Organ-preserving and reconstructive microsurgery of the fallopian tubes in tubal infertility: still an alternative to in vitro fertilization (IVF).
Tubal infertility mostly results from infections. Conception only is possible through complex treatments (in vitro fertilization or surgery). Success cannot be guaranteed, even after repeated treatments. Unfortunately, many couples are not informed about the prospect for success of tubal reconstruction. Problems of in vitro fertilization are low pregnancy and birth rates of 28.4% and <20% respectively (Germany) and the high number of multiple pregnancies (21%). In this retrospective study 462 women with acquired tubal infertility and further 127 women after previous sterilization underwent microsurgical treatment (microsurgical adhesiolysis, anastomosis, fimbrioplasty, salpingostomy, and refertilization due to former sterilization). The main outcome measures are the pregnancy and birth rates following the microsurgical procedure. Pregnancy and birth rates of 43.4% and 29.2%, respectively, were higher than the outcomes post-single in vitro fertilization (abortion: 6.4%, extrauterine pregnancy: 7.9%). When reversal of sterilization was performed, pregnancy and birth rates were higher at 73% and 50.6%, respectively (abortion: 15.7%, extrauterine pregnancy: 6.7%). The advantages of reconstructive microsurgery over in vitro fertilization include the ideally permanent restoration of woman's ability to conceive naturally (repeated pregnancies are possible without further therapy), a high postoperative birth rate overall, and avoidance of multiple births. It is advisable to inform the patient about the objective possibility of reconstructive tubal surgery.
Schippert
Cordula
C
Department of Gynecology and Obstetrics, Division of Reproductive Medicine, Medical School of Hannover, Hannover, Germany. Schippert.Cordula@mh-hannover.de
Hille
Ursula
U
Bassler
Christina
C
Soergel
Philipp
P
Hollwitz
Bettina
B
Garcia-Rocha
Guillermo José
GJ
D000328:Adult; D015331:Cohort Studies; D005187:Fallopian Tubes / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012489:Salpingostomy / Q000379:methods; D013243:Sterilization Reversal / Q000009:adverse effects / Q000379:methods; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult