- Advanced Reproductive Surgery
Laparohysteroscopy:
The Complete Diagnostic & Surgical Solution:
Laparohysteroscopy is a combined surgical procedure that performs laparoscopy (camera examination of the pelvic cavity) and hysteroscopy (camera examination inside the uterus) in a single operation under one anaesthetic. It is the most comprehensive diagnostic and therapeutic procedure available for female infertility, identifying and treating conditions including endometriosis, pelvic adhesions, tubal blockage, uterine polyps, fibroids, and intrauterine adhesions in one sitting. At Samarth IVF, laparohysteroscopy is performed by specialist reproductive surgeons across our centres in India.
What is
Laparohysteroscopy?
Laparohysteroscopy is the simultaneous performance of laparoscopy and hysteroscopy in a single surgical session under general anaesthesia. Rather than two separate operations on two different occasions, both procedures are completed together, offering the most thorough evaluation of the female reproductive system achievable in a single session.
Laparoscopy examines the outside of the uterus, the fallopian tubes, the ovaries, and the pelvic cavity by inserting a thin camera through a small incision near the navel. Hysteroscopy examines the inside of the uterine cavity by passing a thin camera through the cervix without any incision. Together they provide a complete picture of both the external pelvic anatomy and the internal uterine environment.
The procedure is not purely diagnostic. Conditions identified during laparohysteroscopy are frequently treated in the same sitting. Endometriotic lesions are removed, adhesions are divided, ovarian cysts are drained or excised, blocked tubes are assessed, polyps are removed, and uterine septa are incised, all during the same operation. This combined diagnostic and therapeutic approach minimises the number of anaesthetic exposures, reduces total recovery time, and accelerates the path to fertility treatment.
Laparoscopy vs. Hysteroscopy: What Each Examines
Laparoscopy
Examines the outer surface of the uterus, both fallopian tubes, both ovaries, the pelvic peritoneum, and the pouch of Douglas (the space behind the uterus). It directly visualises endometriotic deposits, adhesions, ovarian cysts, hydrosalpinges, and structural pelvic abnormalities that no other test can detect.
Hysteroscopy
Examines the inside of the uterine cavity including the endometrial lining, both tubal ostia (the uterine openings of the fallopian tubes), and the cervical canal. It identifies polyps, submucous fibroids, intrauterine adhesions, uterine septa, and other cavity abnormalities that affect implantation.
Together: The Complete Picture
Laparohysteroscopy provides a complete 360-degree assessment of the female reproductive system. Studies confirm that combined laparohysteroscopy detects significantly more pathology than either procedure alone and changes clinical management in a substantial proportion of patients.
Why Laparohysteroscopy is Recommended for Female Infertility
Many causes of female infertility are invisible to standard non-invasive investigations. Blood tests measure hormones. Ultrasound visualises structures. HSG assesses tubal patency. But none of these investigations can see inside the pelvic cavity directly or detect subtle lesions on the outer surfaces of the reproductive organs. Laparohysteroscopy bridges this gap.
Research published in peer-reviewed journals consistently demonstrates that combined laparohysteroscopy reveals significant pelvic or uterine pathology in 40 to 70 percent of infertile women who had normal or inconclusive findings on prior investigations. Endometriosis is found in 30 to 50 percent of infertile women undergoing laparoscopy, the vast majority of whom had no abnormal findings on routine ultrasound.
Who Should Have Laparohysteroscopy?
Unexplained infertility
All standard investigations normal but pregnancy has not occurred after the expected duration of trying.
Suspected endometriosis
Painful periods, pelvic pain, pain during intercourse, or painful bowel movements, especially if ultrasound is inconclusive.
History of PID/Tuberculosis
History of pelvic inflammatory disease or pelvic tuberculosis: Both cause adhesions and tubal damage that affect fertility.
Previous pelvic/abdominal surgery
Including appendectomy, ovarian cystectomy, myomectomy, or caesarean section, which can all cause adhesions.
Abnormal findings on USG/HSG
Polyps, submucous fibroids, intrauterine adhesions, or uterine septa identified or suspected.
Recurrent implantation failure
Two or more failed IVF cycles with good-quality embryos and no obvious cause.
Recurrent miscarriage
Two or more pregnancy losses requiring uterine cavity and pelvic assessment.
Chronic pelvic pain
Especially when associated with infertility, suggesting endometriosis or adhesions.
Before IVF in selected cases
To optimise the uterine and pelvic environment before an IVF attempt, or to treat known ovarian cysts.
What Laparohysteroscopy: Diagnoses and Treats
The diagnostic and therapeutic scope of laparohysteroscopy is extensive. Below is a comprehensive overview of what can be identified and treated during the procedure.
