Abstract
Aim: Here, we retrospectively analyzed the success rate of reconstructive microsurgery for tubal infertility (RMTI) as a “first-line” approach to achieving tubal reversal and pregnancy after tubal infertility. Patients and Methods: During 9 consecutive years (2005–2014), 96 patients diagnosed with obstructive tubal infertility underwent RMTI (tubal reversal, salpingostomy, and/or tubal implantation) in our centre. The outcomes are presented in terms of tubal reversal rate and pregnancy and correlated with age, level of tubal obstruction, and duration of tubal infertility. Results: The overall tubal reversal rate was 87.56% (84 patients). The 48-month cumulative pregnancy rate was 78.04% (64 patients), of which seven ectopic pregnancies occurred (8.53%). The reversibility rate for women under 35 yo was 90.47%, with a birth rate of 73.01%. The reconstruction at the infundibular segments favored higher ectopic pregnancy rates (four ectopic pregnancies for anastomosis at infundibular level—57.14%, two for ampullary level—28.57%, and one for replantation technique—14.28%), with a significant value for p < 0.05. Conclusions: In the context of IVF “industrialization”, reconstructive microsurgery for tubal infertility has become increasingly less favored. However, under available expertise and proper indication, RMTI can be successfully used to restore a woman’s ability to conceive naturally with a high postoperative pregnancy rate overall, especially in women under 35 yo.
Highlights
Requests for renewing fertility—after consented tubal ligation—arise as a consequence of partner change, improved financial status or, less often, the death of a child
In addition to being unable to conceive naturally, the patients undergoing In vitro fertilization (IVF) are at high-risk of developing multiple pregnancies across all age groups if they do not choose single embryo transfer [5]
We considered that the path to a higher rate of pregnancy is the microsurgical anastomosis for the Fallopian tubes
Summary
Requests for renewing fertility—after consented tubal ligation—arise as a consequence of partner change, improved financial status or, less often, the death of a child Under these circumstances, assisted reproductive technologies (ART) or tubal microsurgical reconstruction are the two efficient, yet different—in terms of approach, indications, success rates, and complications—tools that can enable pregnancy [1,2]. Women undergoing RMTI are facing other risks involving open surgery, general anaesthesia with hospital stay, and tubal re-occlusion. All these are compensated by the prospect of spontaneous pregnancy after natural intercourse, very low risk of multiple pregnancies (
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