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Reproductive surgery for female infertility

INTRODUCTION

The availability of assisted reproductive technology has reduced the need for reproductive surgery as a primary surgical treatment of infertility. When fertility surgery is indicated, operative laparoscopy results in outcomes as good as those from similar procedures performed via open laparotomy and is associated with a shorter hospital stay, lower incidence of ileus, and faster recovery. In addition, there is less contamination of the surgical field with glove powder or lint, bleeding is reduced due to tamponade of small vessels by the pneumoperitoneum, and drying of tissues is minimal because surgery occurs in a closed environment. All of these factors contribute to reduce postoperative adhesion formation and its associated morbidity (eg, pain, impaired fertility, bowel obstruction). Today, reproductive surgery can be divided into three categories: surgery as a primary conventional surgical treatment of infertility, surgery to enhance the pregnancy outcome of in vitro fertilization, and surgery for fertility preservation [1].

Laparoscopic surgery for the treatment of female infertility is reviewed here. The evaluation and nonsurgical treatment of female infertility are discussed separately. (See "Evaluation of female infertility" and "Overview of treatment of female infertility".)

DIAGNOSTIC LAPAROSCOPY

The role of diagnostic laparoscopy in the management of infertility is limited. However, it can be useful in the infertility evaluation of young women with a history of pelvic inflammatory disease, ectopic pregnancy, pelvic surgery, or chronic pelvic pain. In our practice, we usually perform diagnostic laparoscopy or in vitro fertilization (IVF) treatment if three cycles of gonadotropin ovulation induction with intrauterine inseminations are unsuccessful. If adhesions or endometriosis are found during diagnostic laparoscopy and the patient has been appropriately consented, then an operative laparoscopic procedure for improving fertility can be undertaken at the same time.

Diagnostic laparoscopy can be avoided in older women and those with multiple infertility factors. These women are better served by in vitro fertilization, instead of a surgical approach to treatment. The presence of endometriosis and adhesions does not markedly influence the effectiveness of IVF. Today, we rarely perform diagnostic laparoscopy in infertile women. (See "In vitro fertilization".)

Chromopertubation — When laparoscopy is performed for diagnostic or therapeutic purposes in women with infertility, chromopertubation (instillation of dye through the fallopian tubes) is often performed to assess tubal patency. To perform this procedure, a dilute solution of methylene blue dye is instilled through a transcervical cannula (typically through a patent cannula used for uterine manipulation (picture 1)). Spillage of the dye from each tube is noted as a confirmation of tubal patency. If a repair procedure for tubal occlusion is performed, chromopertubation is repeated at the end of the procedure.

                          

