TITLE:
Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility
AUTHORS:
John Jude Kweku Annan, Gerald Owusu Asubonteng, Thomas O. Konney
KEYWORDS:
Diagnostic Laparoscopy, Primary Infertility, Secondary Infertility, Endometriosis, Chromopertubation
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.5,
May
13,
2020
ABSTRACT: Context and Objectives: Tubal factor infertility
accounts for a large portion of female factor infertility. Tubal disease is
responsible for 25% - 35% of female infertility. The most prevalent cause of tubal factor
infertility is pelvic inflammatory disease and acute salpingitis. The incidence
of tubal damage after one episode of pelvic infection is approximately 12%, 23%
after two episodes and 54% after three episodes. Various modalities for investigating tubal factor
infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy),
hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter
being the gold standard. The aim of this study was to determine the role of
diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A
retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of
a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of
Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of
three hundred and ninety-one (391) records of all diagnostic laparoscopy
procedures performed because of infertility in the endoscopic gynecology unit
of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who
underwent diagnostic laparoscopy to assess tubal factor infertility in the
Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital
(KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was
tested by laparoscopy and chromopertubation using methylene blue dye. The
clinical characteristics of these women (age, parity, type of infertility), the
intra-operative
findings and complications were evaluated. Data on age, parity, type of infertility
and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and
laparoscopic findings were missing were excluded from the study. Ethical
approval for the study was obtained from the Institutional Review Board (IRB) for Research and
Development (R & D). A simple percentage
method was used for statistical analysis. Results: A total of 391 women underwent diagnostic laparoscopy for investigation
of tubal factor infertility between 2010 and 2019. The women’s mean age was
33.16 years. The youngest patient was 20 years and the oldest was 46 years. 232
(59.3%) patients were in primary infertility group while 159 (40.7%) patients
were in secondary infertility group. 265 (66.8%) of the women were in the age
group 20 - 35 years. The main laparoscopic
findings for tubal factor were: 57.28% with bilateral tubal occlusion, 16.39%
with unilateral tubal occlusion and 7.92% with hydrosalpinx. 18.41% had
bilateral tubal patency. Other findings were identified during the laparoscopic
procedure. For peritoneal abnormalities, 200 (51.15%) had normal findings, 184
(47.06%) had adhesions and 7 (1.79%) had peritoneal endometriosis. For uterine factor, 185
(47.31%) had normal uterus with no fibroids or adenomyosis, 202 (51.67%) had
uterine fibroids, 2 (0.51%) had uterine anomaly and 2 (0.51%) had adenomyosis. For ovarian pathology, 13
(3.32%) had simple cyst, 2 (0.51%) had endometrioma, 184 (47.07%) had the
ovaries involved in adhesions. 192 (49.10%) of patients had normal looking
ovaries. There was no mortality or conversion to open laparotomy in this
series. Conclusions: Unilateral and bilateral tubal blockade was detected in 73.67% of cases
of infertile women. Diagnostic laparoscopy is a safe procedure.