Surgical management of tubal infertility. A regional study

Abstract

Objective: To investigate an unselected group of patients in a regional area undergoing tubal surgery for infertility and to identify those women who would benefit from surgery and those who should be referred directly to in vitro fertilization (IVF).

Design: A retrospective study based on medical records and questionnaires.

Setting: The Departments of Obstetrics and Gynecology, Gentofte. Glostrup and Herlev Hospitals, University of Copenhagen, Denmark.

Subjects: Two hundred and thirty-six women with primary or secondary infertility undergoing tubal surgery or adhesiolysis during a five year period from 1985 to 1989 with a follow-up period of minimum of 24 months.

Results: Ninety-four women (40%) became pregnant at least once and accounted for the total number of 144 pregnancies. One hundred and forty-two patients (60%) did not become pregnant. The delivery rate was 25%, and 37 women (16%) had at least one ectopic pregnancy. There were no significant differences in the delivery rates of the operations in between, but the risk of ectopic pregnancy was significantly lower after adhesiolysis only than after tubal surgery (p < 0.05). The initial laparoscopic findings could not be used to predict the probability of intrauterine pregnancy.

Conclusion: There is still a place for surgical treatment of tubal infertility, but the risk of ectopic pregnancy should be taken into account before a decision concening line of treatment is made.