Laparoscopic Surgery for Diagnosing Infertility Causes

Miss Huang, a 28-year-old woman, has been seeking medical advice for nearly two years, visiting various hospitals, but the cause of her infertility remains unknown. Eventually, the doctors concluded it as unexplained infertility and recommended laparoscopy. Is it necessary to undergo laparoscopy? Does laparoscopy require anesthesia? Is it considered a surgical procedure?

Laparoscopy is a relatively new surgical technique that has emerged in recent years due to technological advancements. It is considered a surgical procedure and requires anesthesia. Unlike traditional surgery, laparoscopic surgery is a highly skilled procedure performed through 2-4 small incisions of approximately 1 centimeter in the abdominal wall. Instruments are inserted into the abdominal cavity through these small incisions. The procedure involves enlarging the surgical area's visual field (up to 20 times) and transmitting it to a television imaging system. This allows minimally invasive intra-abdominal surgery to be performed using state-of-the-art equipment, which was previously only possible through larger incisions.

In the field of gynecology, laparoscopy is primarily used for diagnosing infertility in patients. It is mainly employed to determine if the fallopian tubes are blocked. Additionally, it can be used to investigate chronic pelvic pain, suspected adhesions, or lesions that are not detectable through conventional examinations.

Despite its importance and convenience, laparoscopy is currently considered a secondary examination due to existing regulations. Patients who undergo laparoscopic examinations for infertility without any other gynecological indications need to bear the expenses themselves. This is currently a blind spot in terms of insurance coverage, and it is hoped that it will be improved in the future. However, there are several situations in which doctors would still recommend undergoing laparoscopy for timely identification of problems and simultaneous examination and treatment:

1. Unexplained infertility, as approximately 70% of cases can find an identifiable cause through laparoscopy.
2. Abnormalities observed during uterine tubal patency test. Since muscle spasms caused by nervousness or pain during the test can lead to false-positive tubal blockage results, further laparoscopic examination may be suggested.
3. Normal uterine tubal patency with no other identifiable causes of infertility, and unsuccessful artificial insemination attempts over a six-month period. In such cases, laparoscopic examination or directly proceeding to in vitro fertilization (IVF) may be recommended.
4. Polycystic ovary syndrome (PCOS) patients who have undergone detailed examinations and have a poor response to ovulation induction drugs may consider laparoscopy.
5. Patients with endometriosis or ovarian endometrioma can benefit from laparoscopy to resolve the condition and check for any tubal adhesions, which can be addressed simultaneously.