Laparoscopic and Hysteroscopic Findings in A Selected Group of Women with Unexplained Infertility: A Cross-Sectional Study.

Background: The role of laparoscopy and hysteroscopy in managing unexplained infertility (UI) is debatable because of the improved success rate of assisted reproductive technologies (ART). This study aims to assess the findings of laparoscopy and hysteroscopy in selected women diagnosed with UI to determine the frequency of such pathological conditions in order to manage them properly.

Materials and methods: The current cross-sectional study was conducted on 96 women who attended an infertility clinic at the educational hospitals of Isfahan University of Medical Sciences from March 2018 to February 2020. The participants had one or more of the following conditions: had failed to conceive after 2-3 cycles of ovulation induction with clomiphene citrate and intrauterine insemination (IUI), had a history of pelvic infection, pelvic surgery, or ectopic pregnancy (EP). Laparoscopy and hysteroscopic findings were recorded for all participants.

Results: Fifty-nine (61.4%) women had primary infertility, while 37 (38.6%) suffered from secondary infertility. In patients with primary and secondary infertility, 42.3 and 43.2% had laparoscopic abnormalities, respectively. Additionally, 33.8 and 21.6% of the participants had hysteroscopic abnormalities in the primary and secondary groups, respectively. The most common findings in the two groups of infertility who had done laparoscopy were endometriosis (21.8%, P=0.201) followed by tubal pathology (13.5%, P=0.952). Also, the most common intrauterine pathology found in both groups were uterine septum (7.2%, P=0.753) and endometritis (6.2%, P=0.241).

Conclusion: Based on the findings of this study, laparoscopy is recommended in UI after three failed IUI and ovarian stimulation, a history of pelvic pain, pelvic surgery, or pelvic infection; however, it seems that further investigation is required to recommend universal hysteroscopy to all women with UI. Nonetheless, it is still emphasized that regional practice in one's local settings may also be effective concerning the prevalence of these pathologies.