Prognostic significance of diagnostic laparoscopy for spontaneous fertility

OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparosco py for subfertility in our department between May 1985 and November 1987 we re identified from, medical records. The impact of tubal occlusion, hydrosa lpinx and adhesions as detected at laparoscopy was studied. Kaplan-Meier cu rves for the occurrence of spontaneous intrauterine pregnancy were construc ted for patients without tubal pathology, with mild tubal pathology (unilat eral pathology or adhesions) and with severe tubal pathology (bilateral pat hology). Fecundity rate ratios (FRR) were calculated to express the associa tion between findings at laparoscopy and the occurrence of spontaneous intr auterine pregnancy. RESULTS: Of the 200 cases that could be analyzed, 129 (65%) showed no tubal occlusion on laparoscopy, 40 (20%) had unilateral tubal occlusion, and 31 (25%) had bilateral tubal occlusion. Unilateral hydrosalpinx was present in 13 (7%) patients, whereas 19 (10%) patients had bilateral hydrosalpinx. Ad justed FRRs were 0.65 and 0.20 for unilateral and bilateral tubal occlusion , and 0.46 and 0.32 for unilateral rand bilateral hydrosalpinx. Peritubal a dhesions were detected in 43% of patients and seemed to have no prognostic significance. CONCLUSION: Severe tubal pathology detected at laparoscopy affects fertilit y prospects strongly. However, since spontaneous intrauterine pregnancies o ccurred even in patients with bilateral tubal occlusion at laparoscopy, thi s technique should not be considered the gold standard in the diagnosis of tubal infertility.