Clinical Pearls:
- Both the procedure resulted in pregnancy rate at par with each other, but the researchers advocate doing diagnostic and therapeutic laparoscopy first in patients with unexplained infertility.
American Society for Reproductive
Medicine (ASRM) 2016 Scientific Congress is currently ongoing at
(October 15 – 19) Salt Lake City, Utah. Some selected abstract
and news from the conference.
It is always an obstetrician dilemma whether to perform laparoscopy first or go for ART in patient diagnosed with unexplained
infertility.
A randomized prospective clinical trial results
by Algergawy A.et al. presented on October 18, 2016 evaluated
the outcome of these two approaches.[1]
The study involved a cohort of 423 patients
who were diagnosed with unexplained infertility based on normal HSG findings,
regular ovulation, normal hormonal profile and normal male partner. These women
were randomized into two groups. Women who underwent COH followed by IUI for 3 cycles
and then ICSI constituted group 1 (205). The second group (218) consists of
women who underwent laparoscopy (Diagnostic and therapeutic).
86 women (41.95%) in the first group
conceived within 1 year, 26 cases
(12.6%) by IUI. and 60 cases (29.26%) by ICSI.
In the
second group, diagnostic laparoscopy revealed multiple pathology like mild to moderate
endometriosis, severe endometriosis and hypoplastic fallopian tube. Adhesiolysis,
ablation and excision of endometriotic implant was performed. The overall pregnancy
rate in group 2 was 84 cases (38.53%).
Although
the pregnancy rate in both group is at par, laparoscopy resulted in better diagnosis
of causes of unexplained infertility resulting in better management of cases.
It also enabled spontaneous pregnancy in significant number of patients thus
avoiding psychological, emotional and physical trauma of ART. It also avoids
the many complications of ART like OHSS and multiple pregnancy.
If the
patient of unexplained infertility does not conceive after laparoscopy, then
ART can always be performed when needed and previous diagnostic laparoscopy
facilitates the results of ART.
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