Semin Reprod Med 2020; 38(01): 029-035
DOI: 10.1055/s-0040-1718942
Review Article

Does Laparoscopy and Hysteroscopy Have a Place in the Diagnosis of Unexplained Infertility?

Mohan S. Kamath
1  Department of Reproductive Medicine, Christian Medical College, Vellore, India
Judith F.W. Rikken
2  Center for Reproductive Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
Jan Bosteels
3  Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
4  Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
5  Department of Development and Regeneration, Gent University, Gent, Belgium
› Author Affiliations


The standard fertility workup includes assessment of ovulation, semen analysis, and evaluation of tubal patency. If the fertility workup is found to be normal, a diagnosis of unexplained infertility is made. The role of laparoscopy in fertility workup has been a matter of debate. The current review presents the evidence for and against laparoscopy and hysteroscopy during fertility workup and subsequently prior to fertility treatment. After appraising the literature, we found the role of diagnostic laparoscopy in fertility workup is limited and is dependent on factors like prevalence of pelvic infection, setting, and availability of expertise. Moreover, whenever a laparoscopy is planned as a part of the fertility workup, the preparation should include ability to carry out simultaneous therapeutic intervention to maximize the benefit. Similarly, the routine use of hysteroscopy in women with unexplained infertility cannot be recommended. There is a need to investigate the impact of choice of tubal test on chances of spontaneous conception and treatment outcomes in women with unexplained infertility. Our future research agenda should also include high-quality multicenter randomized trials assessing the cost-effectiveness of screening and operative hysteroscopy prior to intrauterine insemination or in vitro fertilization.

Publication History

Publication Date:
20 October 2020 (online)

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