Conditions Diagnosed and Treated by Laparoscopy
Endometriosis
Endometriosis is the most important condition identified by laparoscopy that is routinely missed by all other investigations. The laparoscope allows direct visualisation of endometriotic deposits on the ovaries, fallopian tubes, pelvic peritoneum, bladder, and bowel.
Endometriomas (chocolate cysts of the ovary) are drained and the cyst wall is removed or ablated. Superficial endometriotic lesions are fulgurated (destroyed with diathermy) or excised. Deeply infiltrating endometriosis involving the bowel or bladder requires specialist input but can be surgically addressed at the same sitting.
Pelvic Adhesions
Adhesions are bands of scar tissue that form after infection, surgery, or endometriosis and can bind the fallopian tubes to the ovary or to the pelvic wall, angulate the tubes, or prevent normal egg pickup after ovulation. Laparoscopic adhesiolysis (careful division of adhesions using scissors or diathermy) restores normal pelvic anatomy. Pregnancy rates after adhesiolysis for peritubal adhesions are meaningful in selected cases, and even when natural conception remains unlikely, improving anatomy improves IVF access to the ovaries and the quality of egg collection.
Fallopian Tube Assessment and Treatment
The fallopian tubes are directly inspected under the laparoscope. Patency is confirmed by injecting a blue dye (methylene blue) through the cervix and watching for it to spill from the fimbrial ends of the tubes. Distal tubal blockage and hydrosalpinx (fluid-filled tubes) are identified.
Hydrosalpinx salpingectomy (removal of the blocked tube) is strongly recommended before IVF, as hydrosalpinx fluid is toxic to embryos and reduces IVF success rates by approximately 50 percent. Fimbrioplasty (repair of the fimbrial end of the tube) can be performed for mild distal disease in selected cases.
Ovarian Cysts
Functional cysts, dermoid cysts, endometriomas, and other ovarian masses are assessed laparoscopically. Benign cysts can be removed or drained at the same sitting. Cystectomy for endometriomas is performed with careful technique to minimise damage to the surrounding healthy ovarian tissue and preserve ovarian reserve. Frozen section histology can be requested if a cyst has features that raise concern.
Uterine Fibroids (Serosal and Subserosal)
Fibroids on the outer surface of the uterus (subserosal and serosal fibroids) are visible and assessable laparoscopically. Large subserosal fibroids distorting uterine shape are removed by laparoscopic myomectomy. While subserosal fibroids generally have less impact on fertility than submucous fibroids, very large fibroids can affect uterine blood flow and implantation.
Polycystic Ovaries and Ovarian Drilling
For women with PCOS who have not responded to ovulation induction medications, laparoscopic ovarian drilling (LOD) is a surgical option. Multiple small punctures are made in the ovarian capsule using diathermy or laser, reducing androgen production and often restoring spontaneous ovulation. LOD avoids the multiple pregnancy risk associated with gonadotrophin injections and can produce durable improvement in ovulation for 6 to 12 months.
Conditions Diagnosed and Treated by Hysteroscopy
Endometrial Polyps
Polyps are identified directly under hysteroscopic vision and removed using hysteroscopic scissors, a resectoscope loop, or a morcellator. Polypectomy consistently improves pregnancy rates in women with infertility or recurrent implantation failure. Studies show improvement in spontaneous conception rates and IVF outcomes following hysteroscopic polypectomy. Removed tissue is sent for histological examination to exclude atypical or malignant pathology.
Submucous Fibroids
Submucous fibroids that protrude into the uterine cavity are resected hysteroscopically using a resectoscope or morcellator. Complete removal of submucous fibroids significantly improves implantation rates and reduces miscarriage risk. The degree of fibroid penetration into the uterine wall (classified as FIGO type 0, 1, or 2) determines whether complete removal is achievable in a single hysteroscopic session.
Uterine Septum
A uterine septum is the most common uterine anomaly and the one most strongly associated with recurrent miscarriage. Hysteroscopic septal incision (metroplasty) divides the septum using scissors or diathermy under hysteroscopic guidance, restoring a normal uterine cavity. Post-operative miscarriage rates drop significantly after successful metroplasty. The procedure is straightforward, takes 20 to 30 minutes, and requires no incisions.
Intrauterine Adhesions (Asherman Syndrome)
Adhesions inside the uterine cavity (intrauterine adhesions or IUAs) are divided hysteroscopically using fine scissors to restore the uterine cavity. After adhesiolysis, post-operative oestrogen therapy promotes endometrial regeneration and prevents re-adhesion. Outcome depends on the severity and extent of adhesions. Mild to moderate Asherman syndrome responds well to hysteroscopic treatment.
