What Is Laparoscopy and Why Is It Used in Infertility?
Laparoscopy is a minimally invasive surgical procedure that allows a doctor to view the inside of the abdomen and pelvis directly, using a thin camera called a laparoscope. In the context of infertility, laparoscopy is invaluable for diagnosing and treating a range of conditions that cannot be detected by ultrasound, blood tests, or even HSG (tube dye test).
At Mother Hospitals & IVF Center, Boduppal, Dr. E. Prashanthi Reddy — who trained in advanced laparoscopy at the Satwalekar Institute, Hyderabad — uses this procedure both as a diagnostic tool and a treatment in the same sitting, minimising the need for multiple procedures.
What Can Laparoscopy Find That Other Tests Miss?
Many causes of infertility are invisible to routine investigations. Laparoscopy can identify:
- Endometriosis: The presence of uterine lining tissue outside the uterus. Even mild endometriosis significantly reduces fertility, and it is only definitively diagnosed by laparoscopy and biopsy.
- Pelvic adhesions: Bands of scar tissue from previous infections (PID), surgery, or endometriosis that distort the anatomy and block egg-sperm meeting.
- Fallopian tube damage: HSG may show tubes are "open" but laparoscopy can reveal fimbrial adhesions, hydrosalpinx, or subtle tube damage that prevents natural conception.
- Ovarian cysts (endometriomas): Chocolate cysts from endometriosis reduce ovarian reserve and egg quality.
- Uterine fibroids: Submucosal fibroids that distort the uterine cavity, and subserosal or intramural fibroids that compress the tubes.
- Uterine anomalies: Septum, bicornuate uterus, or accessory horns that cause recurrent miscarriage.
The Laparoscopy Procedure: What to Expect
Before the Procedure
You will be advised to fast for 6-8 hours before surgery. Pre-operative blood tests, ECG, and anaesthesia evaluation are done beforehand. Laparoscopy is typically performed on Day 5-10 of your menstrual cycle, after the period has ended but before ovulation.
During the Procedure
Under general anaesthesia, 2-3 small incisions (5-10mm) are made — one at the navel and one or two on the lower abdomen. Carbon dioxide gas is introduced to gently inflate the abdominal cavity, giving the surgeon a clear view. The laparoscope (camera) is inserted through the navel incision. Any treatment — removal of endometriosis, adhesion release, tube opening, or cyst removal — is performed using instruments through the other incisions.
After the Procedure
Most patients go home the same day or after overnight observation. You may feel bloated and have mild shoulder pain (from the gas) for 1-2 days. A follow-up consultation is scheduled within 1-2 weeks to review findings and plan next steps.
When Is Laparoscopy Recommended for Infertility?
Dr. Prashanthi Reddy typically recommends laparoscopy in the following situations:
- Unexplained infertility — especially after failed IUI cycles
- Suspected endometriosis (based on pain symptoms, CA-125 levels, or ultrasound findings)
- Abnormal HSG (blocked or hydrosalpinx tubes)
- History of pelvic inflammatory disease (PID) or previous abdominal surgery
- Recurrent pregnancy loss (to check for uterine anomalies)
- Before IVF in cases where a hydrosalpinx is suspected (which, if present, significantly reduces IVF success and should be removed or clipped before IVF)
Laparoscopy vs. HSG — Which Is Better?
HSG (Hysterosalpingogram) is an X-ray dye test that assesses tube patency and the uterine cavity. It is less invasive and done without anaesthesia. However, HSG can miss up to 30-40% of pelvic pathology, particularly endometriosis and adhesions. Laparoscopy remains the gold standard for comprehensive pelvic evaluation. In many cases, both tests are used together — HSG for initial assessment, laparoscopy for confirmation or treatment.
After Laparoscopy: What Happens Next?
If laparoscopy finds and treats a correctable cause, natural conception rates improve significantly — especially in cases of mild-to-moderate endometriosis, where successful laparoscopic treatment doubles the pregnancy rate in the following 12 months. If laparoscopy finds no treatable cause, it confirms that unexplained infertility is truly the diagnosis — and the focus shifts to IVF treatment as the most effective option.
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