Diagnostic Laparoscopy for Infertility: What It Can Find and What to Expect

Written by Mannat Fertility Editorial Team | Medically reviewed by Dr. Archana Agarwal, MBBS, DipGO, RCOG (Associate), Medical Director, Mannat Fertility Clinic, Bangalore

Do you know that some causes of infertility are completely invisible to both blood tests and ultrasound? Endometriosis, pelvic adhesions and the subtler tubal problems can all exist inside you without ever appearing on any non-invasive investigation, and yet every one of them can significantly impair a woman’s ability to conceive. Diagnostic laparoscopy is the only investigation which allows direct visualisation of your pelvic organs, which means it is the only one which identifies the conditions that would otherwise go completely undetected. At Mannat Fertility we recommend it selectively rather than for every patient, and we recommend it for those cases where the clinical picture suggests that something may be getting missed.

What Is Diagnostic Laparoscopy?

Laparoscopy is a minimally invasive surgical procedure which is done under general anaesthesia, and in it a thin camera-tipped instrument, which is called a laparoscope, is inserted through a small incision near your navel. Your pelvic cavity is then gently inflated with carbon dioxide, and the surgeon examines your uterus, your ovaries, your fallopian tubes and the peritoneal surfaces directly on a monitor.

The term diagnostic means that the primary intention here is to look and to assess. However, in practice, if a problem does get identified during that same procedure, then it is very often possible to treat it surgically at the same time, which turns a diagnostic procedure into a therapeutic one without you needing a second operation.

What Can Diagnostic Laparoscopy Find That Other Tests Miss?

This is the central reason why laparoscopy remains so relevant even despite all the advances in imaging. There are several significant causes of infertility which either do not show up on an ultrasound at all, or which can only ever be confirmed visually:

• Endometriosis and particularly the minimal and mild disease, meaning Stage I and II, which produces no distinctive ultrasound appearance. Laparoscopy is the only way of diagnosing endometriosis definitively, and even the experienced sonographers cannot reliably detect the superficial peritoneal lesions on imaging.
• Pelvic adhesions which are scar tissue left from a prior infection, from surgery or from endometriosis, and which can tether your fallopian tubes, your ovaries or your uterus in ways that impair the egg pickup and the tubal transport, all without any clear appearance on an ultrasound.
• Tubal factors where hysterosalpingography, or HSG, tests whether your tubes are open but cannot assess whether they function normally or whether they are surrounded by adhesions. During a laparoscopy a dye gets flushed through the cervix and is then observed entering the pelvis, which is called chromotubation, and it gives a far more direct view of tubal patency than HSG alone does.
• Ovarian pathology meaning the small endometriomas or the surface abnormalities which were not visible on a prior ultrasound.

How Is the Procedure Performed?

On the Day

A diagnostic laparoscopy is usually performed as a day procedure, so you come in, you have the operation, and you go home the same day provided the recovery is straightforward. You will be nil by mouth from midnight on the night before. The procedure itself takes 30 to 60 minutes, and this depends on what is found and on whether any treatment is being performed simultaneously. Two or three small incisions are made, with one near your navel for the camera and the smaller ones on your lower abdomen for whichever instruments are needed.

Recovery

Most patients experience some shoulder or upper-chest discomfort for a day or two afterwards, and this is referred pain coming from the carbon dioxide gas which was used to inflate the cavity, and it resolves as that gas is absorbed. Mild abdominal soreness and fatigue for two to five days are both normal. Most women return to light activity within a week and to full activity within two weeks, although this does vary if surgical treatment was performed at the same time.

When Is Diagnostic Laparoscopy Recommended for Infertility?

Laparoscopy is not routine for every fertility workup, and the decision is based instead on the clinical picture. It is most clearly indicated when:

• Your symptoms suggest endometriosis, meaning painful periods, deep dyspareunia, or cyclical bowel or bladder symptoms
• An HSG or a hysteroscopy has shown up an abnormality which needs further clarification
• A full standard workup has returned normal results and yet conception has still not occurred
• A prior pelvic infection, surgery or adhesive disease raises the likelihood of structural factors which are not visible on imaging

Can It Be Both Diagnostic and Therapeutic?

Yes it can, and this is one of the principal advantages which laparoscopy has. If endometriosis is found then it can be excised or ablated in that same session. Adhesions are able to be divided, ovarian cysts can be removed, and blocked tubes can be assessed and sometimes corrected, which combines the diagnosis and the treatment into one single operation and avoids you needing a second general anaesthetic.

If you have been advised to consider a diagnostic laparoscopy, or if your fertility workup has reached the point where the non-invasive investigations have not provided a full explanation, our surgical team at Mannat Fertility can assess your case and discuss with you whether laparoscopy is the right next step. Book a consultation with our specialists in Bangalore.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist.