الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Causes of infertility in the female partner include disorders of ovulation, tubal disease, and uterine or cervical factors. Endometriosis also has been implicated as an independent cause of infertility.
Owing to its non invasive nature and low cost, hysterosalpingography (HSG) is widely used as a first line approach to assess the patency of the fallopian tubes and uterine anomalies in the routine fertility workup.
The aim of our study was to assess the utility of Hysterolaparoscopy as one step procedure and compare it with HSG, in the subset of ovulatory infertile women with normal pelvic sonography, seminogram ,hormonal assays and HSG.
Even in women thought to be at low risk for significant pelvic pathology affecting reproduction, the yield was high.
Laparoscopy was helpful in making a decision to go to assisted reproductive technology, particularly when infertility had been of long duration and in older women.
This observational cross sectional analytical study was done in 200 patients with primary and secondary infertility. It was conducted at the infertility clinic at Alexandria Maternity University hospital in the period from July 2017 to March 2018.
We assessed the role of combined hysterolaparoscopy in female infertility patients with no significant clinical, ultrasonography, laboratory or HSG findings and calculated the incidence of various pathological conditions in the female reproductive tract leading to infertility.
Out of 200 patients, 116 (58%) had primary and 84 (42%) had secondary infertility. The patients in secondary infertility group were older compared to primary group. The most common intrauterine pathology in both the groups was uterine septum. Next most common intrauterine lesion was endometrial polyp. Adnexal adhesions and endometriosis were the most common abnormalities detected in laparoscopy in both groups. The prevalence of endometriosis, unilateral and bilateral tubal block was higher in primary group. The operative interventions, both hysteroscopic and laparoscopic were also noted.
Generally speaking, laparoscopic abnormalities were higher in both group than hysteroscopic ones.
Laparoscopy was found to be a better predictor of future fertility than HSG. Also in women who are at an increased risk of having tuboperitoneal pathology, diagnostic laparoscopy should be offered early in the infertility work-up.
The laparoscopy could detect pelvic abnormalities in about 60% and intrauterine abnormalities was about 43% in infertile patients .These results was near others observed by similar studies .
For all mentioned earlier, we and others concluded that combined hystero-laparoscopy is a safe, effective and reliable method in comprehensive evaluation of female infertility. It is a very useful tool in detecting the correctable missed pelvic abnormalities in patients with the normal ovulation, HSG and semen analysis. It will also help us to take decision regarding the need for ART in required patients, thus avoiding further emotional and financial trauma to the couples.