Investigation of pregnancy outcomes, either spontaneous or through assisted reproductive techniques, in patients undergoing diagnostic laparoscopy and/or operative/office hysteroscopy due to primary or secondary infertility

Objective: The aim of this study was to investigate the pregnancy outcomes, either spontaneous or through assisted reproductive techniques, in patients who underwent diagnostic laparoscopy and/or operative/office hysteroscopy due to primary or secondary infertility. Materials and Methods: The study included 144 patients diagnosed with primary or secondary infertility at the Süleyman Demirel University Hospital, Department of Obstetrics and Gynecology, between January 2021 and May 2024, who underwent diagnostic laparoscopy (L/S) and, according to indications, office/operative hysteroscopy (H/S) for adhesiolysis, chromotubation, cystectomy, cyst aspiration, etc., and for uterine cavity control or septum resection. Initially, laparoscopic entry was performed for all patients. Then, diluted methylene blue was administered into the uterine cavity via an HSG cannula for chromotubation. Septum resection was performed in patients with uterine septum using operative hysteroscopy. For exclusion of intrauterine pathology, uterine cavity control was performed using office hysteroscopy, and findings were recorded. Surgical interventions were performed in patients with adhesions, endometriosis, ovarian cysts, or tubal pathology. Results: A total of 76 (52.7%) patients had primary infertility, and 68 (47.2%) had secondary infertility. Among primary and secondary infertile patients, 25% and 26.5% had cysts; 27% and 26.5% had septum; 35,5% and 38.2% had adhesions; 10.5% and 7.4% had endometriosis; and 94.7% of primary infertile and 92.6% of secondary infertile patients had bilateral/unilateral tubal patency. β-hCG was positive in 42 (55.3%) of the primary infertile patients and 37 (54.4%) of the secondary infertile patients. Among the β-hCG positive primary infertile group, 3 (7.1%) achieved pregnancy through IUI, 12 (28.6%) through IVF, and 27 (64.3%) spontaneously. Of these pregnancies, 8 (19%) resulted in spontaneous abortion, 23 (54.8%) in cesarean section, and 11 (26.2%) in normal spontaneous vaginal delivery (NSVD). In the secondary infertile group, 4 (10.8%) achieved pregnancy through IUI, 5 (13.5%) through IVF, and 28 (75.6%) spontaneously. Of these pregnancies, 8 (21.6%) resulted in missed abortion, 20 (54.1%) in cesarean section, and 9 (24.3%) in normal spontaneous vaginal delivery. In both groups, higher rates of spontaneous pregnancy and cesarean delivery were observed after surgery. Conclusion: We believe that the surgical correction of commonly detected pelvic and uterine pathologies in patients undergoing simultaneous laparoscopic and hysteroscopic surgery for infertility has positively contributed to pregnancy outcomes. Keywords: Assisted reproductive techniques, hysteroscopy, infertility, laparoscopy, pregnancy