ABSTRACT
To study the ovum pickup mechanism and the fimbrio-ovarian relation in fertile and cases of unexplained infertility and to design a method for investigation and anticipation of the state of ovum pickup. Prospective clinical study. Department of Obstetrics and Gynecology Kasr El Aini Hospital, Cairo University, Egypt. Fifty fertile and twenty five cases of unexplained infertility. In all cases the fimbrio-ovarian relation is studied by determining the length of the ovulation border, the site of ovulation on that border and the length of the firnbria ovarica. It is also determined by a simple test [The fimbrio-ovarian accessibility test]. The fimbrio are held by non-traumatizing grasper and their ability to reach and/or to cover the ovulation site are taken as prove for successful ovum pickup. In addition, cases having suspected failed ovum picking are treated by controlled superovulatton, drilling of the ovary at an accessible site to the fimbrio ovarica and also by freeing short fimbrio ovarica, or partial bisection of the ovarian ligament using bipolar diathermy to allow for more ovarian accessibility to the fallopian tube and hence improving the fimbrio -ovarian juxtaposition. The ovulation site is found to be usually accessible to the fimbrio end of the tube [94%] in the fertile cases and not accessible [92%] in the infertile cases. Correction of the fimbrio-ovarian relation in the infertile cases was associated with a cumulative ongoing pregnancy rate of 68%. Failed ovum pickup should be considered as one of the important causes of unexplained infertility. The suggested "firnbrio - ovarian inaccessibility" should be considered in these cases. Correction of the fimbrio-ovarian relation, to make ovum pickup possible, should be considered as a method for treating such cases