Treatment Of Tubal Infertility Research Articles

Proposal for individual treatment by tubal occlusion factor based on the results of salpingoscopic salpingoplasty.

As a treatment for tubal infertility, falloposcopic tuboplasty (FT) is one of the options for patients who wish to conceive naturally. Based on the results of FT, we propose an appropriate time of transitioning to assisted reproductive technology (ART) for tubal infertility. We examined the outcomes of cases of tubal infertility during the period from June 1999 through March 2021 who were performed tuboplasty at our hospital using the FT catheter system under laparoscopy. The number of treated cases was 828. There were 243 cases of endometriosis and 119 cases of genital chlamydial infection. By FT, 712 cases (86.0%) were successfully recanalized. Of the 712 cases, 189 conceived naturally (26.5%) and miscarriages were 23 cases (12.2%), ectopic pregnancies were 8 cases (4.2%). The mean duration from FT to pregnancy was 6.5 months in natural pregnancy group, 90% of them were pregnant within 14 months. In endometriosis cases, the pregnancy rate after FT did not change significantly among clinical stage. Even when the fallopian tube was recanalized by FT, if the couple is unable to conceive naturally, they had better to consider switching to ART at about 14 months. When the couples with endometriosis consider switching to ART, we suggest deciding without considering the rASRM stage.

Cost-Effectiveness Analysis of Tubal Surgery Versus in Vitro Fertilization As Treatment for Tubal Infertility

Study Objective: Surgical management of tubal factor infertility has largely been replaced by in vitro fertilization (IVF). Trainees now have little exposure to surgical techniques such as fimbrioplasty and tubal reanastomosis. This study compares the cost-effectiveness of tubal surgery and IVF for tubal factor infertility. This comprehensive analysis includes costs and probabilities from the infertility treatments themselves to adverse birth outcomes depending on the mode of conception. Design This cost-effectiveness analysis compares surgery and IVF in decision trees for hydrosalpinx, proximal obstruction, endometriosis, and previous sterilization. Clinical probabilities and effectiveness were derived from published literature. Estimated costs were taken from the reimbursements from five major third party payers to a major teaching hospital. Analysis was performed with TreeAge Pro Healthcare 2020 for Windows. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results Our initial analysis includes tubal factor infertility caused by hydrosalpinx, proximal occlusion, endometriosis, and prior sterilization. Fimbrioplasty for hydrosalpinges with mild pathophysiological changes was more cost-effective than IVF. Fimbrioplasty for hydrosalpinges with advanced changes cost less than IVF, but were not very effective. Likewise, surgical repair of proximal occlusions was more cost-effective than IVF despite the failure rates of these procedures. Laparoscopic excision of endometriosis demonstrated more cost-effectiveness than IVF at all stages of disease. However, with higher maternal age and severe disease that makes ovarian dysfunction an overriding infertility factor, IVF is more cost-effective. Tubal reanastomosis was more cost-effective than IVF for patients Conclusion Surgical intervention should be considered as a viable alternative for tubal factor infertility treatment in certain cases. Continued training in tubal surgery should be encouraged in both residency and fellowships.

Association between interpersonal relational factors in couples with tubal infertility and delayed decision-making on definitive treatment: a case control study

Background: Infertility affects about 10% of couples and is often characterized by delay in initializing seeking of treatment, which culminates in delay in appropriate decision-making on definitive management. This creates a need for understanding the determinants of delay in order to strategize on corrective intervention. Objective: To determine the association between interpersonal relational factors among couples with tubal infertility and delayed decision-making on definitive treatment. Method: This was an unmatched case-control study at Kenyatta National Hospital Infertility Clinic amongst women with tubal infertility in who decisions on definitive treatment had been made. Cases were patients with delayed decision-making (≥4 years), whereas controls were patients without delayed decision-making (<4 years). Results: Age >35 years (OR 15.93, OR 95% CI 5.36-47.38, p <0.001), low education level (OR 8.56, OR 95% CI 2.98- 24.58, p <0.001) and rural residence (OR 8.74, OR 95% CI 2.89-26.48, p<0.001) were associated with delay. Formal marriage was negatively associated with delay (OR 0.17, OR 95% CI 0.05 – 0.50, p <0.001). Prolonged duration to effective communication on difficulty in conception (≥ 25 months), (OR 20.3, OR 95% CI 2.52 – 162.83, p <0.001) and being blamed by the male spouse (OR 12.73, OR 95% CI 4.54 – 35.62, p <0.001) were significantly associated with delay. Support by the male spouse, including performance of semen analysis (OR 0.17, 95% CI 0.06 – 0.49, p <0.001) was negatively associated with delayed decision-making on definitive management. In relation to marital conflict, the strongest associations with delay were noted with threats of divorce (OR 47.31, OR 95% CI 9.93 – 225.45, p <0.001), sexual constraints (OR 42.46, OR 95% CI 8.96 – 201.29, p <0.001) and physical violence (OR 27.46, OR 95%CI 3.44 – 218.78, p < 0.001). Conclusion: Adverse inter-relational factors among couples with infertility are significantly associated with delay in decision-making on appropriate treatment of tubal infertility. It is recommended that adequate education on preparedness for infertility as a possible outcome be encouraged, in order to minimize delay in seeking treatment.

