Intrauterine Pregnancy Rate Research Articles

The hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients

To study the consistency of hysteroscopy findings and histological chronic endometritis (CE) in recurrent implantation failure (RIF) cases, and to compare their values in indicating antibiotic treatment. Sixty RIF cases (January 2009-January 2010) and 202 consecutive RIF cases (May 2010-April 2012) in Peking University Third Hospital reproductive medical center were studied. 60 RIF patients' endometrial samples redid section and CD38/CD138 immunohistochemical stain for CE screening. In 202 RIF cases, the presence of hyperemia, mucosal edema, and micropolyps under hysteroscopy were considered CE diagnostic parameters. Antibiotic was offered to part of the patients. The patients' clinical outcomes were analyzed by statistical methods. In 202 RIF cases, the hysteroscopy CE rate was 66.3 %, while histological CE rate was 43.6 %. The sensitivity and specificity of hysteroscopy were 35.2 and 67.5 %. In histological CE patients, 68 cases underwent regular antibiotic treatment and 20 did not. Two groups had similar clinical pregnancy rates (35.3 vs. 30.0 %), embryo implantation rates (18.9 vs. 20.4 %) and ongoing pregnancy rates (29.4 vs. 25.0 %). In hysteroscopy CE patients, the implantation rate (18.6 vs. 4.9 %) and ongoing pregnancy rate (29.3 vs. 7.4 %) significantly increased (P < 0.05) with antibiotic treatment, and higher intrauterine pregnancy rate in treatment group (29.3 vs. 11.1 %). In reviewing the chosen 60 RIF cases, the histological CE rates were similar in both pregnancy and non-pregnancy group after subsequent embryo transfer. CE occurs frequently in RIF patients; hysteroscopy has more diagnostic and treatment value for them.

The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy rate in IVF cycles

ObjectiveTo evaluate the relationship between the pregnancy rate (PR) and the positioning of the intrauterine catheter at embryo transfer (ET) under transabdominal ultrasound (US) guidance in in vitro fertilization (IVF) cycles. Study designProspective data analysis of 281 consecutive US-guided fresh ETs performed by a single physician at Yeditepe University Hospital IVF Center, Istanbul, Turkey, after controlled ovarian hyperstimulation between April 2012 and March 2013. The length of the uterine cavity (A), the distance between the fundal endometrial surface and the tip of inner catheter (B), the distance between the fundal endometrial surface and the air bubbles (C), and the pregnancy rates (PRs) were recorded. ResultsThe mean age of the patients was 33.25±5.5 years. Of all transfers, 115 (40.9%) resulted in a clinical pregnancy. With regard to distance (C), the clinical intrauterine pregnancy rates were 65.2%, 32.2% and 2.6% in the <10mm, 10–20mm, and 20mm distance groups, respectively. The PR was dramatically reduced in cases with >10mm between the fundal endometrial surface and the air bubbles, although this did not reach statistical significance. Between those patients who conceived and those who did not, there was no significant difference in terms of the distance between the fundal endometrial surface and the tip of inner catheter, the ratio of A/B or the ratio of B/C. ConclusionsThe final position of the air bubble used as an identifier of the position of the embryo at ET can be determinative for PR, although it cannot be predicted. Clinical pregnancy rates appeared higher in cases with air bubbles closer to the fundus and the optimal position of the air bubble seems to be a distance of <10mm from the fundal endometrial surface. It could be advisable to monitor the final position of air bubble at ET for identifying PR. In addition, the depth of uterine cavity may be considered to indirectly be important factor as it affects ET depth. The optimal distance between the fundal endometrial surface and the tip of inner catheter is 1.5–2cm. Further well-designed randomized controlled trials are required to optimize ET technique in the future.

Does a difficult intrauterine insemination lower pregnancy rates and live birth rates?

Does a difficult intrauterine insemination lower pregnancy rates and live birth rates?

