BACKGROUND FACTORS AND SCORING SYSTEMS IN RELATION TO PREGNANCY OUTCOME AFTER FERTILITY SURGERY

Background. A study was initiated to identify background factors, clin ical features and pre-operative scoring systems of importance for futu re selection of patients suitable for fertility surgery. Methods. Surg ical procedures, background factors and scoring systems for tubal lesi ons and adnexal adhesions and risk factors for ectopic pregnancy were analyzed with respect to possible correlation to subsequent fertility in a retrospective study of 246 patients undergoing fertility surgery (adhesiolysis, salpingostomy, tubal anastomoses, implantation and myom ectomy) between 1986 and 1990. Follow-up periods varied between one to six years. Results. In 94% of cases a second look laparoscopy was per formed. Adhesiolysis was done in 62%. The conception rate was 41.1%, t he ectopic pregnancy rate was 14.6% and the delivery rate was 22.0%. M yomectomy procedures were most successful, with a delivery rate of 44. 0% and no ectopic pregnancy. Previous ectopic pregnancy indicated a hi gher risk for recurrence, as did a high risk score for ectopic pregnan cy. The extent of tubal damage was most relevant to subsequent fertili ty Salpingostomies in women with mild or moderate tubal damage resulte d in a delivery rate of 25.4% compared with those with severe damage ( 5.6%). No deliveries were seen after lysis of extensive adnexal adhesi ons. Conclusion. Adhesion formation is not negligible and a second loo k laparoscopy is recommended. Women with fibroids should always be con sidered for fertility Surgery, not only because of high success rates, but also as an adjuvant to subsequent in vitro fertilization. Patient s with previous ectopic pregnancy, extensive adhesions and unfavorable tubal scores should not be considered for surgery but referred for in vitro fertilization.