The effect of selective salpingography and fallopian in the treatment of fallopian tubal infertility

Objective To evaluate the efficacy of selective salpingography (SSG) and fallopian tube recanalization(FTR) in treating fallopian tubal infertility. Methods 127 patients with fallopian tubal infertility who treated with SSG and FTR were analyzed. Results Among 127 patients, there were 19 patients with both salpingemphraxis.After SSG, we found 9 cases of 11 fallopian tubes were unobstructed.After SSG and FTR, 108 fallopian tubes were unobstructed, the effective rate was 80.00%.After one year following-up, 41 cases (34.75%) were fertilized. Conclusion SSG and FTR were effective for patients with salpingemphraxis.The treatment was safe, effective and less harmful for patients.It is worthy for clinical application. Key words: Salpingemphraxis; Infertility; Interventional recanalization

Analysis of the effect of laparoscopic tubal repair plastic surgery in the treatment of tubal infertility

目的 探讨腹腔镜下输卵管修复整形术治疗输卵管性不孕疾病的临床治疗效果.方法 选取57例输卵管性不孕患者为研究对象,将其根据随机数字表法分为两组.其中观察组患者30例,对其行腹腔镜下输卵管修复整形受术治疗.对照组患者27例,行传统开腹手术治疗.观察比较两组患者手术时间、肠道排气时间、术后住院时间及术后两年内患者宫内妊娠的情况.结果 观察组患者平均手术时间为(43.4±8.7)min,术后肠道排气时间为(13.7±3.5)h,术后住院时间为(3.8±1.2)d,均短于对照组的(81.2±9.2)min、(70.6±10.2)h、(9.1±1.4)d(t=11.32、15.76、9.76,均P<0.05).观察组术后12、24个月妊娠率分别为56.7%、83.3%,均高于对照组的29.6%、51.9%(χ2=8.76、8.98,均P<0.05).结论 腹腔镜下输卵管整形手术创口微小,治疗输卵管性不孕的治疗效果显著,值得在基层医院推广。

Clinical research of tubal infertility treated by fallopian tube intubation interventional therapy with hysteroscope

Objective To investigate the treatment effects of fallopian tube intubation interventional combined with traditional Chinese medicine therapy with hysteroscope in the treatment of tubal infertility.Methods 96 infertility patients diagnosed of tubal obstruction by the hysterosalpingography (HSG) were randomly divided into two groups.48 patients in the observation group received the fluid therapy through fallopian tube intubation with hysteroscope combined with traditional Chinese medicine,and 48 patients in the control group received conventional hydrotubation treatment.The treatment effect of the two groups was compared.Results After treatment,the tubal patency rate of the observation group and control group was 70.8％ and 27.1％ respectively,the difference was statistically significant (P ＜ 0.05).Conclusion The hysteroscopic tubal intubation interventional therapy combined with traditional Chinese medicine in the treatment of tubal infertility is safe,effective.The clinical treatment effect is obviously better than the conventional hydrotubation treatment. Key words: Infertility, female ; Hysteroscopy; Fallopian tube patency tests

The clinical efficacy of hysteroscopic tubal cannulation hydrotubation surgery and wire intervention combined with traditional Chinese medicine in the treatment of tubal infertility

Objective To observe the clinical efficacy of hysteroscopic tubal cannulation hydrotubation surgery and wire intervention combined with traditional Chinese medicine in the treatment of tubal infertility.Methods 58 patients were diagnosed as tubal obstructive infertility by hysterosalpingraphy.They were treated with hysteroscopic tubal cannulation hydrotubation surgery,Cook wire dredge for proximal blocked fallopian tube,herbal oral administration and enema.Results There were 32 cases of proximal tubal obstruction,65 cases of not very block in all 58 patients.There were 78 smooth fallopian tubes,14 not very smooth tubes,5 blocked tubes after the treatment.The smoothing rate was 80.4％.Conclusion Hysteroscopic tubal cannulation hydrotubation surgery and wire intervention combined with traditional Chinese medicine in the treatment of tubal infertility is significantly effective,with high success rate and good effect,worthy of popularization and application. Key words: Tubal infertility; Hysteroscope; Traditional Chinese medicine therapy

Fécondation in vitro : ponction blanche : méfions-nous !

A 30-year-old woman undergoing an In Vitro Fertilization (IVF) treatment for tubal infertility and for whom no oocyte was retrieved at the puncture (“white puncture”) presented an ectopic pregnancy. The patient was asymptomatic except some bleeding events reported for several days prior to the puncture. The ovulation monitoring was normal throughout the stimulation by gonadotrophin and hCG was administered for the final oocyte maturation on the twelfth day of stimulation at a rate of 2771 pg/ml of estradiol with a perfect ultrasound follicular growth. This case demonstrates that we have to beware of a “white puncture” and that the hCG measurement the day of the oocyte retrieval is necessary because of the possibility of an ectopic pregnancy.