Low-dose methotrexate treatment in ectopic pregnancy: a retrospective analysis of 164 ectopic pregnancies treated between 2000 and 2008

Ectopic pregnancy is an acute, potentially life-threatening condition. The aim of this study was to compare the results of surgery and methotrexate treatment in women with ectopic pregnancy, along with a review of the literature. 164 women with ectopic pregnancy, treated from 2000 to 2008 at the university gynecology department, were examined in a retrospective analysis. Patients with diagnosed ectopic pregnancy underwent one of the following treatments: Salpingotomy, salpingectomy or administration of a single dose of 30 mg methotrexate. The main outcome measures were treatment success rate, rate of patients wishing to have children after the ectopic pregnancy, and rates of pregnancy, live births, recurrent ectopic pregnancy, miscarriage, use of assisted reproduction and side effects. There were no significant differences in success rates between the groups (methotrexate 83.9 %, salpingotomy 88.2 %, salpingectomy 96.8 %). Significantly more patients in the salpingotomy group wished to become pregnant afterward than in the salpingectomy group. No significant differences were observed between the groups in the rates of intrauterine pregnancy, live births, recurrences, miscarriages, or side effects. With defined inclusion criteria, similar results can be achieved with low-dose single administration of 30 mg methotrexate in comparison with surgical treatment for ectopic pregnancy. On the basis of the data presented here, further research to establish optimal dosages for methotrexate is needed.

Fertility after ectopic pregnancy: the DEMETER randomized trial

Does treatment for the resolution of ectopic pregnancy (EP) affect subsequent spontaneous fertility [occurrence of an intrauterine pregnancy (IUP)]? There is no significant difference in 2 years subsequent fertility neither between methotrexate and conservative surgery for less active EP nor between conservative and radical surgery for the most active EP. No randomized trial has compared radical and conservative surgery treatments. A recent review of the Cochrane database did not conclude about fertility due to insufficient data. Prospective studies from EP registries in two regions of France (Auvergne and Greater Lille) have suggested that fertility is similar after medical treatment and conservative surgery and lower after radical surgery. This randomized controlled trial included all women with an ultrasound-confirmed EP. Women were divided into two arms according to the activity of the EP (defined by Fernandez's score). In arm 1 (less active ectopic pregnancies, i.e. Fernandez's score <13 and no haemodynamic failure), medical treatment was considered practicable, and women were randomly allocated to conservative surgery with a systematic post-operative i.m. methotrexate injection within 24 h or to an i.m. methotrexate injection alone. In arm 2 (active ectopic pregnancies), medical treatment was considered impracticable, and, thus, all women had to undergo surgery; they were randomly allocated to either a radical or conservative procedure, the latter including a post-operative methotrexate injection. Sample sizes (n = 210 in arm 1 and n = 230 in arm 2) were computed to provide a statistical power of 80% to detect a 20% difference in subsequent cumulative fertility rates between treatments in each arm. The total duration of the trial was 5 years. The trial took place in 17 centres in France from 2005 to 2009. Two hundred and seven women were included in arm 1 and 199 in arm 2. Cumulative fertility curves were drawn with the Kaplan-Meier method and compared with the log-rank test. Hazard ratios (HRs) were computed with the Cox model. Analysis was performed according to the intention-to-treat principle. Arm 1: cumulative fertility curves were not significantly different between medical treatment and conservative surgery. HR was 0.85 (0.59-1.22) P = 0.37. The 2-year rates of IUP were 67% after medical treatment and 71% after conservative surgery. Arm 2: cumulative fertility curves were not significantly different between conservative and radical surgery. HR was 1.06 (0.69-1.63) P = 0.78. The 2-year rates of IUP were 70% after conservative surgery and 64% after radical surgery. Inclusion in this trial was more difficult than expected, especially in arm 2 in which women were reluctant to radical surgery. In consequence, the sample size was slightly lower than planned. However, due to a lower proportion of lost to follow-up than expected (10% instead of 15%), the statistical power remained very close to 80%. As it is a multicentre randomized trial, the results may be generalized with satisfactory confidence. The results of this trial invite gynaecologists to reconsider the management of EP and to modify balance between considerations of initial recovery and preservation of fertility. NCT00137982 on the WHO International Clinical Trials Registry Platform.

