The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility

Abstract

Background and objectives: The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility.

Methods: We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation.

Results: In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727).

Conclusion: Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.

Keywords: Adhesions; Appendicitis; Female infertility; Tube pathology.

Figure 1.

Flowchart of study participants.

Figure 2.

Technique of single-incision laparoscopy and chromopertubation. First, the pelvis is visualized before injection (a). The vagina is then injected with methylene blue dye, seen filling the Fallopian tubes from intra-abdominally (b). Finally, passage of methylene blue through the Fallopian tubes into the abdominal cavity positively confirms normal patency (c).