Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination.
OBJECTIVE
To evaluate the accuracy of diagnostic laparoscopy after normal hysterosalpingography (HSG) and before intrauterine insemination (IUI) with respect to laparoscopic findings leading to a change of treatment decisions in couples with male subfertility, cervical hostility, or idiopathic infertility.


METHODS
Retrospective chart review.


METHODS
University medical centre.


METHODS
Infertility patients who had undergone diagnostic laparoscopy after a normal HSG and before IUI in a period of 5 years.


METHODS
Diagnostic laparoscopy in infertility work-up before IUI.


METHODS
Prevalence of laparoscopic findings leading to change in treatment decision.


RESULTS
Of 495 patients, 21 (4%) had severe abnormalities that resulted in a change of treatment to in vitro fertilization or open surgery. In 103 patients (21%) abnormalities, endometriosis (stages I and II), and adhesions were directly treated by laparoscopic intervention, followed by IUI treatment. If surgery to remove early stage endometriosis does not improve pregnancy rates, then the laparoscopic yield would be 40 out of 495 (8.1%).


CONCLUSIONS
Diagnostic laparoscopy altered treatment decisions in an unexpectedly high number of patients before IUI. This suggests that laparoscopy may be of considerable value, provided the change in treatment is effective. Further prospective studies are required to assess whether the diagnostic use of laparoscopy is cost effective and whether interventions as result of laparoscopic findings are effective in improving pregnancy rates.
Tanahatoe
Sandra
S
Department of Obstetrics, Gynaecology and Reproductive Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. s.tanahatoe@vucm.nl
Hompes
Peter G A
PG
Lambalk
Cornelis B
CB
D002584:Cervix Uteri / Q000473:pathology; D004715:Endometriosis / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000453:epidemiology; D007248:Infertility, Male / Q000453:epidemiology; D007315:Insemination, Artificial; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008499:Medical Records; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors