DIAGNOSTIC UTILITY OF HYSTERO-LAPAROSCOPY IN THE EVALUATION OF INFERTILITY

Background: Infertility affects 10–15% of couples in the reproductive age group, and despite advances in diagnostics, many pelvic and intrauterine pathologies remain undetected by routine imaging. Diagnostic hystero-laparoscopy (DHL) offers a single-step, minimally invasive modality for comprehensive evaluation. The study aimed to assess the diagnostic utility of hystero-laparoscopy in identifying abnormalities among women with primary and secondary infertility. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Index Medical College Hospital & Research Centre, Indore, over 12 months. One hundred infertile women (70 primary, 30 secondary) fulfilling inclusion criteria underwent DHL in the early proliferative phase. Hysteroscopy assessed uterine cavity lesions, while laparoscopy evaluated tubal, ovarian, and peritoneal factors. Chromopertubation was performed for tubal patency. Data were analyzed using SPSS v25.0, with p < 0.05 considered significant. Results: Laparoscopic abnormalities were more frequent than hysteroscopic abnormalities (37% vs. 17% in primary infertility; 33% vs. 23% in secondary infertility). Endometriosis (16%) was the leading pelvic pathology in primary infertility, while adnexal adhesions (13%) predominated in secondary infertility. Other laparoscopic findings included tubal pathology (7%), myomas (5%), ovarian pathology (5%), and uterine anomalies (2%). On hysteroscopy, uterine septum was the most common intrauterine abnormality (11%), followed by polyps (6%) and myomas (3%). Chromopertubation revealed unilateral block in 9% and bilateral block in 8% of patients. Overall, 64% of women demonstrated at least one abnormality, with 9% showing combined findings on both procedures. Minor complications occurred in 6% of patients, with no major morbidity. Conclusion: DHL effectively identified a high burden of pelvic and intrauterine pathologies, many undetected by conventional investigations. Its comprehensive diagnostic yield and safety profile reinforce its role as a gold standard in infertility evaluation, enabling early and targeted management to improve reproductive outcomes.