Infertility laparoscopy in perspective: review of five hundred cases.

The review of a 3-year, 500-case experience has revealed a marked change in the indications for infertility laparoscopy that has evolved over the past decade. In cases of unexplained infertility, 44% of 182 laparoscopies disclosed unsuspected pelvic abnormalities; 72% of 106 patients who had previously undergone various pelvic surgical procedures had abnormal postoperative tubal sequelae; 37% of abnormal hysterosalpingograms were found to be misdiagnoses; 25% of 65 evaluations for consideration of reversal of tubal sterilization found inoperable tubal remnants; and 80% of 54 patients who had had a previous diagnosis of, and treatment for, endometriosis had residual endometriosis and/or tubal factors. No laparoscopies were done to evaluate ovulatory disturbances. The indications and findings in this large series allow the authors to offer guidelines for the timing of laparoscopy in the evaluation of infertile women.