Tubal surgery vs. assisted reproduction.
DOI:
https://doi.org/10.18597/rcog.649Keywords:
Tubal surgery, salpingolysis, fimbrioplasty, salpingoneostomy, assisted reproductionAbstract
Every infertile couple with tuboperitoneal factor must be completely studied; this includes semen analysis, basal levels of FSH on the third day of the cycle, histerosalpingography and diagnostic laparoscopic. These studies are important to determine if the couple should be offered fertility surgery or Assisted Reproductive Technology (ART).
The accumulative pregnancy rates in adhesiolysis of minimal (avascular, filmy) adhesions are between 50% and 60%, to 0% births with extensive (dense, vascular) adhesions, therefore these patients must go to ART program.
In the case of tubaric phymosis the microsurgery for fimbrioplasty has a pregnancy rate of 60% versus a 30 % by laparoscopy, so for the treatment of this pathology the microsurgery is recommended.
The pregnancy rates, in the case of hydrosalpinx with a small and minimum tubaric injured (presence of mucous folds in the histerosalpingography and less of 2 centimetres of diameter) are between a 28% by microsurgery and a 24 % by laparoscopy, in case of a severed injured the patient, must go to ART.
The clinic pregnancy rates after IVF-TE with tubaric factor vary between a 30.8% and 12.8% depending on the age of patient; having better rates in women under 35, and not good in women over 40.
When we consider the cumulative pregnancy rates after four cycles of assisted reproduction against ovariosalpingolysis, fimbrioplasty or salpingoneostomy, then the former achieves better results on each front. Nevertheless it would be wrong to predict that reconstructive surgery will soon be history. First of all, if surgery is successful it offers the possibility of conceiving in multiple cycles and to achieve multiple consecutive pregnancies. The risk of multiple gestation is lower after surgical treatment.
Economic factors, on the other hand, can also influence decision-making.
The above results suggest that younger women with mild or moderate tubeperitoneal disturbance are primary candidates for tubal reconstructive surgery, while older patients with severe disease or frozen pelvis should be directed immediately to an assisted reproduction program.
Author Biography
Jaime Saavedra Saavedra
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