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39 - Surgical Preparation of the Patient for In Vitro Fertilization

from PART III - ASSISTED REPRODUCTION

Published online by Cambridge University Press:  04 August 2010

By
Eric S. Surrey
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

Surgical management of tubal abnormalities, endometriosis, and uterine fibroids has traditionally been employed to enhance fertility in the absence of the assisted reproductive technologies as has been reviewed elsewhere in this text. Can these procedures be employed not only as alternatives to the assisted reproductive technologies but also as adjuncts? In this chapter, we will review the evidence surrounding the effect of reproductive surgery for these conditions on in vitro fertilization (IVF) cycle outcome.

DISTAL TUBAL DISEASE

IVF was originally designed to overcome infertility due to irreversible tubal disease or for those who did not wish to undergo surgical repair. A large body of literature has reported that either unilateral or bilateral hydrosalpinges may exert deleterious effects on IVF cycle outcome (1–10) (Table 39.1). Camus et al. performed a meta-analysis of nine retrospective controlled series and five published abstracts encompassing 1,004 patients with hydrosalpinges and 4,588 control patients with tubal factor infertility but without hydrosalpinges (11). Significant decreases in pregnancy, implantation, and delivery rates were appreciated in the hydrosalpinx groups (odds ratios 0.64, 0.63, and 0.58, respectively). Only one investigation included in the meta-analysis noted no difference in pregnancy or implantation rates in hydrosalpinx patients as opposed to controls (12). One confounding variable in that particular trial may be the low implantation and ongoing pregnancy rates in the control group.

Keywords

assisted reproductive technologydistal tubal diseaseendometriosisin vitro fertilizationsalpingectomyuterine fibroidsproximal tubal occlusion
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 361 - 370
Publisher: Cambridge University Press
Print publication year: 2008

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