Human Reproduction Update Advance Access originally published online on June 11, 2007
Human Reproduction Update 2007 13(5):477-485; doi:10.1093/humupd/dmm014
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The position of diagnostic laparoscopy in current fertility practice
1 Department of Obstetrics and Gynaecology, Imeldahospitaal, Imeldalaan 9, 2820 Bonheiden, Belgium 2 Endoscopic Training Centre Antwerp, ZNA STER Site Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerpen, Belgium 3 Universitaire Vrouwenkliniek, University Hospital Gent, De Pintelaan 185, 9000 Gent, Belgium 4 Leuven University Fertility Centre, Department of Obstetrics and Gynecology, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
5 Correspondence address. Tel: +32 15 505205; Fax: +32 15 420106; E-mail: jan.bosteels{at}imelda.be
In everyday clinical practice, it is not always clear if and when exactly in the fertility work-up a diagnostic laparoscopy should be offered. The aim of this review is to analyse the available evidence with respect to alternative diagnostic methods for detecting tuboperitoneal infertility and with respect to the position of diagnostic laparoscopy in women with infertility. A literature search of the National Library of Medicine and the National Institutes of Health (PubMed) was performed using the key words ‘diagnostic laparoscopy and infertility’. The study methodology was carefully considered in an effort to present conclusions preferably based on randomized controlled trials (RCTs). The routine use of diagnostic laparoscopy for the evaluation of all cases of female infertility is currently under debate. According to data published in retrospective non-controlled studies, diagnostic laparoscopy after several failed cycles of ovulation induction enables the detection of a significant proportion of pelvic pathology amenable to treatment. A Cochrane review has shown that laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovarian syndrome is at least as effective as gonadotrophin treatment, and results in a lower multiple pregnancy rate. The role of laparoscopy before the start of treatment with intrauterine insemination is controversial, according to one RCT. In women with bilateral ultrasonically visible hydrosalpinges, two RCTs have demonstrated increased implantation and pregnancy rates in IVF cycles after salpingectomy. Although RCTs which have studied the benefit of laparoscopic surgery in moderate or severe endometriosis are still lacking, its value has generally been accepted. In conclusion, some specific clinical settings, solid evidence is available to recommend the use of diagnostic laparoscopy in current fertility practice. There is however a need for more RCTs to answer remaining questions regarding its value in the diagnosis and treatment of some patients with infertility.
Key words: diagnostic laparoscopy / ovulation induction / endometriosis / intrauterine insemination / in vitro fertilization
Received on February 13, 2007; revised April 14, 2007; accepted on April 25, 2007
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