To assess the value of laparoscopy in infertile women with normal hysterosalpingograms, with and without risk factors suggesting pelvic disease.
Study Design
We retrospectively reviewed 1,022 consecutive charts from a tertiary infertility practice. In 265 women, laparoscopies were performed after normal hysterosalpingograms.
Results
Laparoscopies were normal in 136 (51%) women, whereas 129 (49%) had one or more abnormal laparoscopic findings, including minimal or mild endometriosis (n = 85), moderate or severe endometriosis (n = 11), adnexal adhesions (n = 27), subserosal myomas (n = 17), ovarian neoplasms (n = 5), distal phimosis (n = 1) and salpingitis isthmica nodosa (n = 1). Only 7% of cases had findings that might require standard operative laparoscopy or laparotomy, although not all were causally related to infertility. A history of dysmenorrhea or dyspareunia increased the likelihood of detecting endometriosis from 41% to 64% and 69%, respectively. The presence of both symptoms increased the likelihood to 83%.
Conclusion
In the presence of a normal hysterosalpingogram, laparoscopy identified other pelvic disease in about half of patients. Because most abnormalities were mild, this knowledge can be used to plan a micro-laparoscopic approach for many women, reserving traditional or operative laparoscopy for women with an abnormal hysterosalpingogram or extensive disease following micro-laparoscopy. Alternately, knowledge of the nature and severity of the expected laparoscopic findings might lead to bypassing laparoscopy in favor of assisted reproduction when the perceived benefit of surgical intervention is small.
diagnostic laparoscopy infertile women normal hysterosalpingogram, laparoscopy findings after normal HSG infertility, endometriosis detection laparoscopy normal tubal patency, mild endometriosis diagnosis infertility workup, dysmenorrhea dyspareunia predictors endometriosis laparoscopy, micro-laparoscopy versus operative laparoscopy infertility, pelvic adhesions adnexal findings unexplained infertility, hysterosalpingography limitations detecting pelvic disease, retrospective review laparoscopy tertiary infertility practice, prevalence endometriosis unexplained infertility laparoscopic evaluation
al-Badawi et al. 1999, al-Badawi 1999
Cite this article
al-Badawi, I. A., Fluker, M. R., & Bebbington, M. W. (1999). Diagnostic laparoscopy in infertile women with normal hysterosalpingograms. The Journal of reproductive medicine, 44(11), 953-957.
al-Badawi IA, Fluker MR, Bebbington MW. Diagnostic laparoscopy in infertile women with normal hysterosalpingograms. J Reprod Med. 1999;44(11):953-957.
al-Badawi, Ismail A., et al. "Diagnostic laparoscopy in infertile women with normal hysterosalpingograms." The Journal of reproductive medicine, vol. 44, no. 11, 1999, pp. 953-957.
A technique of translaparoscopic salpingoscopy is utilized to evaluate the ampullary segment of the Fallopian tube in patients suffering from infertility. Comparison of this technique with hysterosalpingography in a series of 32 patients with hydrosalpinges demonstrates its superiority in the evaluation of the tubal mucosa. This new diagnostic approach allows a more accurate selection of patients for either microsurgical repair, in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT).
Shenoy-Bhangle AS et al., 2026·J Magn Reson Imaging·
Endometriosis is a chronic multisystem disease caused by the presence of endometrium-like tissue outside the endometrial canal, inciting inflammation and fibrosis. Transvaginal ultrasound (TVUS) and MRI have replaced diagnostic laparoscopy as the noninvasive imaging modalities of choice for diagnosis and pre-surgical planning. Advanced disease in the pelvis can distort/obliterate anatomic planes and obscure the extent of pelvic organ involvement at laparoscopy. Unlike laparoscopy, MRI is not limited by anatomic distortion and provides accurate multi-compartment assessment of deep pelvic endometriosis involving the uterus and its ligaments, adnexa, bowel, distal ureters, urinary bladder, and pelvic nerves. Additionally, MRI can help detect extra-pelvic organ involvement in the same study. Use of a dedicated MRI protocol and structured reporting template improves multidisciplinary communication and provides a pre-surgical road map; helps patient counseling as well as assessing the need for additional intraoperative organ-specific expertise such as colorectal surgery or urology. Knowledge of MRI and laparoscopic correlation enhances recognition of the key MRI findings to include in the report for optimizing surgical outcomes. This article focuses on the role of MRI in the diagnosis and pre-surgical mapping of pelvic endometriosis, with correlation to laparoscopic findings. Evidence level: 1. Technical efficacy: 5.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, a condition that affects approximately 1% to 2% of pregnancies in the United States. Ectopic pregnancy is a potentially life-threatening condition and accounts for 2.7% of pregnancy-related deaths. Most ectopic pregnancies (approximately 97%) occur within the fallopian tube, commonly linked to underlying fallopian tube abnormalities. Such abnormalities may result from prior infections (eg, gonorrhea or chlamydia), tubal surgeries (including sterilization), prior ectopic pregnancies, or exposure to diethylstilbestrol in utero. Additional risk factors include conception while using intrauterine devices (IUDs) or progesterone-only contraceptives. Although rare, ectopic pregnancies can also occur outside the fallopian tube, such as in the cervix, ovary, abdomen, uterine cornua, or cesarean scars. These extratubal ectopic pregnancies are less likely to be associated with the typical risk factors or tubal pathology, making their diagnosis and management particularly challenging. Regardless of the location, early detection is critical for conservative treatment and improving outcomes. Ectopic pregnancy often causes lower abdominal pain, typically on one side, along with vaginal bleeding. Symptoms like dizziness, fainting, shoulder pain, or severe pelvic pain may indicate a ruptured ectopic pregnancy. However, these signs can mimic other conditions, eg, early normal intrauterine pregnancy, miscarriage, ovarian cyst rupture, or appendicitis. Therefore, differentiating ectopic pregnancy from conditions with similar clinical features can be difficult, making prompt medical evaluation crucial for accurate diagnosis and treatment. Management primarily aims to preserve fertility, improve diagnostic accuracy, and provide psychological support. Treatment varies, depending on clinical stability, ectopic location, beta-human chorionic gonadotropin (β-hCG) levels, and ultrasound findings ranging from expectant management to surgical interventions. In select cases, nonsurgical treatment with methotrexate may be effective, especially when pregnancies are diagnosed early and meet specific criteria. However, medical treatment is less likely to succeed in cases involving larger masses, high β-hCG levels, or visible embryos. Advanced or ruptured cases typically require urgent surgical intervention.
Endometriosis is a benign disease that can cause pain and infertility in women. Debate exists over how endometriosis should best be diagnosed. On one hand, endometriosis can be diagnosed by directly examining pelvic anatomy via a surgical procedure known as diagnostic laparoscopy. On the other hand, the disease can be diagnosed via non-surgical means such as using medical imaging, the symptoms described by the patient and whether the patient responds to non-surgical therapies such as medication. In this debate article, we argue in favour of diagnostic laparoscopy. We review the safety of the procedure, compare the ability of diagnostic laparoscopy vs medical imaging to detect endometriosis and consider the benefits of formally diagnosing or ruling out the condition.