ABSTRACT
Assisted reproductive techniques yield high rates of success for women with tubal factor infertility. Because they are potentially effective for all categories of infertility, for two decades, clinical and basic research in infertility has been focused on IVF techniques and outcomes, rather than developing surgical techniques or training infertility subspecialists in tubal microsurgery. Nonetheless, in comparison with IVF, reconstructive tubal surgery is inexpensive and offers multiple opportunities to attempt conception. Performing laparoscopic salpingostomy prior to IVF in women with good prognosis tubal disease may improve the outcome of subsequent IVF, while offering the potential for spontaneous conception. Tubo-tubal anastomosis for reversal of tubal ligation, performed either by a microsurgical technique through a mini-laparotomy or by laparoscopy, is preferable to IVF in younger women with no other fertility factors, because it offers potentially higher cumulative pregnancy rates. Surgery is the only alternative for women with tubal factor infertility who for personal or other reasons are unable to undergo assisted reproductive techniques. Tubal reconstructive surgery and assisted reproductive techniques must be considered complementary forms of treatment for women with tubal factor infertility, and training in tubal reconstructive surgery should be an integral part of subspecialty training in reproductive endocrinology and infertility.
Subject(s)
Fallopian Tube Diseases/surgery , Fallopian Tubes/surgery , Infertility, Female/therapy , Plastic Surgery Procedures/methods , Reproductive Techniques, Assisted , Fallopian Tube Diseases/complications , Fallopian Tube Diseases/therapy , Female , Humans , Infertility, Female/etiology , Microsurgery/methods , Pregnancy , Sterilization, Tubal/rehabilitationABSTRACT
OBJECTIVE: To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization. DESIGN: Population-based retrospective cohort study. SETTING: Hospitals in Western Australia. PATIENT(S): All women aged 20-44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898). INTERVENTION(S): Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment. MAIN OUTCOME MEASURE(S): First live-delivery rates. RESULT(S): There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18-23) within the first year after reversal, 40% (95% CI 38-42) at 2 years, 51% (95% CI 48-53) at 5 years, and 52% (95% CI 50-55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40-44 years (26%) compared with younger women (aged 20-29, 30-34, and 35-39 years) (50%, 56%, and 51%, respectively). CONCLUSION(S): Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.
Subject(s)
Live Birth/epidemiology , Sterilization Reversal/statistics & numerical data , Adult , Female , Humans , Infant, Newborn , Maternal Age , Middle Aged , Pregnancy , Pregnancy Rate , Retrospective Studies , Sterilization, Tubal/rehabilitation , Sterilization, Tubal/statistics & numerical data , Treatment Outcome , Western Australia/epidemiology , Young AdultABSTRACT
OBJETIVO: Descrever a experiência de reanastomose tubária microcirúrgica com avaliação laparoscópica anteriorem 66 pacientes e rever as características clínicas, taxas de gravidez, recanalização tubária e fatores que influenciaram os resultados. MATERIAL E MÉTODOS: Entre janeiro de 1991 e julho de 2003, 66 pacientes foram avaliadas quanto à possibilidade de reversão de esterilização tubária prévia, na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicinado ABC. RESULTADOS: Das 66 pacientes que foram submetidas à laparoscopia diagnóstica, 21 (31,81) tiveram areanastomose tubária contra-indicada, sendo os principais fatores desta contra-indicação: obstrução tubária cornual(23,8), aderências extensas (19) e hidrossalpinge (14,2). Das 45 pacientes restantes (68,18) a reanastomose foi realizada. Com uma média de idades de 37,86 (+ - 3,6) anos e com um intervalo de médio de tempo de 8,17 (+ -3,4) anos entre a salpingotripsia e sua reversão. A taxa de recanalização foi de 71,11 (32/45). Das 45 pacientes, 11 não voltaram ao ambulatório, concretizando uma taxa de 24,4 de perda de seguimento. Houve uma taxa de gravidez de 64,7 (22/34) sendo 8,82 de ectópicas. CONCLUSÃO: Tendo em vista os nossos resultados, a microcirurgia tubária a despeito dos progressos da fertilização assistida segue sendo a técnica de escolha para pacientes laqueadas
Subject(s)
Humans , Female , Pregnancy , Adult , Sterilization, Tubal/statistics & numerical data , Sterilization, Tubal/rehabilitation , Pregnancy/statistics & numerical data , Microsurgery , Sterilization Reversal/statistics & numerical data , Sterilization Reversal/methods , Anastomosis, Surgical/methods , Fallopian Tubes , Salpingostomy/methodsABSTRACT
Os autores têm como objetivo avaliar o número de gestações ocorridas em mulheres que se submeteram à reversão da laqueadura tubária,bem como os fatores associados ao desejo de reversão e os fatores prognósticos para o sucesso da mesma
