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Importance of salpingoscopy and microsalpingoscopy in unexplained infertility
Oral Presentations
75. Study of the Pregnancy Rate in Patients with Endometriosis after Laparoscopic Surgery H Shimanuki, I Kikuchi, H Takeuchi. Juntendo University School of Medicine.
Objective. To study the effect of laparoscopic surgery on the pregnancy rate in infertile patients with endometriosis. Methods arzd Results. Of 1051 patients who were diagnosed as having endometriosis at our department during the period from 1993 to 2001, 163 infertile patients who did not have any infertility factors other than endometriosis were enrolled in the study. The mean age was 32.1 + 3.8 years and the mean duration of infertility was 39.3 + 29.3 months. One hundred thirty-six of the patients underwent laparoscopic surgery for endometriosis such as ovarian chocolate cyst and complete cul-de-sac obliteration (CCDSO), and other 27 were diagnosed as having endometriosis when they underwent laparoscopy with pencil-thin instruments after a diagnosis of unexplained infertility. The median of AS RM scores was 46.3 points (1-146). Pregnancy was confirmed in 72 of the 163 patients (44.2%) after the surgery, and 60 became pregnant without the help of assisted reproductive technology (ART). There were no significant differences in the pregnancy rate between mild cases at stage I or II according to the r-ASRM classification (51.3%) and severe cases at stage III or IV (42.1%) and between surgical procedures adopted. In addition, there were no significant differences between the pregnant group and nonpregnant group with regard to paranleters other than the age, such as the duration of infertility, r-ASRM score, adhesion score of the uterine adnexa, and surgical procedure. CorzHusiorz. It is expected that a pregnancy rate that is almost equivalent to that with the help of ART can be achieved by performing laparoscopic surgery in infertile patients with endometriosis, irrespective of the severity of endometriosis and surgical procedure.
76. Recurrence and Pregnancy Rate after Surgical Treatment of Endometriosis M Busacca. University of Milan, M. Melloni Hospital, Milan, Italy.
Objective. To analyze any differences between laparoscopy and laparotomy in terms of recurrence and pregnancy rate in patients with endometriosis. Desigrz. Retrospective comparative analysis of two consecutive series. Settirzg. Tertiary care center for endometriosis in Italy. Patierzts. Over a period of thirty years a population of 1422 patients who underwent surgical therapy for endometriosis was reviewed. Laparoscopic surgery (group A) was performed in 1094 patients (76.9%), mostly after 1980, and laparotomy (group B) in 328 (23.1%). The two groups were comparable for age (31.6 vs 32.9 yrs), and for stage of disease (rAFS: 23.2 vs 25.9). Number of patients who desired a pregnancy was also similar (44.9% vs 40%).
Measure~erzts arzdMairz Results. Presence of peritubal and periovarian adhesions at time of intervention was similar in the two groups (39% vs 31.8%). At a mean follow-up of 27 months, an objective recurrence was observed in 11.2% of patients, 8.2% in laparoscopy group and 18.6% in laparotomy group (P>.005), whilst painful symptoms appeared in similar proportion in both groups (19.6% vs 18.2%). Seventy-six out of 101 patients who showed a recurrence underwent a reintervention. The pregnancy rate among patients who desired a pregnancy was significantly higher in group A (49.3% vs 35.2%; P > .01). Corzclusiorz. In patients with endometriosis laparoscopy seems to be a better surgical choice in terms of recurrence and pregnancy rate.
77. Importance of Salpingoscopy and Microsalpingoscopy in Unexplained Infertility HC Verhoeven. Center for Reproductive Medicine, Dusseldorf Meerbusch, Germany.
Objective. To determine the importance of endoscopic evaluation of the tubal mucosa for the early selection of patients with unexplained or minor male infertility for IVF instead of expectant therapy. Desigrz. A single-center prospective study. Settirzg. Private assisted reproductive technology unit. Patierzts. Fifty patients presenting unexplained infertility or reduced sperm quality. Irzterverztiorzs. Salpingoscopy and Microsalpingoscopy at the time of Transvaginal Endoscopy, later on intrauterine insemination. Measummerzts arzd Mairz Results. The correlation between an~pullary mucosa damage and the number of dye-stained nuclei on the tubal epithelium and the pregnancy rate after 1UI. Fifty infertile patients showed no pathology at the time of transvaginal Hydrolaparoscopy. Five (10%) showed intra-anlpullary adhesions, 17 (34%) severe tubal damage at the time of microsalpingoscopy. First results showed a statistically reduced pregnancy rate after 1UI in patients with damaged tubal mucosa. Corzclusiorz. Detection of tubal pathology could be of great importance when deciding whether IVF or expectant treatment is the better option for patients with unexplained or minor tubal infertility.
78. Outcome of Bowel Injury During Transvaginal Endoscopy HC Verhoeven. Center for Reproductive Medicine, Dusseldorf Meerbusch, Germany.
Objective. To evaluate the outcome of bowel injury during Transvaginal Endoscopy (TVE). Desigrz. Retrospective chart review, comparing our own results with a multinational multicenter survey. Settirzg. Private Infertility Centers. Patierzts. Infertile patients without obvious pathology.