Congenital Uterine Anomalies
Adhesions inside the uterine cavity (intrauterine adhesions or IUAs) are divided hysteroscopically using fine scissors to restore the uterine cavity. After adhesiolysis, post-operative oestrogen therapy promotes endometrial regeneration and prevents re-adhesion. Outcome depends on the severity and extent of adhesions. Mild to moderate Asherman syndrome responds well to hysteroscopic treatment.
Chronic Endometritis
Chronic low-grade inflammation of the uterine lining (chronic endometritis) is now recognised as a significant cause of recurrent implantation failure. During hysteroscopy, the endometrial lining is inspected for characteristic findings (micropolyps, strawberry pattern). Biopsy confirms the diagnosis. Treatment with targeted antibiotics resolves the infection in most cases and improves IVF outcomes.
The Laparohysteroscopy Procedure at Samarth IVF: Step by Step
Before the Procedure
Laparohysteroscopy is performed under general anaesthesia and requires admission to the surgical facility on the day of the procedure. Pre-operative preparation includes a pre-anaesthetic evaluation with blood tests and ECG for safety clearance, fasting for at least 6 to 8 hours before the procedure, and a pre-operative discussion with your surgeon about expected findings, planned interventions, and what to expect during recovery. The procedure is typically scheduled in the first half of the menstrual cycle, after menstruation has ended and before ovulation, when the uterine lining is thin and the uterine cavity is easiest to visualise.
During the Procedure
After general anaesthesia is administered, the patient is positioned carefully and the surgical team proceeds with the laparoscopy component first. A small incision is made at the navel and the abdomen is inflated with carbon dioxide gas to create a working space. The laparoscope is introduced and the pelvic organs are methodically examined. Additional instrument ports are placed if treatment is required.
Once the laparoscopic component is complete, hysteroscopy is performed. A thin hysteroscope is passed through the cervix into the uterine cavity. The cavity is distended with fluid to allow clear visualisation. Polyps, fibroids, septa, and adhesions are addressed under direct vision. The entire combined procedure typically takes 45 minutes to 2 hours depending on the findings and extent of treatment required.
After the Procedure
Most patients recover in hospital for 4 to 8 hours and are discharged the same day or the following morning. Post-operative pain is managed with oral analgesics and is typically mild to moderate. The small laparoscopic incisions are closed with absorbable sutures or skin closure strips and heal within 7 to 10 days. Mild vaginal spotting after hysteroscopy is normal and settles within a few days.
Most women return to light activities within 2 to 3 days and to full normal activity within 5 to 7 days. Recovery from more extensive laparoscopic surgery such as large cyst removal or extensive adhesiolysis may take 7 to 14 days. Your surgeon will advise on the appropriate time to resume intercourse or start fertility treatment based on what was found and treated.
When Can Fertility Treatment Start After Laparohysteroscopy?
This depends on what was found and treated. For diagnostic-only procedures or minor treatments such as small polyp removal, the next menstrual cycle is usually sufficient recovery time before starting IUI or IVF. For more extensive interventions such as large fibroid removal or extensive adhesiolysis, a recovery period of 2 to 3 months is typically recommended to allow healing and endometrial regeneration before embryo transfer. Your Samarth IVF specialist will provide a personalised timeline.
Benefits of LaparohysteroscopyOver Separate Procedures
Single anaesthetic exposure
Combining both procedures in one operation reduces the risks associated with repeated general anaesthesia.
Comprehensive diagnosis in one session
Both the pelvic cavity and uterine cavity are evaluated together, ensuring no cause of infertility is missed.
Simultaneous diagnosis and treatment
Conditions identified are addressed immediately, avoiding a second procedure.
Reduced total recovery time
One combined recovery period rather than two separate recovery periods.
Cost efficiency
One hospital admission, one anaesthetic fee, and one surgical session rather than two.
Faster path to fertility treatment
By resolving diagnostic uncertainty and treating correctable causes in one step, the couple can proceed to IVF or other treatments sooner.
Changes management in significant proportion of cases
Studies show laparohysteroscopy alters the clinical management plan in 40 to 70 percent of infertile women who had previously normal non-invasive investigations.
Risks and Limitations of Laparohysteroscopy
Laparohysteroscopy is a well-established, safe surgical procedure when performed by trained surgeons. However, as with any surgical procedure, risks exist and patients should be counselled thoroughly before consenting.
Anaesthetic risks:
General anaesthesia carries small risks including allergic reactions and respiratory complications. Pre-operative assessment minimises these risks.
Bleeding:
Intraoperative or post-operative bleeding may occur, particularly during cyst removal or myomectomy. Significant bleeding requiring blood transfusion is rare.
Injury to adjacent structures:
The bladder, bowel, ureters, and major blood vessels are adjacent to the operative field. Injury is rare in experienced hands but is a recognised complication requiring immediate surgical management.
