title: Use of laparoscopy in unexplained infertility.
abstract: OBJECTIVE
  The use of laparoscopy in unexplained infertility work-up is still a subject of debate, although laparoscopy remains the gold standard for diagnosis and treatment of several pelvic pathologies. The objective of this study was to assess the rates and types of pelvic pathologies observed during diagnostic laparoscopy, and the pregnancy rate in couples with unexplained infertility following laparoscopy.
  
  
  METHODS
  Prospective study, from November 2003 to October 2009, including 114 infertile, spontaneously ovulating women with normal clinical examination, ovarian reserve assessment, pelvic ultrasound scan and patent tubes on hysterosalpingography. Semen analyses were normal according to the World Health Organization criteria. After three cycles of ovulation induction with or without intra-uterine insemination and no pregnancy, women were referred for diagnostic laparoscopy.
  
  
  RESULTS
  Laparoscopy revealed pelvic pathology in 95 patients. Endometriosis, pelvic adhesions and tubal disease were observed and treated in 72, 46 and 24 patients, respectively. Following laparoscopy, bilateral and unilateral tubal patencies were observed in 107 and five patients, respectively. Pregnancy was observed in 77 out of 102 patients who tried to conceive after surgery, 35 of whom conceived using their own tubes.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy should be strongly considered in unexplained infertility work-up, and tubal efficiency should not be underestimated.
authors.affiliation: Department of Obstetrics and Gynaecology, Pôle Femme-et-Enfant, CHU Jean Verdier, APHP, Bondy, France.
authors.forename: C
authors.initials: C
authors.lastname: Bonneau
authors.forename: O
authors.initials: O
authors.lastname: Chanelles
authors.forename: C
authors.initials: C
authors.lastname: Sifer
authors.forename: C
authors.initials: C
authors.lastname: Poncelet
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery; D005184:Fallopian Tube Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D000267:Tissue Adhesions; D014463:Ultrasonography