Diagnostic laparoscopy for unexplained subfertility: a comprehensive review

Abstract

Dealing with unexplained infertility is still non-guided, and patients are prone to different and sometimes discordant management strategies based on physician's preferences. However, much has been discussed in this matter, especially when it comes to the use of laparoscopy in patients with unexplained subfertility. In this debate article, we discussed data found in the literature concerning the utility of laparoscopy in these patients, leading us into establishing a new paradigm that will serve in orienting the physicians to when the procedure should be performed.

Keywords: endometriosis peritubal adhesions; in vitro fertilization; laparoscopy; unexplained infertility.

Figure 1

The algorithm proposed to illustrate the areas of utility of the procedure along the way of managing unexplained infertility. ¹Risk factors include symptoms (dysmenorrhea, dyspareunia), previous pelvic surgery, secondary infertility, 3-year duration of infertility, previous PID or positive Chlamydia antibody titers, no OCP use. ²Young age is defined as age below 30 years, while old age above 35 years ³Mild findings included one-side thick adhesions or two-side filmy adhesions, minimal or mild endometriosis, one-sided phimosis, hydrosalpinx or tubal occlusion ⁴ Severe findings include moderate or severe endometriosis, two-sided hydrosalpinx/phimosis, bilateral dense adhesions and frozen pelvis.