Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery

Abstract

Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy. We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8–15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed with t test, Chi-Square test, ANOVA or ROC as appropriate. Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis ( P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients ( P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) ( P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%. The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.

Magnetic Resonance Imaging Feature Analysis and Evaluation of Tubal Patency under Convolutional Neural Network in the Diagnosis of Infertility

“…Compared with the routine examination of obstetrics and gynecology, MRI greatly reduces radiation damage [ 14 ] and can accurately display the internal organs and surrounding tissue structure of the pelvic cavity [ 15 , 16 ], thus showing significant advantages in the differential diagnosis of some reproductive system diseases. MR-HSG combines MRI technology with the gynecological examination, which greatly reduces radiation damage and greatly improves the accuracy of detection results [ 17 ].…”

The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility

“…Tubal factor infertility (TFI) refers to a type of infertility in which women cannot be fertile due to blockage, adhesion, and patency of the fallopian tubes (1). TFI is the most common cause of female infertility, accounting for >30% of female infertility cases (2). Accurate evaluation of the patency, adjacent relationship, and function of the fallopian tubes is of foremost importance, not only for diagnosis but also for timely and precise treatment.…”

Pregnancy outcomes in patients with tubal infertility following laparoscopic treatment: a multivariate predictive study

“…In addition, the rate of tubal patency is nearly always unsatisfactory. Alternatively, laparoscopic treatment may be beneficial as it improves the efficacy of dredging and reduces the occurrence of adverse reactions (4). Therefore, a multivariate predictive study was conducted on patients with tubal infertility who were treated with laparoscopy, and their pregnancy outcomes were analyzed.…”