Infection:
Post-operative pelvic or wound infection can occur. Prophylactic antibiotics are routinely administered.
Adhesion formation:
Surgery itself can cause adhesions, though careful surgical technique and use of anti-adhesion barriers minimises this risk.
Incomplete treatment:
Not all conditions can be fully resolved laparoscopically or hysteroscopically in a single session. Some cases require staged procedures.
No improvement in fertility:
Laparohysteroscopy identifies and treats correctable causes but does not guarantee pregnancy. Age, egg quality, and male factor remain important independent determinants of outcome.
Laparohysteroscopy at Samarth IVF: Our Approach
At Samarth IVF, laparohysteroscopy is performed by specialist reproductive surgeons with dedicated training in minimally invasive fertility surgery. We combine diagnostic precision with surgical expertise to deliver the most complete assessment and the most effective treatment in a single procedure.
Reproductive surgeons, not general gynaecologists: our surgeons focus specifically on fertility-preserving pelvic surgery.
Full video documentation: the entire procedure is recorded and reviewed with the patient at the post-operative consultation.
Histological analysis: all removed tissue is sent for laboratory examination.
Coordinated fertility planning: findings from laparohysteroscopy directly feed into your fertility treatment plan, discussed with you at a detailed post-operative review.
Day-care surgery: most patients are admitted and discharged on the same day, minimising disruption.
Available at main centres with full surgical infrastructure across India.
Laparohysteroscopy AcrossSamarth IVF Centres in India
Laparohysteroscopy and fertility-preserving reproductive surgery are performed at Samarth IVF centres with full surgical facilities. Our main centres are equipped with advanced laparoscopic towers, hysteroscopic equipment, video recording systems, and full anaesthetic support.
Sambhajinagar (Aurangabad), Maharashtra: Main HQ with full surgical and IVF facilities, plus 2 Level-1 Centres
Washim, Maharashtra | Buldhana, Maharashtra | Parbhani, Maharashtra | Omerga (Umarga), Maharashtra | Gondia, Maharashtra
Dehradun, Uttarakhand | Jamnagar, Gujarat | Kalaburagi (Gulbarga), Karnataka | Bhopal, Madhya Pradesh | Farrukhabad, Uttar Pradesh | Lucknow, Uttar Pradesh
- FAQ
Frequently Asked Questions
Laparoscopy examines the outside of the uterus, fallopian tubes, ovaries, and pelvic cavity. Hysteroscopy examines the inside of the uterine cavity. Laparohysteroscopy performs both simultaneously under one anaesthetic, providing a complete assessment of the entire female reproductive system in a single procedure.
The procedure is performed under general anaesthesia so there is no pain during surgery. Mild to moderate abdominal discomfort and shoulder tip pain are common post-operatively and typically resolve within 24 to 48 hours. Most patients manage well with oral pain relief and return to light activities within 2 to 3 days.
The combined procedure typically takes 45 minutes to 2 hours depending on findings and extent of treatment. A diagnostic-only procedure takes approximately 45 to 60 minutes. Extensive endometriosis treatment or fibroid removal takes longer.
For women with correctable pathology such as endometriosis, pelvic adhesions, polyps, fibroids, or uterine septa, treating these conditions improves pregnancy rates meaningfully. Even when natural conception remains unlikely, optimising the pelvic and uterine environment improves IVF outcomes.
For minor procedures, attempting conception from the next menstrual cycle is usually appropriate. For extensive procedures, a recovery period of 2 to 3 months is typically recommended. Your Samarth IVF specialist will advise the appropriate timeline for your specific situation.
Yes. Laparoscopy requires only 2 to 3 small incisions of 5 to 10 mm each. Hysteroscopy requires no incisions at all. This minimally invasive approach results in less pain, faster recovery, smaller scars, and lower complication rates compared to open surgery.
Laparohysteroscopy can remove visible lesions, drain and excise endometriomas, and divide adhesions effectively. Deeply infiltrating endometriosis may require specialist multidisciplinary involvement. Endometriosis can recur after surgery with recurrence rates of 20 to 40 percent within 5 years.
For women with suspected significant pelvic pathology, laparohysteroscopy is typically performed before IVF. For repeated IVF failure without obvious cause, it is recommended to investigate hidden causes. For straightforward infertility with normal investigations, IVF may be attempted first.
Laparohysteroscopy leaves only 2 to 3 small scars of 5 to 10 mm each in the abdomen, which fade significantly over 6 to 12 months. Hysteroscopy leaves no visible scars as it requires no skin incisions.
Laparohysteroscopy is performed at Samarth IVF main centres with full surgical infrastructure. Patients at all 14 centres across India can be referred to the nearest main centre for surgical evaluation and treatment with full coordination of pre-operative and post-operative care.
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