Laparoscopy in female infertility. Diagnosis and prognosis for subsequent pregnancy

Laparoscopy for the investigation of infertility was performed in 433 women. The rate of pathologic findings was 70%. No fewer than 55% of patients with no history of gynecologic disease and normal hysterosalpingography (HSG) were found to have pathologic findings. When comparing the patency of the Fallopian tubes at HSG and laparoscopy the overall agreement was 71%. Sixty-eight of the patents with no other cause for infertility had the abdominal tubal ostia catheterized at laparoscopy. In 20 of these, small adhesions that could interfere with ovum pick-up were found and divided. The pregnancy rate in this group was 70%, which is significantly higher than the pregnancy rate of 44% in 59 otherwise normal patients who did not have their tubes catheterized. The subsequent pregnancy rate for patients with different findings at laparoscopy is described. The role of HSG compared with laparoscopy is discussed. It is concluded that laparoscopy should be performed in all patients of female infertility, with the exception of those who have bilateral hydrosalpinges without patency on HSG. These patients are offered laparotomy for salpingostomy without laparoscopy. The catherterization of the Fallopian tubes at laparoscopy is a new method to find an easily treatable cause of infertility.