Indications to tubal reconstructive surgery in the era of IVF

Abstract

In recent years, the treatment of tubal infertility has witnessed a shift from reconstructive surgery to in vitro fertilization. However, tubal surgery retains specific advantages, and appropriate preoperative evaluation allows improved selection of patients who are candidates for tubal reconstructive surgery by identifying the patients with good reproductive prognosis. Of pivotal importance in the selection of patients is the intratubal direct evaluation performed at salpingoscopy. Term pregnancy rates of approximately 70% and 65% may be obtained in patients with periadnexal adhesions and bilateral distal tubal occlusion, respectively, when a normal tubal mucosa is observed at salpingoscopy.

Anatomical causes of female infertility and their management

“…Proximal tubal occlusion occurs in 10% of 25% of women with tubal disease [12]. A lack of passage of the contrast medium at the level of the intramural‐isthmic portion of the fallopian tube may be due to a true pathological occlusion resulting from post‐infectious fibrosis; an obstruction due to technical artifacts, such as adequacy of cervical seal, level of intrauterine pressure achieved; a spasm of the uterine‐tubal ostium; the thick endometrium acting as a valve; or plugs of amorphous material of unknown etiology, often appearing to form a cast of the tube [14]. It was reported that in 42% to 95% of cases, women diagnosed as having PTO actually do not have the condition [15,16].…”

Is there still a role for reconstructive microsurgery in tubal infertility?

“…In the presence of only mild or moderate tubal disorder, term pregnancy rates of 65% for salpingostomy, 70% for adhesiolysis, and up to 80% for reversal of sterilization have been reported [4 , 16,17]. The pregnancy outcome has been found to be uniformly poor after surgical treatment in patients with severe tubal disease (<15%) [18,19].…”

Ectopic Pregnancy Following Reconstructive, Organ-Preserving Microsurgery in Tubal Infertility

“…In the presence of only mild or moderate tubal pathology, term pregnancy rates of 65% to 80% for salpingneostomy, adhesiolysis and reversal of sterilization have been reported (Marana et al, 2003(Marana et al, , 2008; Practice Committee of American Society for Reproductive Medicine, 2008). The ectopic rate for mild disease is reported to be 1%-10% (Boer-Meisel et al, 1986;Winston & Margara, 1991;Nackley & Muasher, 1998), in contrast, EP rates can increase up to 20% to 40% in the presence of intrinsic tubal damage, salpingitis isthmica nodosa and severe tubal pathology (Posaci et al, 1999;Taylor et al, 2001;Pandian et al, 2008).…”