DOCSLIB.ORG

Tubal Stump Pregnancy in ART Patients Two Cases of Ectopic Stump Pregnancy After IVF-ET

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tubal Stump Pregnancy in ART Patients Two Cases of Ectopic Stump Pregnancy After IVF-ET ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.10.002026 Chiara Di Tucci. Biomed J Sci & Tech Res Case Report Open Access Tubal Stump Pregnancy in ART Patients Two cases of ectopic stump pregnancy after IVF-ET Di Tucci Chiara*, Schiavi Michele Carlo, Iacobelli Valentina, Donfrancesco Cristina, Piccioni Maria Grazia, Perniola Giorgia, Muzii Ludovico and Benedetti Panici Pierluigi Department of Gynecologic-Obstetrical and Urologic Sciences, Italy Received: Published: *Corresponding: Octobet author: 22, 2018; : November 13, 2018 Chiara Di Tucci, Department of Obstetrics and Gynecology, Italy Abstract Ectopic pregnancy (EP) is a complication of pregnancy in which the embryo attaches outside the uterus. The rate of ectopic pregnancy is about 1 and 2% that of live births, though it may be as high as 4% among those using assisted reproductive technology (ART). We present two cases of interstitial stump pregnancies in patients who previously underwent salpingectomy for ectopic pregnancies, and a review of the literature. One patient has been treated with methotrexate (MTX) before the removal of the tubal stump, while the second has gone directly to laparoscopic (LPS) surgery. Transvaginal ultrasound examination is essential for early and accurate management of this condition. It should be quickly performed to rule out a stump interstitial pregnancy in women who conceive by ART after bilateral salpingectomy. A correct attitude towards this condition is not yetKeywords: internationally standardized and both medical and surgical options should be promptly considered. In vitro Abbreviations:Ectopic pregnancy (EP); Assisted reproductive technologies (ART); Tubal stump; Methotrexate (MTX); In fertilization Vitro (IVF) EP: Ectopic Pregnancy; ART: Assisted Reproductive Technologies; MTX: Tubal Stump Methotrexate; IVF: Fertilization Introduction Ectopic pregnancies (EP) represent the most serious occurred in a fallopian stump after in vitro to the contralateral tube. We report two cases in which the EP fertilization (IVF) in complication of the first trimester of pregnancy. In the vast majority women subjected to monolateral salpingectomy for a history of of the cases the embryo prematurely implants itself in the fallopian ectopic pregnancy. We present also a review of literature about tube before arriving in the uterine cavity. Only in approximately interstitial pregnancies in tubal stump (Table 1) and a review about 2% of the cases EP occur in different regions such as the cervix, EP in unusual sites in women with previous salpingectomy (Table the ovary or the abdominal cavity [1-5]. An atypical and insidious 2) [6-10]. severeTable 1event: Review is that of literature:the embryo interstitial migrates pregnancies from the uterine in tubal cavity stump. Gravity Mode of Gestation, Internal Author Year Age Previous operation history Management and parity conception weeks Bleeding Subtotal Spontaneous Appendicectomy, left salpingo- Corti,Rolandi 1964 35 G3,P2 oophorectomy for a serous ovarian 5+3d 50 ml [1] hysterectomy cyst Spontaneous Poor Laparotomic Righ salpingo- oophorectomy for tubal stump Benzi [2] 1967 27 G2,P0 5 excision of right ectopic pregnancy Spontaneous None Laparotomic Appendicectomy, Ovarian stump Krzaniak [3] 1968 30 G2,P2 9 excision of left tubal cystectomy Spontaneous Appendicectomy, Left salpingo- A single i.m. dose of Bernardini [4] 1998 36 G4,P0 