[Catheterization of the tubal ostium using hysteroscopy under laparoscopic guidance]. / Cateterización del ostium tubario bajo guía histeroscópica con control laparoscópico.

It is considered that one out of five couples present a transitory problem of infertility during their reproductive life and the most frequent cause is the tubarian pathology; from these, the proximal obstruction occupies between 25 and 30% of the cases. Unfortunatelly, the conventional method use to study tubarian patency such as histerosalpingography or the direct observation by laparoscopy and selective chromotubation, frequently do not allow to differentiate between an insufficient filling of the tubes, tubarian spasm or a true mechanical obstruction. There are certain selective tubarian cannulation techniques, for example, the catheterism with hysteroscopic guidance which is extremely usefull in the diagnosis of tubarian patency or in the confirmation of partial or total proximal tubal disease. The procedure permits to diagnosticate precisely the tubarian obstruction and also if it is due to the presence of a true pathology or simply functional, or secondary to a tubarian spasm; besides it also works as a therapeutic procedure since in the first case permits the lysis of laxe adherencies and the removal of the amorfus material that obstructs the tube and permits the catheterization. The present study determines the utility of catheterization of the tubarian ostium by hysteroscopy with laparoscopic control using the Novy (Cook, Ob/ Gyn) catheter in patients with infertility problems due to proximal obstruction of one or both of the fallopian tubes, to confirm or discard the presence of a pathological obstruction. The results are evaluated in terms of tubarian permeability and the pregnancy rate after the procedure.

[Laparoscopy and hysteroscopy in Müllerian duct malformations: usefulness and reproductive results]. / Laparoscopia e histeroscopia en malformaciones müllerianas: utilidad y resultados reproductivos.

Determine the type and the possibility of corrective surgery, reproductive results of infertility patients with Müllerian malformations. The clinic and the laparoscopic and hysteroscopic evaluation were performed to 40 patients with Müllerian anomalies and infertility history analyzing the reproductive results. The uterine septum was present in 23/40 patients (57.5%), bicornual uterus in 6/40 (15%), didelfus uterus 5/40 (12.5%), arcuate uterus 4/40 (10%), unicorn uterus 2/40 (5%). After septum resection we had 13 pregnancies (56.5%). 2 abortions, 4 already delivered and 7 continue normal evolution with on twin case. Strassman metroplasty by laparotomy was performed in 4 cases of bicornual uterus achieving pregnancy in two cases. In one didelfus uterus, a salpingoclasy of the smaller horn was done as an alternative. Of the arcuated uterus, the small septum was removed. Of the unicorn uterus, one pregnancy was lost in the first trimester and the other one reach the term date. Our data show that the endoscopic procedures can perform the correct diagnosis of the Müllerian anomalies and of course the best surgical treatment improving the fertility rates.

[Occurrence of pregnancy after microsurgical treatment of sterile patients with tubo-ovarian adhesive diseases]. / Frecuencia de embarazos después de tratamiento microquirúrgico en pacientes estériles por enfermedad adherencial tuboovárica.

In the last years, the adherence adnexal disease has been increased due to pelvic infections. This may cause infertility problems depending, of the nature, extension and localization inside the pelvis. In this paper we inform the results obtained in 70 patients with adnexal adhesions to whom it was performed a salpingo-ovariolysis with microsurgery technology, with the purpose of promote the fertility. All the patients received pre, trans and postoperative support (Heparin, steroids and antimicrobials). The minimal time of postoperative observation was at least 6 months. In 27 (Group I) of the 70 cases (38.6%), the adherences were avascular (IA & IIA based on Hulka's classification); and in the 43 patients of the group II (61.4%), the lesions were dense and vascular (IB & IIB). In group I, 15 pregnancies were obtained (55.6%), 13 at term, 1 miscarriage and 1 ectopic pregnancy; in the group II we documented 9 pregnancies (20.9%), 5 at term, 4 miscarriage (I trimester).