Laparoscopic and Hysteroscopic Surgery for Infertility in Bangladesh: Current Practice and Future Perspectives

Abstract

Background: Infertility affects approximately one in six people globally and has become an increasingly important public health concern in Bangladesh. Female infertility is commonly associated with tubal disease, endometriosis, uterine abnormalities, pelvic adhesions, and congenital uterine anomalies. The rapid adoption of minimally invasive gynecological surgery, particularly laparoscopy and hysteroscopy, has transformed the diagnosis and treatment of these conditions.

Objective: To review the current role of laparoscopic and hysteroscopic surgery in infertility management in Bangladesh, summarize evidence-based indications, discuss surgical outcomes, and highlight future opportunities for expanding minimally invasive reproductive care.

Methods: This narrative review synthesizes international clinical guidelines, systematic reviews, and Bangladeshi literature on minimally invasive gynecological surgery. Recent recommendations from the World Health Organization and evidence-based fertility surgery guidelines were incorporated.

Results: Laparoscopy remains the gold standard for diagnosing pelvic pathology, including endometriosis, pelvic adhesions, and tubal disease, while hysteroscopy is the gold standard for evaluating and treating intrauterine abnormalities such as polyps, submucous fibroids, uterine septa, and intrauterine adhesions. Evidence demonstrates improved spontaneous pregnancy rates after hysteroscopic adhesiolysis, polypectomy, and selected laparoscopic procedures, although routine surgery is not recommended for all infertile women. Bangladesh has experienced remarkable growth in minimally invasive gynecology through specialized tertiary hospitals and trained surgeons.

Conclusion: Laparoscopic and hysteroscopic surgery have initiated a new era of infertility treatment in Bangladesh by providing safer, less invasive, and fertility-preserving interventions. Expansion of training, standardized national guidelines, equitable access, and integration with assisted reproductive technologies are essential for improving reproductive health outcomes.