In vitro fertilization versus tubal surgery: is pelvic reconstructive surgery obsolete?
OBJECTIVE
To compare the results of pelvic reconstructive surgery with cumulative success rates of IVF for couples with tubal factor infertility.


METHODS
Outcomes of pelvic surgery were obtained from a review of articles from the literature identified by directed Medline searches. Cumulative pregnancy rates of 771 couples with tubal factor infertility treated at the Cornell IVF program between December 1989 and December 1992 were calculated by life-table analysis.


RESULTS
Overall delivery rate per transfer for patients with tubal factor was 28.9% (303 deliveries per 1,048 transfers) and did not appear to be affected significantly by the presence of a secondary diagnosis. A significant decline in pregnancy rates was observed with advancing age: age < 30 years, 48.4%; 30 to 34 years, 44%; 35 to 38 years, 28%; 39 to 40 years, 20%; 41 to 42 years, 9%; and > 42 years, 4.3%. Cumulative pregnancy rates for cycles 1 to 4 were 32%, 59%, 70%, and 77%, respectively, in patients with only tubal factor, and 28%, 55%, 62%, and 75% in patients with tubal combined with other associated infertility factors.


CONCLUSIONS
Our experience suggest that > 70% of women with tubal factor infertility will have a live birth within four cycles of treatment with IVF. These results compare favorably with the best outcomes after tubal reconstructive surgery. In older women, because of the rapid decline of fertility potential with advancing age, efforts should be directed toward the treatment method that provides the highest likelihood of success within the shortest time interval.
Benadiva
C A
CA
Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York 10021, USA.
Kligman
I
I
Davis
O
O
Rosenwaks
Z
Z
D000328:Adult; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000209:etiology