Place of Fertiloscopy in Infertile Work-up: A 4000 Cases Continuous Series

Following the work of Gordts, we have described the technique of transvaginal hydrolaparoscopy and we gave it the name of fertiloscopy in 1997.Almost twenty years after it seems interesting to review this technique trhough an extensive series.Designed at the beginning as an alternative to laparoscopy, fertiloscopy has rapidly demonstrated its superiority in term of diagnostic in pelvic evaluation.This superiority was established through a prospective randomized study in 2003 (the FLY study)Being purely diagnostic at the beginning, fertiloscopy became then a therapeutic tool. It is possible to perform limited adhesiolysis, to treat minimal endometriosis and to do ovarian drilling in PCOS patients. 380 ovarian drilling has been practiced with a pregnancy rate of 57,8% in the 6 following months (n=220).Our serie demonstrates the fiability of the technique allowing in 34,5% of cases to detect abnormalities non seen with the classical noninvasive methods.Fertiloscopy is very safe with a complication rate of 0,4% (n=16) the main complication being the rectal injury always treated conservatively since the injury is small and under the peritoneum.However as every new technique there is a learning curve which is rather short but mandatory.This need of training is probably the main reason why this technique experiment some difficulty to be widely spread throughout the world, despite the fact that fertiloscopy is in the program of some university diploma such as Strasbourg or Clermont-Ferrand.Fertiloscopy should be proposed systematically before IVF. However in more than 1 case out of 3 IVF is practiced without any endoscopic pelvic evaluation.For all these reasons we have contributed to develop a fertiloscopy simulator to facilitate the training.Lastly we do believe that a reproductive surgeon should be present in every reproductive center, which is not the case today.