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Literature review current through: Oct 2014. | This topic last updated: Oct 17, 2014.
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References
Top
  1. Tulandi T, Marzal A. Redefining reproductive surgery. J Minim Invasive Gynecol 2012; 19:296.
  2. Tulandi T, Collins JA, Burrows E, et al. Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions. Am J Obstet Gynecol 1990; 162:354.
  3. Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 1997; 337:217.
  4. Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi. Hum Reprod 1999; 14:1332.
  5. Jacobson TZ, Barlow DH, Koninckx PR, et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 2002; :CD001398.
  6. Garner E. Laparoscopy in the management of endometriosis. Infertil Reprod Med Clinics North Am 1997; 8:359.
  7. Tulandi T, al-Took S. Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation. Fertil Steril 1998; 69:229.
  8. Bateman BG, Kolp LA, Mills S. Endoscopic versus laparotomy management of endometriomas. Fertil Steril 1994; 62:690.
  9. Saleh A, Tulandi T. Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Fertil Steril 1999; 72:322.
  10. Hemmings R, Bissonnette F, Bouzayen R. Results of laparoscopic treatments of ovarian endometriomas: laparoscopic ovarian fenestration and coagulation. Fertil Steril 1998; 70:527.
  11. Loh FH, Tan AT, Kumar J, Ng SC. Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 1999; 72:316.
  12. Donnez J, Wyns C, Nisolle M. Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril 2001; 76:662.
  13. Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 1998; 70:1176.
  14. Vercellini P, Vendola N, Bocciolone L, et al. Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment. J Reprod Med 1992; 37:577.
  15. Saleh A, Tulandi T. Surgical management of ovarian endometrioma. Infertil Reprod Med Clin North Am 2000; 11:61.
  16. Vercellini P, Chapron C, De Giorgi O, et al. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol 2003; 188:606.
  17. Jones KD, Sutton C. Patient satisfaction and changes in pain scores after ablative laparoscopic surgery for stage III-IV endometriosis and endometriotic cysts. Fertil Steril 2003; 79:1086.
  18. Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 2004; 82:1633.
  19. Tang Y, Chen SL, Chen X, et al. Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst. Fertil Steril 2013; 100:464.
  20. Namnoum A, Murphy A. Diagnostic and Operative Laparoscopy. In: TeLinde's Operative Gynecology, 8th ed, Lippincott-Raven, Philadelphia 1997. p.389.
  21. Audebert A, Pouly JL, Bonifacie B, Yazbeck C. Laparoscopic surgery for distal tubal occlusions: lessons learned from a historical series of 434 cases. Fertil Steril 2014; 102:1203.
  22. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0 (Accessed on December 10, 2013).
  23. Saleh WA, Dlugi AM. Pregnancy outcome after laparoscopic fimbrioplasty in nonocclusive distal tubal disease. Fertil Steril 1997; 67:474.
  24. Hesla J. Laparoscopic management of distal tubal disease. Infertil Reprod Med Clinics North Am 1997; 8:425.
  25. Marana R, Catalano GF, Muzii L, et al. The prognostic role of salpingoscopy in laparoscopic tubal surgery. Hum Reprod 1999; 14:2991.
  26. Schlaff WD, Hassiakos DK, Damewood MD, Rock JA. Neosalpingostomy for distal tubal obstruction: prognostic factors and impact of surgical technique. Fertil Steril 1990; 54:984.
  27. Rock JA, Katayama KP, Martin EJ, et al. Factors influencing the success of salpingostomy techniques for distal fimbrial obstruction. Obstet Gynecol 1978; 52:591.
  28. Patton PE, Williams TJ, Coulam CB. Results of microsurgical reconstruction in patients with combined proximal and distal tubal occlusion: double obstruction. Fertil Steril 1987; 48:670.
  29. Strandell A, Lindhard A. Why does hydrosalpinx reduce fertility? The importance of hydrosalpinx fluid. Hum Reprod 2002; 17:1141.
  30. Meyer WR, Castelbaum AJ, Somkuti S, et al. Hydrosalpinges adversely affect markers of endometrial receptivity. Hum Reprod 1997; 12:1393.
  31. Ng EH, Ajonuma LC, Lau EY, et al. Adverse effects of hydrosalpinx fluid on sperm motility and survival. Hum Reprod 2000; 15:772.
  32. Daftary GS, Kayisli U, Seli E, et al. Salpingectomy increases peri-implantation endometrial HOXA10 expression in women with hydrosalpinx. Fertil Steril 2007; 87:367.
  33. Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancy rates after in vitro fertilization-embryo transfer. Fertil Steril 1998; 70:492.
  34. Camus E, Poncelet C, Aucouturier JS, et al. [Hydrosalpinx and fertilization in vitro-embryo transfer: abstention or salpingectomy? Abstention, salpingectomy or salpingostomy?]. Gynecol Obstet Fertil 2001; 29:466.
  35. Dechaud H. Hydrosalpinx and ART: hydrosalpinges suitable for salpingectomy before IVF. Hum Reprod 2000; 15:2464.
  36. Johnson N, van Voorst S, Sowter MC, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev 2010; :CD002125.
  37. Bildirici I, Bukulmez O, Ensari A, et al. A prospective evaluation of the effect of salpingectomy on endometrial receptivity in cases of women with communicating hydrosalpinges. Hum Reprod 2001; 16:2422.
