title: Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy.
abstract: OBJECTIVE
  To determine whether the mini-invasive surgery still play a role in the diagnostic workup and in the management of the couples affected by unexplained infertility.
  
  
  METHODS
  170 infertile women (age range 25-38 years) with documented normal ovarian, tubal and uterine function underwent combined hysteroscopic and laparoscopic surgery; 100 women refused surgery or ART treatment (control group) choosing expectant management. A retrospective assessment questionnaire was proposed to enrolled women to collect the rate of spontaneous or ART-induced pregnancies.
  
  
  RESULTS
  The combined surgery revealed pelvic pathologies in 49.4% of patients, confirming the diagnosis of unexplained infertility only in 86 of studied patients. In this group of 86 selected women, 28 of them achieved a spontaneous pregnancy and 23 women obtained pregnancy after ART. The Chi-square analysis shows that the pregnancy rate was not influenced by the employment of ART. In the group of 100 control women, only 14 (14%) achieved a spontaneous pregnancy after 18 months of expectant management.
  
  
  CONCLUSIONS
  Combined laparoscopy and hysteroscopy in women with unexplained infertility may reveal previously undiagnosed pathologies that could require ART, and in those without abnormal surgical finding, ART does not improve pregnancy rate.
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Cicco
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy. tagliaferrivale@libero.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Tagliaferri
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Selvaggi
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Romualdi
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Florio
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Immediata
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lanzone
authors.affiliation: Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, L.go Agostino Gemelli, 8, 00168, Rome, Italy.|Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", 70021, Acquaviva Delle Fonti, BA, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Guido
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000175:diagnosis / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods*; D000069342:Medical Overuse; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D055815:Young Adult
keywords: Hysteroscopy; Laparoscopy; Overtreatment; Pregnancy outcome; Unexplained infertility