Last updated date: 03-Mar-2023
Originally Written in English
Failure to conceive after a year of unprotected frequent intercourse is described as infertility. It affects around 10-15% of all marriages. the leading causes of infertility are Tuboperitoneal disease, ovulatory abnormalities , uterine factors, and male factor infertility. In individuals with no overt clinical signs, hysterolaparoscopy is a useful diagnostic tool for detecting concealed disease. Even after a normal HSG, laparoscopy can reveal the existence of peritubal adhesions, periadnexal adhesions, tubal pathology, and endometriosis in 35-68 percent of patients. Diagnostic hysteroscopy is a valuable tool for detecting uterine abnormalities and other intrauterine disorders.
Infertility is one of the three most common gynecological disorders, impacting 186 million individuals globally and causing psychological stress, worry, and sadness. Initial infertility was more common than secondary infertility (57.5 versus 42.5 %). With the advancement of reproductive age, more individuals are being diagnosed with a variety of gynecological illnesses. It is critical to rule out endocrine abnormalities, infections, and systemic diseases in order to properly handle each patient.
Endometriosis, polycystic ovarian syndrome, uterine abnormalities, endometrial polyps, uterine fibroids, and early ovarian insufficiency are the most prevalent causes of female infertility. Patients are frequently interested in addressing infertility issues, but others are initially interested in treating gynecological diseases and then consider infertility.
The amount of time that passes between the minimally invasive surgical clearance of genital disease and the choice to procreate can also have an impact on treatment outcomes. As a result, pre- and postoperative antimüllerian hormone (AMH) and follicular reserve assessments are critical.
Hysteroscopy is a minimally invasive treatment that allows the endocervical canal, uterine cavity, endometrium, and tubal ostia to be seen. Laparoscopy also enables for the examination of uterine, tubal, and ovarian capacity.
In primary and secondary infertility, laparoscopic findings (pelvic inflammatory illness, endometriosis) are more common than hysteroscopic findings (polyps, uterine septum). Laparoscopy discovered abnormalities in 35% of women with primary infertility and hysteroscopy in 17% of instances, whereas hysterolaparoscopy revealed abnormalities in 26% of patients with main/secondary infertility.
In addition to hormone, ovarian reserve, and ovulation testing, noninvasive diagnostics for infertility are ultrasonography, sonohysterography, MRI, HSG, or hystero-salpingo contrast sonography (HyCoSy). Pathologies that are normally undetected by conventional imaging procedures are identified and corrected through hysterolaparoscopy. Because of potential consequences such as decreased ovarian reserve, postoperative adhesions, or a probable delay in infertility therapy, the justification for surgical treatment must be carefully considered.
Many studies indicate that laparoscopy should be explored for women with unclear infertility etiology since it reduces the overall expenses of the protracted treatment plan and enhances the quality of life of the women who desire to conceive.
Reasons of infertility
It provides significantly more detailed information regarding the status of the womb than other imaging methods, such as ultrasound or magnetic resonance imaging. Medical laparoscopy has been used to discover a variety of disorders that would have been impossible to notice without the additional information supplied by therapeutic laparoscopy. The following are some of the issues that may be causing infertility and that Diagnostic Hysterolaparoscopy will detect:
Endometriosis is a painful condition in which the tissue that lines the inside of the womb spreads outwards. With diagnostic Hysterolaparoscopy, your doctor can easily diagnose this.
- Fibroid of the uterus
Rings of smooth muscle fibers and fibrous connective tissue form uterine tumors. These are normally harmless, although their thickness and location may cause reproductive problems. Diagnostic Hysterolaparoscopy assists your doctor in detecting and identifying troublesome fibroids so that they can be removed.
Adhesions are rings that can form in the womb and are also known as damaged tissue. In certain cases, they can also lead to infertility. Adhesions will be accurately identified and treated using diagnostic Hysterolaparoscopy.
- Ovaries Cysts
Cysts seldom cause symptoms, but if they do, diagnostic hysterolaparoscopy can find them inside the womb and treat them accordingly.
- Ectopic pregnancy
It is a hazardous disease because the embryo attaches outside the womb rather than within. A hysterolaparoscopy can be used to diagnose it.
- Tubal permeability
Because blocked fallopian tubes prevent an egg from traveling to the womb and may be the cause of infertility, a clinical hysterolaparoscopy may be conducted to check whether both fallopian tunnels are open.
What is Hysterolaparoscopy?
Diagnostic Hysterolaparoscopy is a diagnostic procedure used to assess issues relating to infertility in the female reproductive organs. Laparoscopy is a sort of surgical treatment that involves the insertion of a tiny fiber optic wire with a camera at the end known as a Laparoscope. During the surgery, the Laparoscope is introduced into one of multiple incisions created by the doctor.
The camera feed allows the doctor to view comprehensive images from within the uterus on an external screen, which the doctor utilizes to diagnose the patient. These disorders are generally connected to infertility but a uterine examination may identify a variety of problems.
Hysterolaparoscopy is widely used across the world and has shown to be a reliable technique in the diagnosis and treatment of infertility. This is because it offers far more thorough information about the state inside the uterus than other imaging procedures, such as ultrasound or an MRI. Diagnostic laparoscopy is used to diagnose a variety of problems that would be difficult to recognize without the additional information provided by diagnostic laparoscopy. These are some of the problems that may be causing infertility and that Diagnostic Hysterolaparoscopy can detect:
- Endometriosis: Endometriosis is a painful and uncomfortable disorder in which the tissue that borders the interior of the uterus grows outside. Your doctor can readily diagnose this with diagnostic hysterolaparoscopy.
