Polycystic Ovarian Syndrome and Fertility

Routine pelvic examination gives limited information. For Tubal & ovarian assessment e.g. endometriosis, adnexal adhesions-Laparoscopy is the gold standard. 10% to15% of sub fertile women have endometrial polyps, sub mucous fibroids, uterine septum, or intrauterine adhesions-hysteroscopy is the gold standard. Removal of endometrial polyps improves PR to over 60%. Removal of sub mucous fibroidsimproves PR to nearly 40% vs. 21% with expectant management. Role of diagnostic laparoscopy in infertility:suspected endometriosis, tubal blockage, suspected peri-tubular adhesions, hydrosalpinges, pelvicinflammatory disease, mullerian anomaly, unexplained infertilityand distention of fallopian tube. Fertility outcome is improved (42%) after laparoscopic treatment even with repeated IVF failures due to severe endometriosis. Hydrosalpinx can be diagnosed by: TVSsensitivity of 34% and HSG-sensitivity of 65%. Hydrosalpinges visible on USG benefit most from surgical intervention in terms of pregnancy after IVF. Hydrosalpinx and its effect on IVF: overspill, mechanical flushing of the embryos from the uterine cavity, decreased endometrial receptivity, fluid collected in fallopian tube is embryo toxic. Patients with hydrosalpinges visible on ultrasound may be more significantly affected. Uterine leiomyoma's are the most common tumor of the female reproductive

tract and affect 30-40% of reproductive-age women. Approximately 50% of women who have not previously conceived become pregnant after myomectomy. Operative experience has a learning curve. Minimal access surgery goes hand in hand with ART. For both laparoscopic and hysteroscopic surgery proper training & experience is required. There is no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of sub-fertile women. More RCT are needed to substantiate the effectiveness.