From 1977-1989, 298 ectopic pregnancies were treated pelviscopically at the Dept. of Gynaecology Hospital of the University of Kiel. 26 tubes were already ruptured. In 251 patients (84%), organ preserving treatment was possible, 205 treatment by longitudinal salpingotomy. 46 tubal abortions were extracted. In 47 patients (16%), who did not wish to augment their family any further, or in whom recurrence of tubal pregnancy occurred on the same side, salpingectomy was performed. Complications required re-pelviscopy in 5% and laparotomy in another 1%. The intrauterine pregnancy rate in 143 patients desiring pregnancy was 58%. Abortions occurred in 8%. A recurrence of ectopic pregnancy in the ipsilateral tube occurred in 10%, in the contralateral tube in 6%. 9 patients desiring pregnancy had already undergone salpingectomy on the contralateral side or were treated pelviscopically by longitudinal salpingotomy because of ectopic pregnancy on both sides. Three of them gave birth to healthy infants.

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33 patients with tubal pregnancies, who had been treated by pelviscopy with organ preservation between 1978 until the beginning of 1988 have had follow-up examinations from within 4 months to 2 years after their first operation. In 15 (45%) of these 33 patients we found adhesions in the true pelvis on initial pelviscopy; these adhesions were lysed in all cases. During a second inspection of the abdominal cavity – either by laparotomy (Cesarean section; 4 patients) or by repelviscopy (29 patients) – mainly avascular, filmy adhesions on one or both adnexae were found in 17 cases (52%). The pelviscopic treatment of ectopic pregnancy does not completely prevent the development of postoperative adhesions. The concomitant pelviscopic adhesiolysis during the treatment of ectopic pregnancy reduces the degree of severity of the recurring adhesions.

47 patients out of the IVF-program of the Department of Obstetrics and Gynecology University of Kiel, who demonstrated in previous stimulation cycles premature LH surges, were treated in two modalities with a down regulation applying the GnRN-analogue decapeptyl (DTRP-6 LH/RH) and a concomitant HMG- or FSH-stimulation. The down-regulation was started after ovulation up to a negative LH/RH test followed by a concomitant gonadotropin stimulation in group 1. In group 2 a parallel treatment with decapeptyl and HMG or FSH was performed from day 2 of the cycle. 10 husbands of the punctured patients had pathological sperm. In both groups 6 patients were discarded from of the stimulation protocol as their oestradiol responses were not adequate, sperm contamination was detected late in one case, and in one patient a premature LH surge occurred once again. In 36 patients vaginal follicular punctures were performed. With respect to pregnancies group 1 revealed a much higher pregnancy rate than group 2. It seemed better to start the down-regulation with the GnRH-analogue decapeptyl in the luteal phase of the previous cycle. The treatment with decapeptyl should not only be applied in patients with previous LH surges but also in order to establish a synchronous follicular maturation in ovulating patients treated for in-vitro fertilization, or gamete-intra-Falloppian-tube-transfer.

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