- Uterine fibroid: Uterine fibroids are growths that originate from bands of smooth muscle cells and fibrous connective tissue. These are generally innocuous, but depending on their size and placement, they might induce infertility. Your doctor can use diagnostic hysterolaparoscopy to diagnose and identify symptomatic fibroids in order to remove them.
- Adhesions: Adhesions, also known as scar tissue, are scar tissue bands that can occur in the uterus. In certain situations, they can also result in infertility. With diagnostic Hysterolaparoscopy, adhesions can be diagnosed and treated properly.
- Ovarian cysts: Cysts seldom produce symptoms, but when they do, diagnostic hysterolaparoscopy can be utilized to locate them in the uterus and treat them appropriately.
- Ectopic pregnancy: This is a dangerous disorder in which the embryo attaches outside the uterus rather than in the typical place. It may be identified with hysterolaparoscopy.
- Tubal patency: A diagnostic hysterolaparoscopy can be performed to determine whether or not the fallopian tubes are open; blocked fallopian tubes prevent an egg from traveling to the uterus and may be a cause of infertility.
How to Prepare?
Tell your doctor if you:
- Are or might be pregnant.
- Are taking any medicines.
- Are allergic to any medicines.
- Have had bleeding problems or take blood-thinners, such as aspirin or warfarin).
- You have taken treatment for any vaginal, cervical, or pelvic infection in the preceding last 6 weeks
- Have any heart or lungs
Diagnostic laparoscopy is not a serious operation, although it does necessitate that the patient be sedated. This implies that the patient will be unconscious during the procedure. The doctor may give the patient instructions that must be closely followed before to the operation, such as avoiding ingesting any drinks or food in the hours before the surgery. The following are the stages that may be taken for your diagnostic hysterolaparoscopy:
- Before entering the operation room, the patient must change into a hospital gown and remove all personal items.
- Once the patient is on the operating table, an anesthesiologist will administer general anesthesia, which will render the patient unconscious for the procedure.
- Before the treatment, an intravenous line may be put into your arm or wrist.
- During the treatment, a catheter may be put into your vagina to collect urine.
- An incision is made below the belly button, and numerous more incisions on the abdomen may be done as well. The incision site may differ from person to person.
- In certain situations, surgeons may place a cannula via another incision to fill the belly with carbon dioxide gas. The gas expands the area within the abdomen, giving the doctor greater room to maneuver into the uterus and acquire a clearer picture. It also reduces the danger of internal harm by pushing the abdominal wall away from other internal organs.
- In order to move the organs into position, another device is placed via an alternative incision, and the doctor should have a clear view of the uterus, fallopian tubes, and ovaries.
- A sample tissue is often removed from the uterine lining to be tested in a lab under a microscope.
- A fluid is sometimes injected into the cervix, uterus, and fallopian tubes to assess patency.
- 10. After the uterus has been thoroughly examined, the surgical equipment and laparoscope are withdrawn from the abdomen.
- After the wounds are stitched and wrapped, it may take many hours for the patient to wake up and fully recover from the effects of the anaesthetic.
Many women endure minor bleeding for many days following hysteroscopy surgery. Mild cramping or soreness is normal following hysteroscopy, although it usually subsides within eight hours. Following the procedure, the carbon dioxide gas used for insufflation may cause some moderate shoulder soreness. Non-prescription pain medications may be beneficial. After undergoing a hysteroscopy, women may wish to take the day off and rest.
As is the case with any surgery, diagnostic laparoscopy carries its own risks. These are listed below:
- Infection: Bacteria that enter the body during the surgery may cause an infection in the abdomen. An infection in the bladder is also possible.
- Adhesions: Scar tissue may develop within the abdomen.
- Hematomas: This is defined as an area of blood away from ruptured blood vessels.
- Uterine perforation: This might happen if one of the surgical devices used during the treatment causes uterine and lining damage.
It is extremely unlikely that any of these hazards will result in major problems as a result of a diagnostic laparoscopic operation, and in most situations, none of these risks will be life threatening. The carbon dioxide used to inflate the abdomen may cause discomfort in the shoulders, chest, and belly immediately during the treatment and for a few hours afterwards. As the gas leaves your body, the pain will go away, and the patient will be able to resume regular activities in a few days.
It may also take a few hours for the patient to fully recover from the effects of general anesthesia; patients may feel disoriented and sleepy. It is recommended that you have someone drop you down and pick you up from the location, as driving while under the influence of anesthetic is dangerous.
If the patient is having significant stomach discomfort after surgery, seek quick medical attention; this might be an indication that an infection has formed in the abdominal area. It is normally suggested to avoid introducing anything into the vagina or engaging in intense exercise for a few days following the procedure. Each patient's post-operative treatment may differ depending on their condition and the outcome of their surgery. Consult your doctor so that you have a clear understanding and are fully informed during the operation.
A helpful approach for identifying and treating infertility and benign uterine disease is combined hysteroscopy and laparoscopy. Both treatments are minimally invasive, dependable, and risk-free, with very little complications. Diagnostic Hysterolaparoscopy is a straightforward procedure that, when conducted correctly, may provide your doctor with the information they need to establish a proper foundation for your fertility therapy.
The technique may provide significant information to your doctor, which may alter the course of your infertility therapy. The therapy that every individual may get varies from person to person; nonetheless, for infertility, acquiring as much information about the uterus and other reproductive organs as possible is a critical step.