Prevalence and Spectrum of Pelvic Pathology in Female Infertility: Role of Diagnostic Laparohysteroscopy in a Tertiary Care Setting

Abstract

Infertility affects roughly 17.5 % of adults globally and female factors contribute to approximately half of cases. Tubal pathology, endometriosis, pelvic adhesions and uterine abnormalities are frequent but often missed on non invasive tests. Diagnostic laparoscopy and hysteroscopy provide direct visualisation of pelvic organs, offer therapeutic opportunities and are therefore widely employed in tertiary centres. This narrative review synthesises evidence from over thirty prospective and observational studies. Combined laparo hysteroscopy identifies pelvic pathology in up to 60–80 % of infertile women and reveals higher disease burden in secondary infertility. Tubal block, adhesions and pelvic inflammatory disease account for 20–40 % of abnormalities, while endometriosis is detected in 6–55 % depending on the population. Ovarian factors such as polycystic ovarian syndrome and cysts are also common. The review discusses indications, technique, diagnostic yield, disease prevalence by category, comparison between primary and secondary infertility, special scenarios like genital tuberculosis and unexplained infertility, and the contemporary debate on routine laparoscopy. Recommendations for clinical practice and future research are provided.