Am. Dlugi et al., PREGNANCY RATES AFTER OPERATIVE ENDOSCOPIC TREATMENT OF TOTAL (NEOSALPINGOSTOMY) OR NEAR-TOTAL (SALPINGOSTOMY) DISTAL TUBAL OCCLUSION, Fertility and sterility, 62(5), 1994, pp. 913-920
Objective: To determine the efficacy of the endoscopic treatment of co
mplete distal tubal occlusion or moderate to severe tubal phimosis and
to analyze outcome using contemporary statistical methodologies. Desi
gn: Prospective cohort analysis. Setting: Tertiary-care institution. P
atients: One hundred thirteen consecutive patients undergoing a neosal
pingostomy or salpingostomy. Interventions: KTP/532 laser (Laserscope,
Santa Clara, CA) laparoscopy. Additional infertility factors were tre
ated postoperatively. Main Outcome Measures: Crude pregnancy rate (PR)
, monthly fecundity rate, monthly probability of pregnancy, cure rate,
and cumulative PRs. Outcome was compared on the basis of the surgical
procedure performed. The impact of endometriosis as well as other fer
tility factors was analyzed. Results: Twenty-three patients conceived
yielding a crude PR of 20.4%, a monthly fecundity rate of 2.6%, a mont
hly probability of pregnancy of 6.4%, and a cure rate of 52.4%. There
were six ectopic pregnancies (5.3%). A significant difference was foun
d among the cumulative pregnancy curves. The cumulative pregnancy curv
e for unilateral salpingostomy differed significantly from that of uni
lateral neosalpingostomy. Patients with endometriosis and no other inf
ertility factors had a significantly better cumulative pregnancy curve
compared with patients without endometriosis or other factors as well
as compared with patients with no endometriosis but with other infert
ility factors. Patients undergoing bilateral neosalpingostomy had a cu
re rate of 9.0% whereas patients undergoing bilateral salpingostomy ha
d a cure rate of 34.2%. Conclusions: Operative endoscopy yields PRs th
at are comparable to those reported in the literature for laparotomy.
The presence of complete bilateral distal tubal occlusion has a negati
ve impact on outcome.