Title: Laparoscopic evaluation of primary and secondary subfertility

Biography:

Setara Binte Kasem is working as associate professor (Gynae & Obstetrics) in Dhaka Medical College Dhaka, Bangladesh. She passed MBBS in 1990. She has done post-graduation degree DGO, MS from Dhaka University & FCPS degree from Bangladesh College of Physicians & Surgeons in gynae and obstretrics. She has worked in Sir Salimullah Medical College, BSMMU, BIRDEM and in different Government institutions. She is interested in research works & has about 20 National & International publications

Abstract

Background: Inability to conceive after one year of unprotected regular intercourse are infertility or subfertility. Prevalence of subfertility in industrialized countries has been quoted as 20%, and seems to be on the rise. Infertility can be primary in which the case the woman has never conceived before or secondary when there is prior conception irrespective of the outcome of the pregnancy. Traditional way to assess the uterine cavity, tubal structure and tubal patency was hysterosalphingography but it is now been largely superseded by laparoscopy and hysteroscopy. The objective of this study was to highlight the role of laparoscopy in establishing the diagnosis of primary and secondary female subfertility and different therapeutic  procedure done at the study centre.

Method: This study was conducted in Female Subfertility and Reproductive Medicine Unite of Gynae and Obstetrics department of Dhaka Medical College Hospital, Dhaka from January 2015 to June 2018. Total 4256 subfertile patients attended the Infertility OPD. Out of these 215 patients were selected for laparoscopy. Those patients who had contraindication for laparoscopy were excluded from study. Detailed laparoscopic findings were recorded.

Results: Out of  4256  subfertile patients total 215 patients were selected for laparoscopy. 136 (63.26%) patients were in primary subfertility group while 79 (36.74%) patients were in secondary subfertility group. In primary subfertility group(n=136), most common laparoscopic finding was PCO in 44 (32.34%) patients followed by  peritubal and periovarian adhesions in 24 (17.65%) patients, Bilateral tubal block in 23(16.91%) patients, Endometriosis in 15(11.03%), Unusal tortuous and lengthy tube in 15(11.03%) patients,  fibroid in 11(8.09%) patients, PID, Hydrosalphinx and Tuboovrian mass in 7 (5.15%) patients, severe adhesion of uterus with surrounding structures in 5 (3.68%) cases, Mullerian agenesis and hypoplasia in 3(2.21%) cases, Adenomyosis in 2(1.47%)  cases, Genital tuberculosis in 2(1.47%)   cases, Streak gonad in 1(0.74%) case. No visible abnormality found in 22( 16.18%) cases, unilateral tubal block present in 25(18.38%) cases, Ovarian cyst present in 12(8.82%) cases.

The commonest finding by laparoscopy in patients with secondary infertility were  PCO in 18 (22.78%) patients  and peritubal and periovarian adhesions in 18 (22.78%)   patients, followed by  Bilateral tubal block in 12(15.19%) patients, fibroid uterus in 12(15.19%) patients, Endometriosis in 10(12.66%), unusal tortuous and lengthy tube in 9(11.30%) patients, severe adhesion of uterus with surrounding structures in 7 (8.86%) cases, PID, Hydrosalphinx and Tuboovrian mass in 6 (7.59%) cases, Genital tuberculosis in 3(1.40%)   cases, Anenomyosis in 1(1.27%) case. No visible abnormality found in 12( 15.19%) cases, unilateral tubal block present in 15(18.99%) cases, Ovarian cyst present in 14(17.72%) cases.

Various laparoscopic procedure done at the same sitting like Ovarian drilling done in 39(28.68%) patients in primary infertility and 13(16.46%) patientts in secondary subfertile group . Adhesiolysis done in 12(8.82%) patients in primary and 10(12.66%) patients in secondary infertile group. Ovarian cystectomy done in 14(10.29%) patients of primary and 9(11.39%) patients of secondary group. Cyst puncture  done in 3(2.21%) and 4(5.06%) patients respectively. Salphingostomy done in 4(2.94%) primary subfertile patient and 1(1.27%) in secondary subfertile patient. Myomectomy done in 2(1.47%) primary subfertile patient. Laparotomy followed by myomectomy done in 4(2.94%) patients in primary and 3(3.80%) patients in  secondary infertility group. Laparoscopy followed by laparotomy for ovarian cystectomy, unilateral salphingooophorectomy done in 3(2.21%) primary and 2(2.53%) secondary subfertile women.