[Laparoscopic assessment following failure to achieve pregnancy after intrauterine inseminations in patients with normal hysterosalpingograms]

OBJECTIVES: To assess the diagnostic benefit of laparoscopy in infertile women thought to be at low risk for altered pelvic anatomy. DESIGN: Retrospective chart review. PATIENTS: 127 infertile patients who underwent laparoscopic evaluation of the pelvis failing to conceive after intrauterine inseminations (IUI) with normal hysterosalpingography (HSG). INTERVENTION: Diagnostic and/or therapeutic laparoscopy. MAIN OUTCOME MEASURES: Presence of pelvic pathology and predictors of pelvic disease. RESULTS: Although the hysterosalpingograms were read as normal in all women, endometriosis stage I-II was found in 64 (50,4%) patients, stage III and stage IV in 4 (3,1%). Adhaesions were diagnosed laparoscopically in 22 (17%) patients and distal tubal disease in 26 (20%). All of this abnormalities were directly treated by laparoscopic intervention. The time between HSG and laparoscopy was positively correlated with appearance of distal tubal disease and pelvic adhaesions. CONCLUSION: Laparoscopic findings could lead to a change of treatment decisions in high number of infertile patients with normal hysterosalpingography.