7 - The Future of Microsurgery in Infertility

Abstract

Microsurgery is used extensively for reconstruction after an inflammatory disease, for reversal of sterilization, and surgery in young or unmarried women. Peritubal and periovarian adhesions are 2 main causes of infertility in women. In salpingolysis cases, it has been shown that with over 53% ciliated cells in the fibria there can be a 60% pregnancy rate using microsurgery. In salingostomy cases, there is an increased pregnancy rate although still less than 30%; however, there is a corresponding increase in the number of ectopic pregnancies. Cornual occlusions due to salpingitis isthmica nodosa, endometriosis, cornual fibromyomata, endosalpingitis, puerperal infection, or polyposis was corrected by tubal implantation before microsurgery, which avoids the disadvantages of implantation. Nearly 45% of the women with inflamed tubes and 60% of sterilization reversals have achieved intrauterine pregnancies. Surgery for ovarian cysts, bleeding corpora lutea, and acute appendicitis may lead to infertility, but by using microsurgery, adhesion formation is limited or removed entirely; however, for ectopic pregnancies, 50% will probably remain infertile even after microsurgery. It is suggested that microsurgery techniques be practiced on extirpated tubes and hysterectomy specimens.