Laparoscopic Tubal Anastomosis. An Assessment of the “One-Stitch Technique”

The aim of the present study was to evaluate fertility outcome after laparoscopic microsurgical tubal anastomosis (one-stitch technique). We carried out a retrospective study of 51 patients seeking reversal of previous tubal sterilization. The mean age of the patients was 33.2 years (range: 30-44.5 years). Surgery lasted 122 minutes on average, (60-204 minutes). Mean time to pregnancy was 8.2 months (4-32 months) and the rate of pregnancy obtained was 56.2%. Twenty seven patients became pregnant and 12 had ectopic pregnancies; of the 15 intrauterine pregnancies, 3 miscarried spontaneously before 9 weeks. Our study observed valuable qualities of feasibility, simplicity and rapidity of the “one-stitch technique” in laparoscopic tubal anastomosis surgery, with related good rates of intrauterine pregnancy. The rate of pregnancy obtained is fairly similar to the rates reported in the literature with the same technique. However, the high proportion of ectopic pregnancies makes us believing that laparoscopic procedures using more than one single stitch should be preferred.

Salpingotomy vs salpingectomy – a comparison of women’s fertility after surgical treatment of tubal ectopic pregnancy during a 24-month follow-up study

Ectopic pregnancy (EP) is usually located in the Fallopian tube and it has a significant adverse effect on womens fertility Three types of EP treatment include: expectant, medical, and surgical radical (salpingectomy) or conservative (salpingotomy) management. The aim of the study was to compare women's fertility after surgical radical or conservative treatment of tubal ectopic pregnancy Out of the 58 patients operated because of tubal EP pregnancy 22 underwent laparoscopic salpingotomy (group 1) and 36 laparoscopic salpingectomy (group 2). EP-related data were obtained from medical documentation (the symptoms, diagnostic tests, EP risk factors, medical reproductive and surgical history clinical status during EP surgery). Follow-up data were collected by means of a telephone interview. The survey included questions focused on women's fertility during a 24-month period following the surgical treatment of EP (conception, subsequent intrauterine pregnancies and ectopic pregnancy). A 24-month follow-up period revealed that the cumulative intrauterine pregnancy rate was higher in group 1 (salpingotomy) as compared to group 2 (salpingectomy), i.e. 50% vs. 41.5%, respectively. Tubal EP returned in 13.6% cases (group 1) vs. 19.4% (group 2). All submitted results are statistically insignificant. Our findings are consistent with the literature which reports a trend of higher odds for intrauterine pregnancy after salpingotomy for surgical treatment of EP as compared to salpingectomy Moreover the risk for recurrent tubal EP is comparable for both methods. Regardless, the decision about the operating range in case of EP always depends on the actual clinical state of the patient.

Comparison of reproductive capacity in women after three different procedures for tubal ectopic pregnancy

Objective To explore the effect of three different procedures on reproductive capacity in young women with tubal ectopic pregnancy.Methods The clinical data on 274 patients with tubal ectopic pregnancy who had been treated from 2006 to 2011 were retrospectively analyzed.55 of the patients underwent abdominal salpingectomy ( resection group ),120 patients underwent laparotomic oviduct fenestration ( fenestration group ),and 99 patients received conservative therapy with MTX ( medication group ) All the patients were followed up for four years,Results The rate of intrauterine pregnancy was found in 180 ( 65.7％ ) patients,while recurrent ectopic pregnancy was found in 16 ( 5.8％ ),Intrauterine pregnancy occurred in 37 ( 67％ ) patients and recurrent ectopic pregnancy developed in one ( 2.2％ ) in resection group:intrauterine pregnancy occurred in 96 ( 80％ ) patients and recurrent ectopic pregnancy developed in two ( 2.2％ ); and intrauterine pregnancy occurred in 47 ( 47.4％ ) patients and recurrent ectopic pregnancy developed in 13 ( 13.1％ ).The rate of intrauterine pregnancy was higher and the rate of recurrent ectopic pregnancy was lower in resection group and fenestration group than in medication group.Conclusions Laparotomic oviduct fenestration has the best effect in preservation of fertility,followed by abdominal salpingectomy.Conservative therapy with MTX not noly has lower fertility,but also has a higher rate of recurrent ectopic pregnancy. Key words: Pregnancy; Tubal ectopic pregnancy; Medical therapy; Fertility

A prospective randomized multicentre study comparing vaginal progesterone gel and vaginal micronized progesterone tablets for luteal support after in vitro fertilization/intracytoplasmic sperm injection

