MICROSURGICAL TREATMENT OF TUBAL STERILITY USING THE CO2-LASER - A REASONABLE ALTERNATIVE TO IVF IN CASES OF TUBAL STERILITY

A retrospective analysis of women treated microsurgically using the CO 2 laser in sterility treatment was performed. The aim of the study was to determine women's personal feeling about the procedure, prognostic factors, success rates, and complications. Included were 192 patients with tubal occlusions or pelvic adhesions treated by means of CO2 las er microsurgery between February 1984 and July 1992. A standardized qu estionnaire was used to evaluate women's procedure-related stress, ext rauterine and intrauterine pregnancy rates, pregnancy complications, a nd postoperative complaints. In 75 cases, records and questionnaires c ontained sufficient data and were included for further analysis. Adhes iolysis alone, unilateral neosalpingostomy, bilateral neosalpingostomy , or new implantation was done in 7%, 52%, 33%, and 8%, respectively. In the range of 1-10, a medium degree procedure-related stress (mean 4 .3, range 1-10) was expressed by the treated women. No surgery-related complications were observed. The overall pregnancy rate was 37.3%, an d 10.7% were tubal pregnancies. In 26.7%, fertility surgery resulted i n intrauterine pregnancies, and 21.3% of the treated women delivered l iving children. Three women had two consecutive pregnancies after surg ery. Women with intrauterine pregnancy, extrauterine pregnancy, and no pregnancy had a mean age of 29.5 +/- 3.8, 27.3 +/- 5.3, and 32.3 +/- 4.2 years, respectively (p = NS). Mean duration of infertility before start of surgical treatment was 42.4 +/- 34.6, 41.6 +/- 25.8, and 48.8 +/- 33.2 months, respectively (p = NS). Intraabdominal instillation o f streptokinase to prevent reformation of adhesions had no significant impact on tubal patency results or pregnancy rates. Our analysis show s that microsurgical procedures for pelvic adhesions and tubal occlusi on using the CO2 laser are efficacious. The intrauterine pregnancy rat e is comparable to that of in vitro fertilization (IVF) in couples wit h only tubal sterility factor.