroscopy prior to ICSI vs. ICSI alone in patients with normal transvaginal ultrasound: a randomized controlled trial. Arch Gynecol Obstet 2015; 291 (01) 193-199
    CrossrefPubMedGoogle Scholar
  • 41 El-Toukhy T, Campo R, Khalaf Y. et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet 2016; 387 (10038): 2614-2621
    CrossrefPubMedGoogle Scholar
  • 42 Hysteroscopy before in vitro fertilization does it improve the outcome?. Available at: clinicaltrials.gov/ct2/show/ NCT01743391. Accessed September 30, 2020
    PubMedGoogle Scholar
  • 43 Rama Raju GA, Shashi Kumari G, Krishna KM, Prakash GJ, Madan K. Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome. Arch Gynecol Obstet 2006; 274 (03) 160-164
    CrossrefPubMedGoogle Scholar
  • 44 Shawki HE, Elmorsy M, Eissa MK. Routine office hysteroscopy prior to ICSI and its impact on assisted reproduction program outcome: a randomized controlled trial. Middle East Fertil Soc J 2012; 17 (01) 14-21
    CrossrefPubMedGoogle Scholar
  • 45 Smit JG, Kasius JC, Eijkemans MJC. et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet 2016; 387 (10038): 2622-2629
    CrossrefPubMedGoogle Scholar
  • 46 Wallach EE. The uterine factor in infertility. Fertil Steril 1972; 23 (02) 138-158
    CrossrefPubMedGoogle Scholar
  • 47 Clark TJ, Gupta JK. Handbook of Outpatient Hysteroscopy. A Complete Guide to Diagnosis and Therapy. London: Hodder Education; 2005
    CrossrefGoogle Scholar
  • 48 Bosteels J, van Wessel S, Weyers S. et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev 2018; 12 (12) CD009461
    PubMedGoogle Scholar
  • 49 Casini ML, Rossi F, Agostini R, Unfer V. Effects of the position of fibroids on fertility. Gynecol Endocrinol 2006; 22 (02) 106-109
    CrossrefPubMedGoogle Scholar
  • 50 Rikken JFW, Verhorstert KWJ, Emanuel MH. et al. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35 (07) 1722
    CrossrefPubMedGoogle Scholar
  • 51 Pérez-Medina T, Bajo-Arenas J, Salazar F. et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 20 (06) 1632-1635
    CrossrefPubMedGoogle Scholar