SUMMARY QUESTION: Is vaginal progesterone gel equivalent to vaginal micronized progesterone tablets concerning ongoing pregnancy rate and superior concerning patient convenience when used for luteal support after IVF/ICSI? Equivalence of treatments in terms of ongoing live intrauterine pregnancy rate has not been demonstrated; the 95% confidence interval (CI) for the difference in ongoing pregnancy rate (-8.2 to 0.1%) did not lie entirely within the pre-specified equivalence interval -7 to 7%. No significant differences in clinical pregnancy rates have been observed between vaginal progesterone gel and other vaginal progesterone products in earlier studies. However, all previous studies included a limited number of patients. This was a randomized, multicentre, controlled, assessor-blinded equivalence trial in 18 fertility centres in Denmark and Sweden between March 2006 and January 2010. A web-based randomization program was used with concealed allocation of patients. Patients were randomized to one of two groups: vaginal progesterone gel or vaginal micronized progesterone tablets. There was no blinding of patients. A total of 2057 women ≤ 40 years of age were included and down-regulated, using the long agonist protocol and rFSH for stimulation. Luteal support was given for 19 days after embryo transfer or until a negative pregnancy test Day 14 after embryo transfer. Patient convenience was assessed using questionnaires to be filled in 14 days after embryo transfer, before pregnancy test. Ongoing intrauterine pregnancy rates were 299/991 (30.2%) (95% CI 27.3-33.0%) in the progesterone gel group and 324/992 (32.7%) (29.7-35.6%) in the micronized progesterone tablet group. The difference in ongoing pregnancy rates between the groups was -4.1% (-8.2 to 0.1%) and the difference in live birth rates was -3.4% (-7.4 to 0.7%), both calculated after correction for significant confounders. Patient convenience and ease of use (1 = very convenient, 10 = very inconvenient) was in favour of progesterone gel, as the overall score was 2.9 (2.7-3.0) for progesterone gel and 4.8 (4.7-5.0; P < 0.0001) for micronized progesterone tablets. This large equivalence trial shows that, even though equality could not be demonstrated, there is no substantial difference in ongoing pregnancy rate between vaginal progesterone gel and vaginal micronized progesterone tablets. It also shows that progesterone gel is considered more convenient by the patients. Blinding of patients was not possible in this study, but since the outcome (pregnancy) is robust, blinding would have been unlikely to affect the results. Unfortunately, owing to an error in the randomization, the intended age distribution allocated older women to the micronized progesterone tablet group. In the analysis of results, adjustments were made for age and number of embryos transferred. The results can be generalized to other women ≥ 18 and ≤ 40 years of age undergoing IVF/ICSI who have regular menstrual cycles (25-35 days), both ovaries present and no more than two previous failed IVF attempts. Merck Serono supported the study but had no influence on the design of the study and was not involved in the analysis of the results or preparation of the manuscript. The trial was issued with the EudraCT number 2005-001248-22 with the Protocol code number 95576471.

Intra-operative hydrotubation improves fertility of women with distal tubal occlusion after reproductive surgery

Hydrotubation has been considered to be a complimentary procedure to reproductive surgery, usually being conducted after surgery. The objective of this work was to assess the potential value of intra-operative hydrotubation in improving fertility of tubal infertile women. 180 tubal infertile women were randomly assigned to one of the three groups: intra-operative hydrotubation (IH), post-operative hydrotubation (PH) or control group. In IH group, the hydrotubation was performed immediately after adhesiolysis during the surgery process, while in PH group it was performed within 3-7 days after the first post-operative menstruation. The incidence of post-operative pelvic infection and average hospitalization length were recorded. The post-operative pregnancy outcomes, including intrauterine pregnancy (IUP) rate and incidence of ectopic pregnancy, were recorded at 2 years follow-up. No significant difference was found among the three groups, either in the incidence of pelvic infection (P = 0.877) or in the average hospitalization length (P = 0.596). At 2 years of follow-up, the rate of IUP in IH group was significantly higher than that in either PH or control group (P = 0.017 and 0.039, respectively), but no difference was observed between PH and control group (P = 0.752). No significant difference in the incidence of ectopic pregnancy was showed among three groups (P = 0.947). The appropriate use of intra-operative hydrotubation can improve the post-operative IUP rate, serving as a complementary procedure for the surgical treatment of fertility reversal.

