Role of Minimal Access Techniques in Tubal Factor Infertility

Joseph, Annie
January 2011
World Journal of Laparoscopic Surgery;Jan-Apr2011, Vol. 4 Issue 1, p59
Academic Journal
Infertility is defined as an inability to conceive a pregnancy after two years of unprotected intercourse. It can be either primary when the female has never conceived or secondary when there has been a previous documented pregnancy--either a live birth or even a failed pregnancy, e.g. miscarriage or ectopic pregnancy. Causes of infertility: * Male factor 40% * Female factor--tubal problem 20% * Ovulatory problems 10 to 15% * Unexplained 10 to 15% * Others 10% The fallopian tube plays an important role in the mechanical transport and physiological sustenance of gametes and early conceptus. Complex and coordinated neuromuscular activity, cilial action and endocrine secretions are required for successful tubal function. Compromised tubal damage can occur after external or internal injury, inhibiting the normal transport of gametes. The overall prognosis for fertility depends principally on the insult and severity of the tissue damage; hence, assessment of tubal damage plays a major role in predicting occurrence of pregnancy and the likelihood of developing ectopic pregnancy. Various methods for the evaluation of tubal factor are complementary and not mutually exclusive. Evaluation of tubal patency and tubal integrity is a key component of diagnostic work-up. Diagnostic laparoscopy is considered as the investigation of choice to explore tuboperitoneal infertility or infertility associated with endometriosis. Standard diagnostic laparoscopy for female infertility when performed in women without previous pelvic pathology or any clinical and sonographic findings may result in normal examination or pathology of doubtful clinical significance. Transvaginal hydrolaparoscopy (THL) is a new procedure to explore the pelvis. This method is based on vaginal access using a needle puncture technique and saline for distension. The introduction of small diameter laparoscopes allowed re-evaluation of transvaginal access for infertility investigation. Vaginal access and hydroflotation allow improved visualization of the tubo-ovarian structures in their normal position with no need for manipulation. THL can be performed on an outpatient basis under local anesthesia. This may reduce the procedure's cost and the incidence of complications associated with general anesthesia, but evidence is lacking to prove that it is superior to laparoscopy. Methods: The literature search had been done with the help of Google search, PubMed, Yahoo, etc. The articles and various reviews had been compared and the conclusion had been drawn accordingly.


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