A careful vaginal examination allows detection of pathology of the pouch of Douglas, such as nodules of the rectovaginal septum or fixed retroverted uterus. The five steps in the fertiloscopy procedure are: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. Hydropelviscopy is performed by first inserting a Verres needle into the pouch of Douglas. This needle is inserted 1 cm below the cervix, and then saline solution is instilled through a perfusion line using no other pressure than gravity. Introduction of a Verres needle and then of the fertiloscope in the pouch of Douglas sometimes raises fear of rectal injury. The fundamental question was to know at an early stage whether fertiloscopy was as accurate as laparoscopy, which was considered at that time the "gold standard" in infertility investigation. The only real complication is represented by rectal injury. However, such injury may be always treated conservatively with antibiotics without surgical intervention.

Fertiloscopy is performed as an ambulatory technique. There are five steps in this procedure: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. One of the prerequisite of operative fertiloscopy was to be as effective as the same procedure practiced during laparoscopy. Compared to laparoscopy, fertiloscopy has also some advantages like the facility to perform salpingoscopy and microsalpingoscopy. Fertiloscopy was first designed to avoid diagnostic laparoscopy. Operative possibilities were developed later. The complication rate is low, almost always avoidable if contraindications are strictly respected. Endometriosis may also be treated by operative fertiloscopy, when minimal or moderate. If the lesions are extensive or severe, then laparoscopy has to be the preferred option. Some techniques like fertiloscopic ovarian drilling in polycystic ovarian syndrome (PCOS) patients have already demonstrated its interest in the pregnancy rate obtained without the risks of ovarian hyperstimulation syndrome (OHSS).