When a couple is having difficulty conceiving, the doctor may recommend certain tests to understand whether there is a structural problem involving the uterus, fallopian tubes or ovaries. In some cases, a diagnostic hystero-laparoscopy may be advised as part of the fertility evaluation.
In this article, Dr. Manisha Kulkarni, Senior Consultant Obstetrician, Gynecologist and Fertility Specialist at MomStory, Hadapsar, explains what hystero-laparoscopy is, how the procedure is performed and how it can help doctors plan further fertility treatment.
What Is Hystero-Laparoscopy?
Hystero-laparoscopy combines two procedures: hysteroscopy and laparoscopy.
Together, these procedures allow the doctor to examine the reproductive organs from different perspectives. Hysteroscopy provides a view of the inside of the uterus, while laparoscopy allows the doctor to examine the uterus, fallopian tubes, ovaries and surrounding pelvic structures from the abdomen.
This can provide useful information when investigating certain causes of infertility.
What Is Hysteroscopy?
A hysteroscopy involves passing a thin scope through the vagina and cervix to examine the inside of the uterus.
During hysteroscopy, the doctor can evaluate:
- The cervix and cervical canal
- The endometrial lining or inner lining of the uterus
- The uterine cavity
- The openings of the fallopian tubes into the uterus, known as tubal ostia
The procedure can help identify abnormalities within the uterine cavity that may be relevant to fertility.
What Problems Can Be Detected During Hysteroscopy?
Hysteroscopy may help identify conditions such as:
- Endometrial or uterine polyps
- Uterine septum
- Abnormalities of the uterine cavity
- Problems involving the tubal openings
An important advantage is that certain abnormalities, such as a polyp or uterine septum, may sometimes be treated during the same procedure when appropriate.
What Is Laparoscopy?
Laparoscopy allows the doctor to examine the reproductive organs from inside the abdomen.
During the procedure, a small scope is introduced through an incision near the navel. This allows the doctor to directly visualise the pelvic organs on a screen.
The doctor can assess:
- The size and appearance of the uterus
- The fallopian tubes
- The ovaries
- The size and appearance of the ovaries
- The presence of ovarian cysts
- Other visible pelvic abnormalities
How Are Blocked Fallopian Tubes Checked?
One important part of a fertility evaluation is determining whether the fallopian tubes are open or blocked.
During hystero-laparoscopy, the doctor can perform a tubal patency test.
A dye is introduced through the cervix into the uterus. During laparoscopy, the doctor observes whether the dye passes through the fallopian tubes and spills into the pelvic cavity.
If the dye passes through the tubes, it indicates tubal patency. If it does not pass normally, further evaluation may be required to understand whether a blockage is present.
Why Is Hystero-Laparoscopy Done for Infertility?
Hystero-laparoscopy can provide information about several reproductive structures during a single procedure.
It may help doctors evaluate:
- The uterine cavity
- The endometrial lining
- The fallopian tubes
- Tubal patency
- The ovaries
- Ovarian cysts
- Polyps or a uterine septum
The findings can help the fertility specialist understand possible factors affecting conception and determine the appropriate next steps in treatment.
However, not every woman experiencing infertility requires hystero-laparoscopy. Whether the procedure is appropriate depends on the individual’s medical history, previous investigations and fertility evaluation.
Is Hystero-Laparoscopy Painful?
Diagnostic hystero-laparoscopy is generally performed under anaesthesia, so the patient should not experience pain during the procedure itself.
According to Dr. Kulkarni, it is usually performed under short general anaesthesia or general anaesthesia.
Your doctor and anaesthesia team will explain the type of anaesthesia planned before the procedure.
Is Hystero-Laparoscopy a Day-Care Procedure?
Diagnostic hystero-laparoscopy is generally considered a minor, day-care procedure in suitable patients.
Recovery is usually relatively quick. According to the doctor, patients can generally start moving around by the following day and prolonged bed rest is usually not required.
Recovery can vary depending on whether only a diagnostic procedure was performed or whether any additional treatment was carried out during the procedure. Always follow your doctor’s individual post-procedure instructions.
How Does Hystero-Laparoscopy Help Plan Fertility Treatment?
One of the main benefits of diagnostic hystero-laparoscopy is that it provides a direct assessment of the uterus, fallopian tubes and ovaries.
If an abnormality is identified, the findings can help the fertility specialist decide what further treatment or investigation may be appropriate.
For example, identifying a uterine abnormality, ovarian cyst or problem with tubal patency may influence the next stage of fertility management.
Conclusion
Hystero-laparoscopy can be an important diagnostic procedure in selected cases of infertility. It combines hysteroscopy, which examines the inside of the uterus, with laparoscopy, which allows the doctor to assess the uterus, ovaries and fallopian tubes from the abdominal side.
It can also help assess whether the fallopian tubes are open and, in certain cases, allow some uterine abnormalities to be treated during the same procedure.
If you are having difficulty conceiving, consult a fertility specialist to understand whether hystero-laparoscopy is necessary in your individual case.
