PREGNANCY RATES AFTER OPERATIVE ENDOSCOPIC TREATMENT OF TOTAL (NEOSALPINGOSTOMY) OR NEAR-TOTAL (SALPINGOSTOMY) DISTAL TUBAL OCCLUSION

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.