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Human Reproduction, Vol. 18, No. 1, 8-11, January 2003
© 2003 European Society of Human Reproduction and Embryology

Debate

Investigation of the infertile couple

Should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?

Sandra J. Tanahatoe, Peter G.A. Hompes and Cornelis B. Lambalk1

Department of Obstetrics, Gynaecology and Reproductive Medicine, ‘Vrije universiteit’ Medical Centre PO Box 7057, 1007 MB Amsterdam, The Netherlands 1 To whom correspondence should be addressed. e-mail: cb.lambalk@vumc.nl

Diagnostic laparoscopy is normally the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment. Recently, there has been a growing tendency to bypass diagnostic laparoscopy after a normal hysterosalpingogram and instead to start direct infertility treatment [intrauterine insemination (IUI) or IVF] for indications such as unexplained infertility, male subfertility and cervical hostility. In our clinic, laparoscopy revealed abnormalities that resulted in changed treatment decisions in 25% of the patients who would normally have been scheduled for IUI if laparoscopy had not been performed. The changed treatments mainly concerned surgery for minimal/mild endometriosis and periadnexal adhesions, both performed during the diagnostic laparoscopy. Because the effect of such interventions on the success rate of IUI has never been described, it still remains unclear whether laparoscopy is usefully performed in these cases. Therefore, further prospective studies should be performed to assess whether delaying, or bypassing entirely, diagnostic laparoscopy is more cost effective and if laparoscopic interventions for intra-abdominal abnormalities are effective in terms of higher pregnancy rates after treatment with IUI.

Key words: diagnostic laparoscopy/endometriosis/hysterosalpingogram/infertility work up/intrauterine insemination


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S.J. Tanahatoe, C.B. Lambalk, and P.G.A. Hompes
The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study
Hum. Reprod., November 1, 2005; 20(11): 3225 - 3230.
[Abstract] [Full Text] [PDF]


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