Intrauterine insemination pregnancy rates do not differ between physicians and nurses

Intrauterine insemination pregnancy rates do not differ between physicians and nurses

Surgical treatment of ectopic pregnancy associated with predisposing factors of tuboperitoneal infertility

Objective: We sought to study the advantages of laparoscopic conservative treatment and pelvic reproductive surgery in patients with ectopic pregnancy and predisposing factors of tuboperitoneal infertility. Material and methods: Patients who had undergone laparoscopic treatment for ectopic pregnancy were considered, with factors for tuboperitoneal infertility, while patients who underwent previous salpingectomy or assisted reproductive technology were excluded. The groups treated by salpingotomy (conservative) or salpingectomy (radical) were compared in terms of spontaneous intrauterine pregnancy rate, cumulative one-year pregnancy rate and recurrence of ectopic pregnancy. We considered patients treated with adhesiolysis, fimbrioplasty, and neosalpingostomy for tubal pathology as part of the fertility surgery group. Results: Among 41 considered patients, 21 (51%) underwent conservative laparoscopic management of ectopic pregnancy. Twenty patients (49%) had salpingectomy. Despite the treatment of tuboperitoneal infertility factors in both groups, the pregnancy rate was significantly higher in the conservative group than in the radical one (76% vs 25%, p < 0.05). The overall cumulative rate of ectopic pregnancy recurrence was 22% and no significant difference was found between conservative and radical treatment (p 0.645). Conclusions:Salpingotomy should be preferred in all patients with ectopic pregnancy associated with factors of tuboperitoneal infertility. Infertility surgery clearly cannot help patients treated with salpingectomy, who obtain lower spontaneous pregnancy rates than those of the conservative group.

Fertility after tubal ectopic pregnancy: results of a population-based study

To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility. Observational population based-study. Regional sistry. One thousand sixty-four women registered from 1992 to 2008. Laparoscopic (radical or conservative), or medical treatment. Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence. The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy. Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.

Fallopian Tube Reanastomosis by Laparotomy versus Laparoscopy: A Meta-Analysis

Objective: To compare efficacy of sterilization reversals by laparotomy versus laparoscopy. Design: Meta-analysis. Search Strategy: Electronic searches were carried out for randomized controlled trials and retrospective and prospective clinical studies. Search engines such as PubMed, Science Direct, Medline and the Cochrane database were made use of. Our restrictions were English human studies published from 1989 to January 2010. Interventions: Microsurgical tubal reanastomosis performed comparing laparoscopy with laparotomy using a microsurgical technique. Outcome Measures:Primary: overall pregnancy rates, including positive clinical pregnancy, intrauterine and ectopic pregnancy rates. Secondary: surgery time. Results: Three retrospective comparative studies were retrieved from international data that investigated laparotomy versus laparoscopy. A total number of 184 patients were included, 88 and 96 respectively undergoing laparoscopy and laparotomy. Pregnancy rates achieved by laparoscopy ranged from 65 to 80.5% (mean 74.43%) and by laparotomy from 70 to 80% (mean 71.33%). A subanalysis of two of the three comparative studies show that laparoscopy reversal surgery requires a statistically significant longer operative time than does laparotomy (p < 0.00001). Conclusions: There is no difference between the laparoscopy and laparotomy approach to tubal reanastomosis when regarding overall pregnancy rates, intrauterine and ectopic pregnancy rates.

ASSESSMENT OF EFFICACY OF LAPAROSCOPIC SURGERY IN TUBAL-PERITONEAL INFERTILITY

Objective: To determine some causes and affecting factors of tubal-peritoneal infertility. To assess the efficacy of laparoscopy in treating tubal-peritoneal infertility. Methods: Prospective study in 126 patients with tubal-peritoneal infertility. Results: Main causes of tubal infertility: Infection: 42.7%, history of operation: 25.6%, endometriosis: 12.8% and other causes and undetermined causes: 18.9%. 79.5% patients have patent tubes through hysterosalpingography. The rate of false obstructed tube through hysterosalpingography was 7.1%. The rate of intrauterine pregnancy after laparoscopy was 21.4%. This rate was associated with the stage of tubal lesons and the highest rate was in the first stage (68.0%). Nobody can get pregnant with the tubal lesions in the third and fourth stage or severe adheson. Conclusion: Main causes of tubal infertility are infection, history of operation and endometriosis. The rate of intrauterine pregnancy and patent tubes in this study is equivalent to some national and international studies. This rate is associated with the stage of tubal le-sions and the degree of tubal adhesion.

