Infertility is a growing concern affecting millions of couples worldwide. A thorough evaluation of the female reproductive system is crucial to identify causes and guide effective treatment. In modern gynecology, laparoscopy and hysteroscopy are considered the gold standard for diagnosing and managing many infertility-related conditions. Procedures such as the laparoscopic tubal patency test, diagnostic hysteroscopy, and laparoscopic ovarian drilling are often performed together in a single sitting to minimize invasiveness while maximizing diagnostic and therapeutic benefit.

Laparoscopic Tubal Patency Test
Importance of Tubal Patency

The fallopian tubes play a central role in fertility by enabling the transport of the egg from the ovary to the uterus. Blockage or damage to the tubes accounts for nearly 30–40% of female infertility cases. Confirming tubal patency is, therefore, one of the first steps in infertility work-up.

Technique

During laparoscopy, the surgeon instills a colored dye such as methylene blue or indigo carmine through the cervix into the uterine cavity. With the laparoscope in place, the dye’s flow through the tubes into the peritoneal cavity is directly visualized.

Findings include:

Free spillage of dye → Tubes are patent

Delayed or partial spill → Tubes may have functional or partial block

No spill → Complete tubal block

Advantages

Direct visualization of tubal function and pelvic anatomy

Ability to simultaneously detect adhesions, endometriosis, or pelvic pathology

High accuracy compared to non-invasive tests such as hysterosalpingography (HSG)

Diagnostic Hysteroscopy
Purpose

The uterine cavity is another critical factor in fertility. Abnormalities such as polyps, fibroids, adhesions (Asherman’s syndrome), or congenital anomalies can prevent implantation and cause recurrent pregnancy loss.

Technique

Hysteroscopy involves inserting a thin telescope (hysteroscope) through the cervix into the uterine cavity. Saline or glycine is used as a distension medium for clear visualization.

Conditions detected and treated include:

Endometrial polyps – removed using hysteroscopic scissors or resectoscope

Submucosal fibroids – resected to restore uterine cavity shape

Adhesions – lysed to improve endometrial receptivity

Septum – excised to improve implantation rates

Advantages

Direct visualization of uterine pathology

Simultaneous diagnostic and therapeutic intervention

Outpatient procedure with minimal recovery time

Laparoscopic Ovarian Drilling
Indication

Ovarian drilling is a treatment primarily reserved for women with polycystic ovary syndrome (PCOS) who are resistant to ovulation-inducing drugs such as clomiphene citrate. PCOS is a major cause of anovulatory infertility, characterized by multiple small follicles, thickened ovarian capsules, and hormonal imbalances.

Technique

The ovary is visualized laparoscopically.

Using monopolar electrocautery or laser, multiple punctures (usually 4–10) are made in the ovarian cortex.

This reduces the androgen-producing tissue and restores a balance in ovarian hormones, often leading to spontaneous ovulation.

Benefits

Induces regular ovulation in up to 80% of women

Improves fertility rates

Reduces need for long-term medication

Minimally invasive and can be combined with other infertility procedures

Combined Approach

Performing these three procedures—tubal patency test, hysteroscopy, and ovarian drilling—in one sitting offers several advantages:

Comprehensive Evaluation: Assesses uterus, fallopian tubes, ovaries, and pelvic cavity in a single procedure.

Therapeutic and Diagnostic: Simultaneously identifies and corrects abnormalities.

Time-Saving: Reduces the number of hospital visits and anesthesia exposures.

Cost-Effective: A combined procedure lowers the overall expense compared to multiple separate interventions.

Higher Pregnancy Rates: By addressing multiple causes of infertility at once, conception chances improve significantly.

Postoperative Care

Most patients are discharged the same day or within 24 hours.

Mild abdominal discomfort is managed with analgesics.

Normal diet and light activities are resumed within 1–2 days.

Patients are advised to attempt natural conception or undergo assisted reproductive techniques as per the doctor’s guidance.

Outcomes and Success

The combined use of laparoscopic tubal patency test, hysteroscopy, and ovarian drilling has shown excellent results in infertility management.

Tubal Factor Infertility: Precise diagnosis helps guide IVF or corrective surgery.

Uterine Abnormalities: Hysteroscopic correction significantly improves implantation and pregnancy outcomes.

PCOS-Related Infertility: Ovarian drilling provides long-term ovulatory cycles with good pregnancy rates.

Conclusion

Laparoscopic tubal patency test, hysteroscopy, and ovarian drilling together form a powerful triad in the evaluation and management of female infertility. They not only diagnose underlying issues but also provide immediate treatment when necessary, minimizing delays in conception.

At advanced institutions such as World Laparoscopy Hospital, these procedures are performed with precision using state-of-the-art technology and under the guidance of skilled experts like Dr. R. K. Mishra. By offering a comprehensive, minimally invasive approach, this combined strategy greatly enhances the chances of achieving successful pregnancy while ensuring patient safety and comfort.