oophorectomy for interstitial tubal 4+5d MTX (100 mg) on NA pregnancy day 61 of gestation Biomedical Journal of Scientific & Technical Research (BJSTR) 8179 Biomedical Journal of Scientific & Technical Research Volume 10- Issue 5: 2018 Spontaneous Laparotomic right salpingo- Laparoscopictubal stump 36 G1,P1 oophorectomy for an ovarian 8 excision of right 20 ml dermoid cyst Takeda [5] 2006 Spontaneous Laparoscopic right salpingo- Laparoscopictubal stump 27 G3,P2 oophorectomy for ruptured ovarian 6 excision of right 100 ml pregnancy Spontaneous Laparotomic Laparoscopic right salpingectomy tubal stump and left right tubal stump excision of right Milingos [6] 2008 38 G6,P3 and laparoscopic excision of the 5+6d NA salpingectomy 22 Spontaneous Laparotomic Left corneal resection for tubal Faleyimu [7] 2008 G2,P0 5 left salpingo- 600 ml pregnancy oophorectomy cauterisation of Spontaneous rightLaparoscopic bleeding tubal Right salpingectomy for tubal Muppala [8] 2009 38 G3,P1 6 stump 500 ml pregnancy Spontaneous Laparoscopic Left salpingo- oophorectomy for an stump Sturlese [9] 2009 30 G1,P0 6 excision of left tubal NA ovarian dermoid cyst induction Laparoscopic Laparoscopic right salpingectomy Ovulation tubal stump 30 G2,P0 8 excision of right 500 ml for tubal pregnancy induction Laparoscopic Laparoscopic right salpingectomy Ovulation tubal stump 40 G7,P4 6 excision of right 550ml for tubal pregnancy Laparoscopic Laparoscopic left salpingectomy for stump 32 G4,P0 IVF-ET 8 excision of left tubal 700ml tubal pregnancy Ko PC [10] 2011 Laparoscopic bilateral Laparotomic salpingectomy for right ovarian stump 30 G3,P0 ICSI-ET 7 excision of tubal 2000ml pregnancy and left tubal pregnancy after ICSI Laparoscopic Laparoscopic left salpingectomy for stump 42 G3,P1 IVF-ET 7 excision of left tubal 20ml tubal pregnancy after IUI Laparoscopic bilateral Laparoscopicstump 32 G4,P0 salpingectomy for bilateral ICSI-ET 6 excision of tubal 200ml hydrosalpinx resection of the left Laparoscopic partial left salpingectomy and right tubal stump 33 G4 P0 IVF-ET 3 100ml Garavaglia total laparoscopic salpingectomy laparoscopic right 2012 [35] bilateral laparoscopic salpingectomy 37 IVF-ET 4 NA for bilateral hydrosalpinx cornuostomy. 2 Laparoscopic laparoscopic bilateral salpingectomy stump Shavit T. [36] 2013 35 G0 P0 IVF-ET excision of tubal NA due to hydrosalpinges Bahareh Spontaneous tubalmonopolar/bipola ligation on the Laparoscopic right salpingectomy r diathermy plus Samiei- Sarir 2013 42 G11 P7 500 ml for tubal pregnancy [37] left side. spontaneous Laparoscopic Laparoscopic left salpingectomy for stump 35 G8 P2 7 excision of left tubal 2000 ml tubal pregnancy bilateral laparoscopic salpingecto Laparoscopic Maruthini et then Laparotomic 2013 33 G0P0 IVF-ET 6 stump 300ml al [38] my for bilateral hydrosalpin x excision of tubal tubal spontaneous for Laparoscopic Nishida M Laparoscopic right salpingectomy excision of left 2015 26 G4 P1 6 the gestational sac NA [39] tubal pregnancy stump, removal of Cite this article: . Tubal 8180 : Di Tucci C, Schiavi Michele C, Iacobelli V, Donfrancesco C, Piccioni Maria G, Perniola Ga, Muzii L, Benedetti Panici P Stump Pregnancy in ART Patients Two cases of ectopic stump pregnancy after IVF-ET. Biomed J Sci&Tech Res 10(5)-2018. BJSTR. MS.ID.002026. DOI 10.26717/ BJSTR.2018.10.002026. Biomedical Journal of Scientific & Technical Research Volume 10- Issue 5: 2018 bilateral tubal ligation for left for left ruptured Emergencyinterstitial LPTM Xu Ying et al. occlusion 2016 28 G0 hydrosalpinx and right tubal IVF-ET 7 500 ml [40] pregnancy Laparoscopic right salpingectomy Souza C. [41] 2018 35 G3 P1 IVF-ET