Role of Laparoscopy in Females

For patients with a history of endometriosis, pelvic infections, or ectopic pregnancy, evaluation with hysteroscopy and laparoscopy is recommended.

Laparoscopy can be postponed for at least 10 months after normal patency or if a unilateral obstruction is revealed by HSG, particularly in females less than 36 years of age with normal ovarian reserve.

The proximal tubal disease accounts for 10-25% of tubal disease. Tubal cannulation is accomplished using a catheter system via hysteroscopy with laparoscopy confirmation.

The evidence is fair to recommend laparoscopic fimbrioplasty for the treatment of mild hydrosalpinx in young women with no other significant infertility factors. Also, there is good evidence for recommending laparoscopic salpingectomy or proximal tubal occlusion in case of surgical irreparable hydrosalpinges to improve IVF pregnancy rates.

In highly resistant PCOS cases, Laparoscopic ovarian drilling can be done. A major advantage of LOD is a decreased risk of multiple pregnancies. There are various hypotheses regarding the mechanism of action, such as nonspecific stromal destruction or the opening of follicular capsules that release follicular fluid, which contains androgens, thereby removing the ovulation block.

A significant reduction in serum androgen levels, an increase in FSH levels, and a decrease in LH pulse amplitude have been observed, independent of the mechanism. However, laparoscopic ovarian drilling is associated with a decrease in ovarian reserve. Also, there is a risk of adhesion formation. Therefore, LOD may be an option in highly resistant cases of PCOS with large bulky ovaries after thorough counselling of the patient.