Pregnancy outcome after laparoscopic fimbrioplasty in nonocclusive distal tubal disease.
OBJECTIVE
To determine pregnancy rates (PR) after fimbrioplasty and salpingostomy in nonocclusive distal tubal disease. To evaluate the relative impact of various factors using contemporary statistical analysis.


METHODS
Prospective cohort.


METHODS
Tertiary institutional infertility clinic.


METHODS
Infertility patients.


METHODS
Fimbrioplasty and salpingostomy.


METHODS
Cumulative PR, monthly fecundity rates, monthly probability of pregnancy, crude PR, and cure rates.


RESULTS
Thirty-five percent of patients conceived with a cure rate of 72.2%, monthly probability of pregnancy of 3.9%, and monthly fecundity rate of 3.9%. Cumulative PRs were 22%, 35%, and 58% at 6, 12, and 24 months, respectively. Pairwise comparisons (unilateral, bilateral, or either) failed to detect any statistical difference between the salpingostomy and fimbrioplasty groups. Salpingostomy patients initially may have a higher tendency to become pregnant but appear to lose that advantage after the first few months. When patients with tubo-ovarian adhesions are excluded from the analysis, patients who underwent a bilateral salpingostomy as their sole procedure had better outcome compared with those who only underwent bilateral fimbrioplasty. There was no significant association between pregnancy outcome and the presence of endometriosis, other infertility factors, or tubo-ovarian adhesions. The staging of adnexal adhesions and endometriosis did not predict pregnancy outcome.


CONCLUSIONS
Laparoscopic fimbrioplasty and salpingostomy are clinically efficacious for the treatment of nonocclusive distal tubal disease. After accounting for statistical interactions of various factors among them, no particular association with pregnancy outcome could be identified. This illustrates the need for a revision of the classification of patients with distal tubal disease.
Saleh
W A
WA
Department of Gynecology and Obstetrics, Henry Ford Hospital, Detroit, Michigan, USA.
Dlugi
A M
AM
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D005184:Fallopian Tube Diseases / Q000601:surgery*; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D010535:Laparoscopy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D012489:Salpingostomy; D013997:Time Factors