Indications to tubal reconstructive surgery in the era of IVF

In recent years, the treatment of tubal infertility has witnessed a shift from reconstructive surgery to in vitro fertilization. However, tubal surgery retains specific advantages, and appropriate preoperative evaluation allows improved selection of patients who are candidates for tubal reconstructive surgery by identifying the patients with good reproductive prognosis. Of pivotal importance in the selection of patients is the intratubal direct evaluation performed at salpingoscopy. Term pregnancy rates of approximately 70% and 65% may be obtained in patients with periadnexal adhesions and bilateral distal tubal occlusion, respectively, when a normal tubal mucosa is observed at salpingoscopy.

Treatment of tubal infertility mainly by acupoint-injection in 64 cases

Sixty-four patients with tubal infertility were treated with a complex therapy of injection on Zigong (Ex-CA 1) and Ciliao (BL 32) and acupuncture on Qichong (ST 30), Guilai (ST 29), Chongmen (SP 12) and Dahe (KI 12), and ginger-partitioned moxibustion on the lower abdomen. As a result, 31 cases were cured 20 cases got marked effectiveness, 8 cases improved and 5 cases failed, and the total effective rate was 92.2%.

Experience of endosurgical treatment of tubal infertility in women

We analyzed the effectiveness of surgical laparoscopy in 107 patients with tubal-peritoneal form of infertility. The women were aged 20 to 25 years - 23 (21.5%), 26 to 35 - 68 (63.6%), 35 and over - 16 (14.9%). The duration of the sterility period varied from 1 to 5 years in 40 patients, from 6 to 9 years in 48 patients, from 10 to 14 years in 15 patients, and from 15 years or more in 4 patients.

Laparoscopy in the treatment of tubal infertility

Since 1992 we have performed 371 bilateral salpingostomies in infertile women (age 20-32 yrs, infertility duration 2-9 yrs) with blockage in the ampullas. Salpingostomy was performed after retrieving the tube from the commisure and filling it with methylene blue. The ampullary part of the tube was grasped at 1 to 2 cm to place the stoma, the wall was coagulated, and the site of greatest thinness of the star scar was dissected by microscissors. The fimbriae were identified and washed with physiologic heparinized solution. The distal tubal serosa was lightly coagulated with point endocoagulation along the perimeter. The abdomen was irrigated with physiologic heparinized solution, and a small amount of solution was left for hydroflotation. Second-look laparoscopy with chromopertubation in 1.5 months revealed 234 patent tubes (63.1%), 66 commissures (17.8%), 23 cases of one patent tube and the other with a hydrosalpinx (6.2%), and 48 recurrent hydrosalpinges (12.9%). One hundred three women conceived within 6 months, with 86 (23.2%) uterine and 17 (4.6%) tubal pregnancies. Laparoscopic treatment of hydrosalpinges restored tubal patency with minimal risk of complications.

Transcervical tubal cannulation and salpingoscopy in the treatment of tubal infertility

Transcervical tubal cannulation and salpingoscopy are two recent techniques used for the evaluation of tubal patency and pathology. Selective tubal cannulation cannot determine the nature of the obstructive process, although it does allow for the demonstration of potential tubal patency. This may be important in deciding whether therapies requiring tubal patency may be used in specific clinical situations. Because currently there are no controlled studies in the literature evaluating this technique, the therapeutic value of the procedure must be considered unproven at this time. Salpingoscopy gives more detailed information concerning the tubal mucosa. The identification of specific tubal lesions has been described with this modality. The predictive value of salpingoscopy in cases of severe anatomic distortion, ie, fibrous obliteration, seems obvious. However, its predictive value in the presence of more subtle lesions needs to be studied further because its role as a therapeutic modality is as yet undefined.

Tubal microsurgery. I. The principles.

Microsurgery has become an accepted method in the treatment of tubal infertility. But microsurgery implies more than the use of magnification alone. The 'microsurgical principles', the adjuvantia and the possible causes for failures of microsurgery are reviewed.

Laser therapy for tubal infertility

In the literature we found reports on anti-inflammatory, analgesic, resolving effect of low-energy laser light in the red part of the spectrum, its irritating effect on receptors of the nervous apparatus, ability to induce ovulation. We have not found any works on laser beams application in treatment of tubal infertility, but taking into account the above mentioned we can assume the possibility of restoration of female reproductive function by laser treatment.

Restoration of the motor function of the fallopian tubes of women with tubal infertility

Chronic salpingitis is the most common cause of infertility in women, especially secondary [1-3]. Treatment of tubal infertility should be aimed not only at restoring patency, but also at normalizing other functions of the fallopian tubes.

New Aspects of the Treatment of Tubal Infertility

Three aspects of the treatment of tubal infertility are discussed: current surgical procedures, including the use of microsurgery; an attempt at tubal transplantation; and the use of in vitro fertilization.