J. Obstet. Gynaecol. Res. Vol. 30, No. 1: 9 – 14, February 2004 9 Blackwell Science, LtdOxford, UKJOGThe Journal of Obstetrics and Gynaecology Research1341-80762004 Asia and Oceania Federation of Obstetrics and GynaecologyFebruary 2004301914Original Article Laparoscopy and hysteroscopy in infertilityT.A. Shokeir et al. Received: January 7 2003. Accepted: October 24 2003. Reprint request to: Tarek A. Shokeir, Department of Obstetrics and Gynecology, Fertility Care Unit, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt. Email: tarek1@mans.edu.eg Clinical Investigations Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: Results of 612 patients Tarek A. Shokeir, Hesham M. Shalan and Mohamed M. El-Shafei Department of Obstetrics and Gynecology, Fertility Care Unit, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt Abstract Aim: To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the eval- uation of female infertility in developing countries. Methods: In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous com- bined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero-tubal junction was attempted. Results: Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post-traumatic and/or post-phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than by hysterosalpingography. The rate of diagnosis of significant lesions by laparoscopy of 64.3% rose to 76.6% when the hysteroscopic findings were included. A significant number of women with secondary infer- tility had abnormal hysteroscopic findings when compared to either women with primary infertility or those requesting sterilization reversal. Hysteroscopic evaluation of the region of utero-tubal junction revealed sig- nificant lesions believed to have caused infertility in comparison with those requesting sterilization reversal. Conclusion: The combined diagnostic approach of laparoscopy and hysteroscopy is recommended in the evaluation of female infertility in communities where the risk of pelvic infections is great. Key words: diagnosis, hysteroscopy, infertility, laparoscopy. Introduction There are numerous specific female etiologic factors that contribute to the inability to conceive, and the pos- sible combinations of them are limitless. 1 Despite the limits of hysterosalpingography (HSG), the World Health Organization recommends only it for the study of the uterine cavity in the standard evaluation of women and most clinicians continue to rely on HSG as their routine test to asses the uterine cavity in these patients. 2 Recent technological improvements in endo- scopic instruments permit the diagnosis of a variety of pathologic lesions that are directly or indirectly responsible for female infertility. 3