The fertiloscope is a type of laparoscope, modified to make it suitable for trans-vaginal application, which is used in the diagnosis and treatment of female infertility. This relatively new surgical technique is used for the early diagnosis and immediate treatment of a number of disorders of the female reproductive organs and can be considered one of the first standard NOTES (Natural Orifice Transluminal Endoscopic Surgery) procedures. A large body of published research is available on the application of this surgical technique using the device. Fertiloscopy provides a minimally invasive, potentially office-based procedure for the clear diagnosis of two major causes of infertility in a manner enabling rational choices at the start of infertility treatment. Published evidence indicates improvement in pregnancy rates with reductions in costs.

Literature review

The published evidence into the use of Fertiloscopy falls into two categories; those studies linked with the original research into the technique itself, and the later (post 2002) evaluations of the product after it was fully developed.

Rationale

If, for the purposes of this discussion, female infertility is considered the main issue (while also considering male infertility where it relates to this particular subject), the huge majority of subfertile women have either: Note that the percentages add up to more than 100% because of overlap where a single patient may have more than one problem. In order to deal with all these causes, there are four main categories of treatment: For any woman, the correct choice of treatment depends on correctly identifying the problem. However, although there are diagnostic procedures that make it possible to make rational choices between these treatments, the full range of these tests is rarely carried out at the start of treatment. As a result, many women receive inappropriate treatment, and only achieve pregnancy after unnecessary delay, and after many cycles of inappropriate treatment that was, in fact, doomed to fail from the start. Fertiloscopy makes it possible to simultaneously identify, in any women, the case for either:

Methods of diagnosis without fertiloscopy

At the present time, the initial diagnostic testing that is carried out is limited. Diagnosis of ovulatory problems is routinely carried out at an early stage and is not mentioned further in this paper. Physical abnormalities of the fallopian tubes, including blockage and mucosal damage, and in the pelvic cavity, including endometriosis and adhesions, are not generally subjected to a comprehensive diagnosis in most countries. The same applies to uterine abnormalities. The normal diagnostic practice is as follows: The overall conclusion is that:

The fertiloscopy procedure

Fertiloscopy combines Lap and Dye, Salpingoscopy and Microsalpingoscopy (MSC) and Hysteroscopy in two instruments presented as a single kit. It uses for the entire procedure a single narrow scope (Hamou 2, from Storz or equivalent) that has a 30-degree chamfer which enables a panoramic view by rotating the scope, and a zero to 100X magnification controlled by a rotating knurled knob: Published papers show that Fertiloscopy, even without its inherent salpingoscopy, is fully equivalent to full laparoscopic investigation. The most important of these is by Watrelot, Nisolle, Chelli, Hocke, Rongieres, Racinet (2003). But because the full procedure includes a dye test and full salpingoscopy/microsalpingoscopy, it produces all the information that could only otherwise be provided by a combination of HSG, plus Lap and Dye, plus Salpingoscopy and Microsalpingoscopy. As we have previously discussed, such a combination is not otherwise practicable, and is never performed. Clinical decisions following fertiloscopy

Consequences of these decisions

The consequences of these decisions can only be judged in relation to the standard model of assessment and treatment prevailing in any country at a particular time. The "standard model" in general use in Europe in 2007 is three cycles of IUI in alternate menstrual cycles, followed by IVF if the IUI is unsuccessful. If we compare what occurs on average to the people in each of the four treatment groups above between the standard model and the fertiloscopy model, we see the following: The overall impact of this is that whereas fertiloscopy makes no difference to the people who are normal (in that nothing is discovered by fertiloscopy), for the other 45% it makes a big difference because they immediately receive the treatment they need, and have a chance of becoming pregnant immediately, whereas without fertiloscopy they would have to go through three cycles of IUI without effect before being offered IVF (which might not be the ideal treatment in any case).