Fertiloscopy and its place in the gynaecologist's armamentarium

Stewart McNamara; Kimberley J Davis; Lionel Reyftmann

doi:10.1111/ajo.13894

Fertiloscopy and its place in the gynaecologist's armamentarium

Aust N Z J Obstet Gynaecol. 2024 Nov 13. doi: 10.1111/ajo.13894. Online ahead of print.

Authors

Stewart McNamara¹, Kimberley J Davis^{2

3}, Lionel Reyftmann^{3

4}

Affiliations

¹ Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia.
² Research Operations, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia.
³ Graduate School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
⁴ Genea Illawarra, Wollongong Day Surgery, Wollongong, New South Wales, Australia.

PMID: 39535443
DOI: 10.1111/ajo.13894

Abstract

Background: Infertility is a prevalent issue worldwide. Current investigation of female pelvic infertility uses transabdominal laparoscopy, exposing patients to its associated risks. An alternative method is fertiloscopy, comprising hysteroscopy, tubal dye studies, and transvaginal hydrolaparoscopy (TVHL), falling under the broader category of VNOTES. This study reviews fertiloscopy cases in Australia to assess its role in managing infertility.

Materials and methods: Retrospective analysis of 76 cases was performed with review of imaging results, fertiloscopy findings and interventions, and fertility outcomes. Statistical analysis was conducted via R Studio v4.1 with means and averages used for descriptive data and a Kruskal-Wallis analysis of variance test used to evaluate differences in continuous variables. Kaplan-Meier curves were constructed to describe cumulative pregnancy incidence, with differences evaluated using log-rank tests. Statistical tests were two-tailed, and a P-value < 0.05 was considered significant.

Results: Of 76 cases, 70 underwent fertiloscopy and 35 an intra-operative intervention. Of the cohort, 53 conceived, 18 spontaneously. The highest chance of spontaneous conception was 44% by day 283. The failure rate of fertiloscopy was 5.3%, and complications occurred in 1.3% of cases.

Discussion: The highest chance of spontaneous conception post-fertiloscopy was 44% by day 283, possibly indicating the time between the procedure and referral to reproductive therapies. This study identified a low associated failure and complication rate, supporting fertiloscopy as a low-risk procedure.

Conclusion: Despite limitations, this study highlights spontaneous pregnancy outcomes and associated low complication and failure rates, emphasising fertiloscopy's role in managing infertility in Australia as a lower risk surgical alternative to standard laparoscopy.

Keywords: fertiloscopy; infertility; ovarian drilling; transvaginal hydrolaparoscopy; tubal pathology.