Do you need to undergo a laparoscopy?
In general, couples who have had trouble conceiving for 6-12 months should undergo a basic infertility evaluation. The tests include a semen analysis, an evaluation for ovarian function, having a pelvic sonogram, and a hysterosalpingogram (HSG). The final diagnostic test is a laparoscopy. However, this procedure is not always necessary.
On the other hand, if the other tests find an abnormality, it seems clear that laparoscopy will be beneficial. When all of the basic tests are normal, it is not obvious if it is worthwhile for a woman to undergo a laparoscopy.
Studies about whether women need to undergo a laparoscopy
Several studies in the past have looked at the likelihood of finding pelvic abnormalities at laparoscopy in patients with “unexplained infertility.” Years ago, several investigators offered those patients a diagnostic laparoscopy.
In these studies, abnormities were in 40% of couples. Approximately 65% of the couples had endometriosis. 35% of the couples had pelvic adhesions. With the results of studies like this, laparoscopy became a standard diagnostic procedure.
However, if during the investigation a semen analysis reveals the man has a very low sperm count and the woman has no other symptoms to suggest the presence of endometriosis and/or pelvic adhesions, then it is unlikely that a laparoscopy will be helpful. It this situation, the man should be evaluated by a urologist to determine if a treatment is available that might increase sperm production in the male. If not, then the couple should proceed with in vitro fertilization (IVF), unless the couple decides to undergo artificial insemination with donor sperm or proceed with adoption.
Women with fallopian tube obstruction may chose to proceed directly to IVF. Also, some couples who were found to have normal finding on the basic fertility tests may choose to try one of the treatments known to increase the chance of conceiving even when the cause of infertility has not been discovered and forego a laparoscopy. They may choose to try clomiphene (or letrozole) with intrauterine insemination (IUI), superovulation with gonadotropins combined with IUI, or IVF. In this situation, the couple is gambling that laparoscopy would not reveal any abnormalities.
Laparoscopy is one of the great tools that is available for treating many gynecological problems, including infertility. However, it is not always necessary for it to be a part of the evaluation of infertility. If you have any questions as to whether a laparoscopy will be helpful, do not hesitate to ask your physician.