Role of Hysterolaparoscopy in Female Infertility

Export Objective: To evaluate the diagnostic yield of combined laparoscopy and hysteroscopy (hysterolaparoscopy) in women with infertility and determine whether performing therapeutic interventions during the same session improves subsequent pregnancy rates. Methods: We conducted a prospective observational study at a tertiary university hospital in Aleppo, Syria, from August 2022 to July 2024. A total of 43 women (age 18–42) with primary or secondary infertility (≥1 year) underwent one-stage diagnostic laparoscopy with chromopertubation and hysteroscopy in the early proliferative phase of the menstrual cycle. Any detected abnormalities were managed during the same anesthesia (e.g., ovarian drilling for polycystic ovaries, adhesiolysis, endometriosis ablation, and septum resection). Preoperative evaluations included hormonal profiles and hysterosalpingography (HSG). The key outcomes recorded were the findings on HSG, laparoscopy, and hysteroscopy; the interventions performed; and the occurrence of pregnancy within 12 months post-procedure. Descriptive statistics were used for data analysis using SPSS, with pregnancy rates compared between those who did and did not receive interventions. Results: The mean age was 30.8±6.3 years, and 53.5% of women had primary infertility. HSG was abnormal in 58.3% of patients (most often revealing unilateral or bilateral tubal occlusion). Laparoscopy identified pelvic pathology in 81.4% of women, primarily peritoneal adhesions (46.5%), polycystic ovaries (32.5%), and tubal blockage (≈30%). Endometriosis lesions were observed in 13.9% and fibroids in 6.9%. Hysteroscopy detected intrauterine abnormalities in 37.2% of cases, with uterine septum (9.3%) being the most frequent finding, followed by intrauterine adhesions (4.6%), submucosal fibroids (4.6%), endometrial polyps (2.3%), and cesarean scar defect (2.3%). Therapeutic procedures were performed in 26 patients (60.5%), most commonly ovarian drilling (in 30.2% of all patients) and adhesiolysis (27.9%). Within 1-year post-surgery, 12 patients conceived, yielding an overall pregnancy rate of 27.9%. Notably, women who underwent therapeutic interventions had a higher conception rate (38.5%) compared to those who had only diagnostic examination with no intervention (11.8%). Conclusions: Combined hysterolaparoscopy provided a comprehensive evaluation of female infertility, detecting a range of tubal, peritoneal, and intrauterine pathologies with greater accuracy than HSG alone. The one-step approach allowed simultaneous treatment of correctable abnormalities, which was associated with improved fertility outcomes in our cohort. Hysterolaparoscopy is a valuable tool in infertility management, it enables diagnosis and therapy in the same session, and its use early in the infertility workup (especially for patients with normal basic investigations or abnormal HSG results) may enhance the chances of successful pregnancy.