Transvaginal hydrolaparoscopy by flexible fiberscope--a study of preliminary cases

Transvaginal hydrolaparoscopy (THL) has become a first-line procedure in infertile women, and THL by flexible fiberscope (THLF) is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. We performed THLF on infertile women based on four indications; (i) tubal obstruction and/or peritubal adhesion as suggested by hysterosalpingography (HSG); (ii) serum antibody against Chlamydia (C) positive for trachomatis; (iii) diagnosis of early stage endometriosis; and (iv) unexplained infertility. Seven women with a chief complaint of infertility were the subjects of the present study. Two of the 7 cases had a history of gynecological surgery. Six of 7 cases had a history of C. trachomatis infection. Four cases had abnormal findings of fallopian tubal patency in hysterosalpingography. Parafallopean tubal atresia and tubal obstruction were observed in 4 cases by THLF. In one case the bilateral ovaries were extremely small and atrophic. None of the cases had serious complications after THLF. After the THLF, six women were able to have a baby by assisted reproductive technology (ART) within two years. As THL was developed using a solid scope, indications for THL have been limited, and have excluded cases with retroverted uterus or peritoneal surgical history. In the present study, THL using a fiberscope was carried out in infertile women with retroverted uterus, and in women with a history of peritoneal cavity surgery to examine the feasibility of extending the indications for THL. Findings on the THLF were given precedence in deciding further treatment strategies. We believe that THLF can be useful in helping patients with these indications to successfully achieve early pregnancy. This study is the first trial of THLF.