Fertility Testing for Women
Anatomical Testing > Diagnostic Laparoscopy
Laparoscopy is a surgical procedure in which a camera is placed through the belly button of the female patient to allow for direct visualization of the pelvic anatomy.
Laparoscopy is still considered the gold standard for diagnosing abnormalities in female anatomy. Even so, the role of laparoscopy has been declining in the fertility evaluation for several reasons.
If a woman has a normal HSG, no history of pelvic pain and a normal ultrasound, the chance that laparoscopy will change either management or treatment outcome is small.
For example, in couples with unexplained infertility (normal sperm, normal HSG, and proof of ovulation), there is a 20% chance that the woman has endometriosis. Endometriosis can make it more difficult for women to get pregnant. Studies have shown that removing endometriosis in women with mild to moderate disease does improve pregnancy rates, but sadly the success rates of surgery are actually quite small.
If we had 12 patients with mild to moderate endometriosis and we performed surgery and removed the endometriosis, 3 of these women would be pregnant within the next 12 months; 3 of 12 women conceiving over a 12 month period is not exactly a high pregnancy rate, especially compared to other therapies. Furthermore, if instead of operating on these women we had watched them expectantly to see how many conceive, 2 of the 12 would have conceived in the same 12 month period. This means we have to perform surgery on 12 women to get just 1 pregnancy we would not otherwise have seen.
To make matters even worse, if there is only a 20% chance that a woman has endometriosis, we would have to operate on 60 women to achieve 1 additional pregnancy.
See Diagnostic Hysteroscopy for more Anatomical Testing information