Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?
This study was undertaken to report the results of microsurgical lysis of peri-adnexal adhesions and identify the patients who should be offered surgery and those who should be treated by in-vitro fertilization (IVF). In all, 19 women had filmy adhesions and 32 had dense adhesions; 68.4% of women with filmy adhesions conceived compared with 34.4% of women with dense adhesions (P = 0.02). In patients with filmy adhesions, the cumulative pregnancy rate 2 years after operation (47%) is similar to that reported after five cycles of IVF (52%), leading us to conclude that such patients should be offered surgery first. Dense adhesions are best treated by IVF. Lysis of filmy adhesions produces a similar intra-uterine pregnancy rate whether performed by laparotomy (57.9%) or laparoscopy (56.6%). As operative laparoscopy offers the greatest patient comfort, it is the treatment of choice in these patients.
Oelsner
G
G
Department of Obstetrics and Gynaecology, Chaim Sheba Medical Centre, Tel Hashomer, Israel.
Sivan
E
E
Goldenberg
M
M
Carp
H
H
Admon
D
D
Mashiach
S
S
D000291:Adnexal Diseases / Q000601:surgery*; D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D006801:Humans; D008866:Microsurgery; D008875:Middle Aged; D000267:Tissue Adhesions / Q000601:surgery*