Fertility outcome analysis after modified laparoscopic microsurgical tubal anastomosis

Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish. The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis. A retrospective study was performed. Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology. Of the 58 patients, the cumulative pregnancy rate (PR) in the 42 patients with follow-up data was 23.8% (10/42), 57.1% (24/42), 66.7% (28/42), and 73.8% (31/42) within 6, 12, 24, and 36 months after surgery, respectively. The intrauterine PR was 69.0% (29/42). Two patients (4.8%) had ectopic pregnancies that occurred within 24 months of surgery; three cases ended in spontaneous abortion. The delivery rate was 83.9% (26/31). The length of operating time was 1.2±0.3 h, with a range of 1.0-2.5 h (60-145 min), and the mean time was approximately 75 min. The blood loss was relatively small, between 10 and 50 ml with an average amount of 22 ml. Thus, the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches. Compared with the traditional laparoscopic tubal sterilization reversal, this modified approach has three advantages: (1) less invasive approach via a trocar reduction; (2) remodeling of tube is better performing tied together after 3-4 sutures; and (3) faster operating time.

EFFICACY OF GYNECOLOGIC LAPAROSCOPY IN TREATING TUBAL-PERITONEAL INFERTILITY

Objective: To assess the efficacy of laparoscopy in treating tubal-peritoneal infertility in some central provinces and western highlands. Materials and methods: prospective study including 126 patients with tubal-peritoneal infertility. Results: The rate of false obstructed tube through hysterosalpingoscopy was 7.1%. The rate of intrauterine pregnancy after laparoscopy was 21.4%. This rate was associated with the stage of tubal leisons and accounted for highest rate in the first stage (68.0%). There were no case of pregnancy in the third and fourth stage of tubal leisons as well as in the dense adheison. The rate of intrauterine pregnancy of salpingostomy and tubalplasty were 20.0% and 72.0%, respectively. 3 months post-operation, 79.5% patients have patent tubes through hysterosalpingoscopy. Conclusion: The rate of intrauetrine pregnancy and patent tubes in this study is able to compared with some national and international studies. This rate is associated with the stage of tubal leisons and the degree of tubal adhesion.

Fertility Outcomes Subsequent to Treatment of Tubal Ectopic Pregnancy in Younger Turkish Women

Study Objective The assessment of future fertility in patients that were hospitalized with diagnosis of tubal ectopic pregnancy. Design Between January 1998 and September 2008, we retrospectively reviewed 219 tubal ectopic pregnancy patients who were hospitalized. The patients using contraceptive methods, underwent previous pelvic or tubal surgery, pregnancy after in vitro fertilization, over the age of 28, and extratubal ectopic pregnancies were excluded. Patients who actively attempted to conceive were included. We called all the patients to see whether they had pregnancy in 24 months, and how long they had waited for this after the operation. Overall, we could not reach 14 patients who were treated surgically (n = 9) or medically (n = 5). Setting Department of Obstetrics and Gynecology, Ege University, Izmir, Turkey. Participants Women aged between 18 and 28 years that were treated because of tubal ectopic pregnancy and have concerns about infertility. Interventions Medical treatment with methotrexate (n = 34), salpingectomy (n = 62) salpingostomy (n = 37). Main Outcome Measures Intrauterine pregnancy rates, ectopic pregnancy rates and mean time to pregnancy after interventions. Results After questionnaire: in the methotrexate group; six of 29 (20%) had no pregnancy; 23 (79%) of them conceived, but three (10%) of the pregnancies were extrauterine. Thirty-seven patients received salpingostomy and 62 patients composed the salpingectomy group. Intrauterine pregnancy rates up to 24 months were established as 65.2% in salpingectomy (n = 55) and 60.1% in the salpingostomy (n = 35) groups respectively. No significant difference was noticed when pregnancy rates were compared among three groups ( P = 0.942). Mean time to pregnancy in methotrexate group was 7.8 ± 2.2 months, and in salpingostomy and salpingectomy groups was 8.7 ± 2.2 and 9.3 ± 3.1 months respectively ( P = 0.841). Conclusion Since we found no difference in terms of pregnancy rates among three groups, medical treatment appears to be more favored with early and accurate diagnosis. After salpingectomy, patients may conceive later in life when compared with other groups so selected patients should be assessed according to their age for the decision of assisted reproductive techniques.

