Laparoscopic Assessment of Ovarian Factors in Primary Infertility: A Prospective Observational Study

Background: Ovarian factors are a common cause of female infertility, yet their true prevalence and associations with pelvic pathology in primary infertility remain underreported in many regions. Laparoscopy offers direct visualisation and the opportunity for concurrent therapeutic intervention.

Objective: To determine the prevalence, laterality, and associated pelvic findings of ovarian pathologies in women with primary infertility using diagnostic laparoscopy.

Methods: This prospective observational study was conducted at Dhaka Medical College in 2024, including 100 women with primary infertility. All participants underwent standardised laparoscopic evaluation. Ovarian diagnoses, laterality, associated pelvic findings, and tubal patency were recorded. Statistical analyses included ANOVA and chi-square tests where appropriate.

Results: Polycystic ovarian morphology (PCOM) was the most common finding (43%), followed by endometrioma (32%), benign ovarian tumours (7%), and hypoplastic ovaries (7%); 11% had normal ovaries. Bilateral involvement occurred in 46.1% of abnormal ovaries, most frequently in PCOM cases. Endometrioma was significantly associated with pelvic adhesions (p = 0.041) and peritoneal endometriosis (p = 0.022). Tubal abnormalities were more common in women with adhesions (58.8% vs. 29.3%, p = 0.018).

Conclusion: PCOM and endometrioma are the leading ovarian pathologies in primary infertility, with a notable proportion demonstrating bilateral involvement. The association between endometrioma, adhesions, and tubal abnormalities reinforces the importance of comprehensive laparoscopic evaluation in infertility workups.

Keywords: Primary Infertility, Laparoscopy, Ovarian Pathology, Endometrioma, Polycystic Ovarian Morphology.