Laparoscopy is by far the most important single test for female infertility. In my view, it nearly always should be considered before entering an IVF programme, unless it is clearly known that a woman has no fallopian tubes, or that there is no possibility of corrective surgery. Sadly, the bodies that run the NHS do not agree with my view and the NICE Guidelines have tried to limit the number of laparoscopies which are done in order to save the NHS money. I believe that this decision actually costs the health service more in the long run due to unnecessary treatment followed failed diagnosis.

Laparoscopy needs an operating theatre and a general anaesthetic, but can normally be done as a day-case. A thin telescope is inserted into the abdominal cavity through a small hole made in the navel. Carbon dioxide, passed into the abdomen, separates the organs so that they can be seen more easily. The telescope is no thicker than a fountain pen, but with the improvement in modern optics, photographs of superb quality can be taken. A surgeon can use the laparoscope to inspect the outside of the uterus, and to test the tubes to see if they are open by injecting coloured dye through them. The whole procedure may take anything from 15 to 30 minutes, and rather longer if it is being used for keyhole surgery (for example to release the fallopian tubes from adhesions).

Laparoscopy is best performed during the second half of your cycle, because the ovaries may show signs of ovulation. Also, an endometrial biopsy can be taken at the same time. A few infertility centres perform a laparoscopy under a local anaesthetic but general anaesthesia allows more detailed inspection.

You will normally find two small dressings on the abdomen afterwards. One covers a single stitch in the navel, and the other a tiny hole near the pubic hairline. This second hole is used to place any fine probes shaped like small knitting needles into the abdominal cavity to move tissues around to get a better view.

Laparoscopy usually causes very little pain or discomfort although some women may feel unwell and need to rest in bed for 24 hours. The commonest side effects are:

• Soreness in the abdomen.
• Soreness in one or other shoulder. This is because the carbon dioxide injected into the abdomen can irritate the nerves to the abdominal lining which happen also to supply the shoulder area.
• Vaginal bleeding. This may occur if the surgeon manipulates the cervix during injection of the dye to check the tubes. It may last two or three days and sometimes longer.
• A sore throat. This rarely lasts more than 24 hours and results from the tube which the anaesthetist has placed down the throat to ensure a safe anaesthetic.
• Sleeplessness or vivid dreams the night after. This is frequently experienced by anyone who has had a general anaesthetic.
• Sickness due to the anaesthetic. Few people experience this nowadays because the action of the drugs is gentler than it once was. There are special drugs that can be given to people known to be prone to sickness after anaesthesia.

The benefits of a laparoscopy are:

• It is by far the best way to determine whether the tubes have been damaged.
• It uniquely shows adhesions in the pelvis that may prevent pregnancy.
• It gives a direct view of the ovaries, and, if done in the second half of the woman’s cycle, enables the surgeon to see whether there has been recent ovulation.
• It gives a good idea of the size of the ovaries. This is important because women with very small ovaries are more likely to produce few eggs during stimulation for IVF.
• It is the best, usually the only way to detect endometriosis.
• It gives an excellent view of the outside of the uterus and may help to detect fibroids or a congenital problem in the womb.
• It can detect relevant scarring elsewhere in the abdomen, in particular, adhesions around the liver, which can indicate a previous infection, which has caused normally undetectable damage to the tubes.
• It facilitates the taking of small pieces of tissue (biopsies) or fluids which give useful pathological or bacteriological information.
• It allows the surgeon to introduce small scissors, a diathermy needle or a laser which can be used to treat a range of conditions from adhesions to polycystic ovaries

After laparoscopy, more women immediately conceive than would be expected by chance. Historically, up to about 15% of our patients with open tubes conceive within three months of laparoscopy.

This test is usually performed under a quick general anaesthetic on a day visit to the hospital. A small telescope, called a hysteroscope, is passed into the uterus through the vagina. It is an excellent means of detecting any polyps, uterine fibroids, adhesions or congenital abnormalities which may be suspected following the results of an HSG test. It can also be used to treat some of these conditions by guiding instruments inside the uterus. It does not replace the HSG which gives detailed information of a different kind.

Tuboscopy requires a fine telescope to be inserted through the abdominal wall under general anaesthetic, in order to inspect the inside of the ovarian end of the fallopian tube. This test, which can be combined with laparoscopy, is of only limited value, except to the surgeon who can charge large fees for it. One alternative is a falloposcopy, namely the passage of a very fine telescope into the fallopian tube from below, through the vagina and uterus. I do not know the going rate for falloposcopy. This telescope is about the thickness of a piece of linen thread, and gives a view of the uterine end of the tube. It is usually attached to a television camera and the result viewed on a screen, but because the optic fibre is so narrow the resolution of the picture is not as good as that seen using tuboscopy. It probably has even less value that tuboscopy and is only included here for completeness.

In the video below, Professor Winston explains some of the different treatments for infertility, including laparoscopy.

Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.

Professor Robert Winston’s Genesis Research Trust raises money for the largest UK-based collection of scientists and clinicians who are researching the causes and cures for conditions that affect the health of women and babies.

Essential Parent is proud to support their wonderful work. You can learn more about them here.