IN-VITRO FERTILIZATION VERSUS TUBAL SURGERY - IS PELVIC RECONSTRUCTIVE SURGERY OBSOLETE

Objective: To compare the results of pelvic reconstructive surgery wit h cumulative success rates of IVF for couples with tubal factor infert ility. Data Resources: Outcomes of pelvic surgery were obtained from a review of articles from the Literature identified by directed Medline searches. Cumulative pregnancy rates of 771 couples with tubal factor infertility treated at the Cornell IVF program between December 1989 and December 1992 were calculated by life-table analysis. Results: Ove rall delivery rate per transfer for patients with tubal factor was 28. 9% (303 deliveries per 1,048 transfers) and did not appear to be affec ted significantly by the presence of a secondary diagnosis. A signific ant decline in pregnancy rates was observed with advancing age: age <3 0 years, 48.4%; 30 to 34 years, 44%; 35 to 38 years, 28%; 39 to 40 yea rs, 20%; 41 to 42 years, 9%; and >42 years, 4.3%. Cumulative pregnancy rates for cycles 1 to 4 were 32%, 59%, 70%, and 77%, respectively, in patients with only tubal factor, and 28%, 55%, 62%, and 75% in patien ts with tubal combined with other associated infertility factors. Conc lusions: Our experience suggests that >70% of women with tubal factor infertility will have a live birth within four cycles of treatment wit h IVF. These results compare favorably with the best outcomes after tu bal reconstructive surgery. In older women, because of the rapid decli ne of fertility potential with advancing age, efforts should be direct ed toward the treatment method that provides the highest likelihood of success within the shortest time interval.