Do patients manage to achieve pregnancy after a major complication of deeply infiltrating endometriosis resection?

ObjectiveTo evaluate the fertility status in women suffering from major postoperative complications following deep endometriosis surgery. Study designA retrospective study in teaching and research hospitals (tertiary centers) including 23 women submitted to the surgical treatment for deep endometriosis and presenting a major postoperative complication. Postoperatively, women desiring pregnancy who conceived were compared to those who did not conceive using Mann–Whitney test and Fisher's exact test. Main outcome measure included the pregnancy rate among these women. ResultsThe overall intrauterine pregnancy rate was 47.8% and the live birth rate was 30.4%. There were 10 spontaneous conceptions and 3 IVF conceptions among 11 patients. Women who did not conceive were older than those who conceived (33.9 vs. 29.3 years; p=0.02). The pregnancy rate after intestinal complications was lower than after urinary complications (33.3% vs. 83.3%; p=0.04). ConclusionFertility remains preserved among women experiencing a major complication after removal of deep endometriosis with a live birth rate of 30.4%. Women experiencing bowel complications have a reduced probability of conception compared with those who experience a urologic complication.

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

Technological advances in fiberoptics and endoscopy have resulted in the development of minimally invasive transcervical tubal catheterization procedures with the potential of improved diagnostic accuracy of tubal disease and transcervical treatment of proximal tubal obstruction (PTO) with reduced risks, costs and morbidity compared with surgical procedures. Fallopian tube recanalization can be performed with catheters, flexible atraumatic guidewires or balloon systems under endoscopic (falloposcopy/hysteroscopy/laparoscopy), sonographic, fluoroscopic or tactile guidance. Falloposcopy provides a unique possibility to accurately visualize and grade endotubal disease, characterize and document endotubal lesions, identify the segmental location of tubal pathology without complications, objectively classify the cause of PTO and guide future patient management. This is in contrast to the surgical and radiological gold standards, laparoscopy and hysterosalpingography, respectively, that are often associated with poor or misdiagnosis of PTO. Nonhysteroscopic transuterine falloposcopy using the linear eversion catheter is a successful, well-tolerated, outpatient technique with a good predictive value for future fertility. Hysteroscopic-falloposcopic-laparoscopic tubal aquadissection, guidewire cannulation, guidewire dilatation and direct balloon tubuloplasty may be used therapeutically to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, guidewire cannulation of proximally obstructed tubes yields much lower pregnancy rates compared with other catheter techniques, despite the high tubal patency rates. Laparo-hysteroscopic selective tubal catheterization with insufflation of oil-soluble radiopaque dye has been reported to be an effective treatment for infertility associated with endometriosis. The various disadvantages associated with fluoroscopic and sonographic techniques limit their application, despite the reportedly high patency and intrauterine pregnancy rates. Recanalization is contraindicated in florid infections and genital tuberculosis, obliterative fibrosis and long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertilitY and previously performed tubal surgery. Distal tubal obstruction is not amenable to catheter recanalization techniques. Tuberculosis, salpingitis isthmica nodosa, isthmic occlusion with club-changed terminal, ampullar or fimbrial occlusion, and tubal fibrosis have been cited as reasons for recanalization failure. In lieu of the poor pregnancy outcomes in patients with severe tubal disease and poor mucosal health following tubal recanalization, as well as poor available technical skills and results with microsurgery, in vitro fertilization and embryo transfer is a valid option in such women. Despite the high diagnostic and therapeutic power of falloposcopic interventions, technical shortcomings with falloposcopy must be overcome before the procedure gains widespread acceptance.