Couples with male factor infertility and repeated IVF failure: can laparoscopic investigation in the woman improve reproductive outcomes?

This study investigated the use of laparoscopy (LPS) in women from couples with diagnosed male infertility (MI) and 3 failed in vitro fertilization (IVF) attempts. 

They found that LPS can identify undiagnosed female infertility (FI) and improve fertility outcomes in these couples. 

Male infertility (MI) affects up to 50% of infertile couples. The treatment recommended in couples with MI is usually in vitro fertilization (IVF). IVF involves fertilizing an egg with sperm in a dish. Intracytoplasmic sperm injection (ICSI) is another technique. The fertilized embryo is grown in the lab and then transferred to the uterus. The success rate of IVF is not 100% with MI. Couples with MI may have several failed IVF attempts. 

Mild MI is associated with relatively high pregnancy rates after IVF. However, some of these couples may still have IVF failure. One possible explanation is undiagnosed female infertility (FI). FI may not always be obvious. Conditions like endometriosis can cause infertility. This involves the growth of tissue similar to the lining of the uterus outside the uterus. Structural abnormalities in the female reproductive organs can also go undetected. A laparoscopy (LPS) is a surgical procedure. It uses a thin tube with a camera inserted through small cuts in the belly to examine organs in the abdomen. It is minimally invasive. It is unclear if an LPS could improve fertility outcomes in couples with MI and prior IVF failure. 

This study included 169 couples. All couples had a diagnosis of mild MI and at least 3 failed IVF attempts. 101 women underwent LPS before an IVF or ICSI cycle. 68 women did not undergo LPS. The main outcomes measured included clinical pregnancy rate (CPR) and live birth rate (LBR).

42.57% of women that underwent LPS were diagnosed with endometriosis. 21.78% of women had pelvic adhesions. Women in the LPS group had a higher CPR (29.7%) than women who did not have LPS (16.18%). The LBR was 2.5-times higher in the LPS group compared to non-LPS group. 

The authors concluded that LPS can identify undiagnosed FI and improve fertility outcomes in couples with MI and failed IVF attempts.

Patients had the option of undergoing LPS. This means that the rates of FI could be different in the whole study population. The number of patients in the study was relatively low. Larger controlled studies are needed.