  38. Murray DL, Sagoskin AW, Widra EA, Levy MJ. The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rates and the benefit of surgical correction. Fertil Steril 1998; 69:41.
  39. Bloechle M, Schreiner T, Lisse K. Recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra. Hum Reprod 1997; 12:703.
  40. Hurst BS, Tucker KE, Awoniyi CA, Schlaff WD. Hydrosalpinx treated with extended doxycycline does not compromise the success of in vitro fertilization. Fertil Steril 2001; 75:1017.
  41. Kontoravdis A, Makrakis E, Pantos K, et al. Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril 2006; 86:1642.
  42. Hitkari JA, Singh SS, Shapiro HM, Leyland N. Essure treatment of hydrosalpinges. Fertil Steril 2007; 88:1663.
  43. Mijatovic V, Veersema S, Emanuel MH, et al. Essure hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization-embryo transfer in patients with a contraindication for laparoscopy. Fertil Steril 2010; 93:1338.
  44. Galen DI, Khan N, Richter KS. Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization. J Minim Invasive Gynecol 2011; 18:338.
  45. Mol BW, Swart P, Bossuyt PM, van der Veen F. Is hysterosalpingography an important tool in predicting fertility outcome? Fertil Steril 1997; 67:663.
  46. Sulak PJ, Letterie GS, Coddington CC, et al. Histology of proximal tubal occlusion. Fertil Steril 1987; 48:437.
  47. Al-Jaroudi D, Herba MJ, Tulandi T. Reproductive performance after selective tubal catheterization. J Minim Invasive Gynecol 2005; 12:150.
  48. Woolcott R, Fisher S, Thomas J, Kable W. A randomized, prospective, controlled study of laparoscopic dye studies and selective salpingography as diagnostic tests of fallopian tube patency. Fertil Steril 1999; 72:879.
  49. Papaioannou S, Afnan M, Girling AJ, et al. Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage. Hum Reprod 2002; 17:2325.
  50. Sankpal RS, Confino E, Matzel A, Cohen LS. Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography. Int J Gynaecol Obstet 2001; 73:125.
  51. Mishell D, Stenchever M, Droegemueller W, Herbst A. Infertility, etiology, diagnostic evaluation, management and diagnosis. In: Comprehensive Gynecology, 3rd ed, Mosby-Year Book, Inc., St. Louis 1997. p.1113.
  52. Papaioannou S, Afnan M, Girling AJ, et al. The effect on pregnancy rates of tubal perfusion pressure reductions achieved by guide-wire tubal catheterization. Hum Reprod 2002; 17:2174.
  53. Spielvogel K, Shwayder J, Coddington CC. Surgical management of adhesions, endometriosis, and tubal pathology in the woman with infertility. Clin Obstet Gynecol 2000; 43:916.
  54. Gomel V, McComb PF. Microsurgery for tubal infertility. J Reprod Med 2006; 51:177.
  55. Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol 2003; 101:677.
  56. Yoon TK, Sung HR, Cha SH, et al. Fertility outcome after laparoscopic microsurgical tubal anastomosis. Fertil Steril 1997; 67:18.
  57. Boeckxstaens A, Devroey P, Collins J, Tournaye H. Getting pregnant after tubal sterilization: surgical reversal or IVF? Hum Reprod 2007; 22:2660.
  58. Rock JA, Guzick DS, Katz E, et al. Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization. Fertil Steril 1987; 48:13.
  59. Cha SH, Lee MH, Kim JH, et al. Fertility outcome after tubal anastomosis by laparoscopy and laparotomy. J Am Assoc Gynecol Laparosc 2001; 8:348.
  60. Hawkins J, Dube D, Kaplow M, Tulandi T. Cost analysis of tubal anastomosis by laparoscopy and by laparotomy. J Am Assoc Gynecol Laparosc 2002; 9:120.
  61. Goldberg JM, Falcone T. Laparoscopic microsurgical tubal anastomosis with and without robotic assistance. Hum Reprod 2003; 18:145.
  62. Rodgers AK, Goldberg JM, Hammel JP, Falcone T. Tubal anastomosis by robotic compared with outpatient minilaparotomy. Obstet Gynecol 2007; 109:1375.
  63. Dharia Patel SP, Steinkampf MP, Whitten SJ, Malizia BA. Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 2008; 90:1175.
  64. Garcia J, Jones GS, Wentz AC. The use of clomiphene citrate. Fertil Steril 1977; 28:707.
  65. Pirwany I, Tulandi T. Laparoscopic treatment of polycystic ovaries: is it time to relinquish the procedure? Fertil Steril 2003; 80:241.
  66. STEIN IF Sr. DURATION OF FERTILITY FOLLOWING OVARIAN WEDGE RESECTION--STEIN-LEVENTHAL SYNDROME. West J Surg Obstet Gynecol 1964; 72:237.
  67. McLaughlin DS. Evaluation of adhesion reformation by early second-look laparoscopy following microlaser ovarian wedge resection. Fertil Steril 1984; 42:531.
  68. Yanagibori A, Kojima E, Ohtaka K, et al. Nd:YAG laser therapy for infertility with a contact-type probe. J Reprod Med 1989; 34:456.
  69. Toaff R, Toaff ME, Peyser MR. Infertility following wedge resection of the ovaries. Am J Obstet Gynecol 1976; 124:92.
  70. Heylen SM, Puttemans PJ, Brosens IA. Polycystic ovarian disease treated by laparoscopic argon laser capsule drilling: comparison of vaporization versus perforation technique. Hum Reprod 1994; 9:1038.
  71. Li TC, Saravelos H, Chow MS, et al. Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynaecol 1998; 105:338.
  72. Felemban A, Tan SL, Tulandi T. Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril 2000; 73:266.
  73. Tulandi T, Huang JY, Tan SL. Preservation of female fertility: an essential progress. Obstet Gynecol 2008; 112:1160.