$24
75. Study of the Pregnancy Rate in Patients with Endometriosis after Laparoscopic Surgery H Shimanuki, I Kikuchi, H Takeuchi. Juntendo University School of Medicine.
Objective. To study the effect of laparoscopic surgery on the pregnancy rate in infertile patients with endometriosis. Methods arzd Results. Of 1051 patients who were diagnosed as having endometriosis at our department during the period from 1993 to 2001, 163 infertile patients who did not have any infertility factors other than endometriosis were enrolled in the study. The mean age was 32.1 + 3.8 years and the mean duration of infertility was 39.3 + 29.3 months. One hundred thirty-six of the patients underwent laparoscopic surgery for endometriosis such as ovarian chocolate cyst and complete cul-de-sac obliteration (CCDSO), and other 27 were diagnosed as having endometriosis when they underwent laparoscopy with pencil-thin instruments after a diagnosis of unexplained infertility. The median of AS RM scores was 46.3 points (1-146). Pregnancy was confirmed in 72 of the 163 patients (44.2%) after the surgery, and 60 became pregnant without the help of assisted reproductive technology (ART). There were no significant differences in the pregnancy rate between mild cases at stage I or II according to the r-ASRM classification (51.3%) and severe cases at stage III or IV (42.1%) and between surgical procedures adopted. In addition, there were no significant differences between the pregnant group and nonpregnant group with regard to paranleters other than the age, such as the duration of infertility, r-ASRM score, adhesion score of the uterine adnexa, and surgical procedure. CorzHusiorz. It is expected that a pregnancy rate that is almost equivalent to that with the help of ART can be achieved by performing laparoscopic surgery in infertile patients with endometriosis, irrespective of the severity of endometriosis and surgical procedure.
76. Recurrence and Pregnancy Rate after Surgical Treatment of Endometriosis M Busacca. University of Milan, M. Melloni Hospital, Milan, Italy.
Objective. To analyze any differences between laparoscopy and laparotomy in terms of recurrence and pregnancy rate in patients with endometriosis. Desigrz. Retrospective comparative analysis of two consecutive series. Settirzg. Tertiary care center for endometriosis in Italy. Patierzts. Over a period of thirty years a population of 1422 patients who underwent surgical therapy for endometriosis was reviewed. Laparoscopic surgery (group A) was performed in 1094 patients (76.9%), mostly after 1980, and laparotomy (group B) in 328 (23.1%). The two groups were comparable for age (31.6 vs 32.9 yrs), and for stage of disease (rAFS: 23.2 vs 25.9). Number of patients who desired a pregnancy was also similar (44.9% vs 40%).
Measure~erzts arzdMairz Results. Presence of peritubal and periovarian adhesions at time of intervention was similar in the two groups (39% vs 31.8%). At a mean follow-up of 27 months, an objective recurrence was observed in 11.2% of patients, 8.2% in laparoscopy group and 18.6% in laparotomy group (P>.005), whilst painful symptoms appeared in similar proportion in both groups (19.6% vs 18.2%). Seventy-six out of 101 patients who showed a recurrence underwent a reintervention. The pregnancy rate among patients who desired a pregnancy was significantly higher in group A (49.3% vs 35.2%; P > .01). Corzclusiorz. In patients with endometriosis laparoscopy seems to be a better surgical choice in terms of recurrence and pregnancy rate.
77. Importance of Salpingoscopy and Microsalpingoscopy in Unexplained Infertility HC Verhoeven. Center for Reproductive Medicine, Dusseldorf Meerbusch, Germany.
Objective. To determine the importance of endoscopic evaluation of the tubal mucosa for the early selection of patients with unexplained or minor male infertility for IVF instead of expectant therapy. Desigrz. A single-center prospective study. Settirzg. Private assisted reproductive technology unit. Patierzts. Fifty patients presenting unexplained infertility or reduced sperm quality. Irzterverztiorzs. Salpingoscopy and Microsalpingoscopy at the time of Transvaginal Endoscopy, later on intrauterine insemination. Measummerzts arzd Mairz Results. The correlation between an~pullary mucosa damage and the number of dye-stained nuclei on the tubal epithelium and the pregnancy rate after 1UI. Fifty infertile patients showed no pathology at the time of transvaginal Hydrolaparoscopy. Five (10%) showed intra-anlpullary adhesions, 17 (34%) severe tubal damage at the time of microsalpingoscopy. First results showed a statistically reduced pregnancy rate after 1UI in patients with damaged tubal mucosa. Corzclusiorz. Detection of tubal pathology could be of great importance when deciding whether IVF or expectant treatment is the better option for patients with unexplained or minor tubal infertility.
78. Outcome of Bowel Injury During Transvaginal Endoscopy HC Verhoeven. Center for Reproductive Medicine, Dusseldorf Meerbusch, Germany.
Objective. To evaluate the outcome of bowel injury during Transvaginal Endoscopy (TVE). Desigrz. Retrospective chart review, comparing our own results with a multinational multicenter survey. Settirzg. Private Infertility Centers. Patierzts. Infertile patients without obvious pathology.
$24