NA Right salpingectomy NA Table 2: Review of literature: EP in unusual sites infor women tubal pregnancy with previous salpingectomies. Gravity and Type of Site of ectopic Author Year Age Previous operation history Management parity fecondation pregnancy upper retroperitoneum right salpingectomy for tubal Ferland [11] 1991 32 G4,P0 IVF-ET abdomen (posterior LPTM pregnancy aspect of the right broad for pregnancies) LPS (bilateral salpingectomy ligament) Fisch [12] 1996 38 G2,P0 IVF-ET LPTM two tubal right uterine cornu LPS (bilateral salpingectomy for 28 G0 IVF-ET LPTM hydrosalpinx) left uterine cornu right salpingectomy for hydrosalpinx, Chen [13] 1998 33 G1,P0 right tuboplasty, successively left IVF-ET LPTM salpingectomy for tubal pregnancy) right uterine cornu 32 G0 bilateral tuboplasty for tubal disease IVF-ET head of pancreas LPTM Dmowsky LPS (bilateral salpingectomy for 2002 34 G0 IVF-ET LPTM [14] hydrosalpinx) tubal pregnancies) toabdomen the uterine ( lower fundus end and of LPS (bilateral salpingectomy for two the omentum, adherent Cormio [15] 2003 30 G2,P0 IVF-ET cecum) LPTM LPS (bilateral salpingectomy for Hsu [16] 2005 29 G0 IVF-ET ovary MTX and LPS hydrosalpinx) Bilateral salpingectomies for two LPS then Seshadri et al. 2010 37 G0 previous ectopic pregnancies in 2001 IVF-ET ovary converted to [42] and 2004 LPTM LPS (bilateral salpingectomy for Cruciani [17] 2011 26 G0 IVF-ET ovary LPS Sadia hydrosalpinx) LPS then Right (2007) and left (2009) Khandaker et 2015 32 G5P1 IVF-ET ovary converted to salpingectomy for tubal pregnancies al. [43] LPTM tubal pregnancies right LPS salpingectomy after two Xu Ying, et al. Emergency 2016 28 G3P0 + left bipolar IVF-ET ovary [39] LPTM Case report salpingectomy for hydrosalpinx Case 1 discharged on day 2 postoperatively and no short- or long-term complications were reported [11-17]. th A 36 years old patient referred to our center to ascertain implantation after IVF-ET at the 58 gestational day. The patient had a history of right salpingectomy for GEU. HCG was 2293 IU/L. Obstetrical examination showed a small uterus with no pain. Ultrasound revealed no intrauterine pregnancy, but a gestational sac of 14 mm adjacent to the right uterine cornu with no signs of embryo viability. Power and color Doppler revealed the presence of the vascular ring with a strong peri-trophoblastic vascular to attempt medical management using the single dose regimen activity (Figures 1 & 3).2 After careful counseling it was decided with i.m. MTX (50mg/m ). Four days after treatment the patient Figure 1: The gestational sac of 13 x 14 mm with no signs complained strong abdominal pains, low blood pressure and severe of embryonic viability in the right interstizial tubal stump anemia. Laparoscopy was carried out and the right tubal stump at 58 days of pregnancy (Case 1). was removed. Histological examination confirmed the diagnosis of ectopic pregnancy of the right tubal stump. The patient was Cite this article: . Tubal 8181 : Di Tucci C, Schiavi Michele C, Iacobelli V, Donfrancesco C, Piccioni Maria G, Perniola Ga, Muzii L, Benedetti Panici P Stump Pregnancy in ART Patients Two cases of ectopic stump pregnancy after IVF-ET.
Load more

Recommended publications
  • Ectopic Pregnancy of the Tubal Stump in ART Patients, Two Case Reports and a Review of the Literature
    Case Report iMedPub Journals Medical Case Reports 2017 www.imedpub.com Vol.3 No.3:32 ISSN 2471-8041 DOI: 10.21767/2471-8041.100067 Ectopic Pregnancy of the Tubal Stump in ART Patients, Two Case Reports and a Review of the Literature Piccioni MG1, Riganelli L1*, Donfrancesco C2,3, Savone D1, Caccetta J1, Merlino L1, Mariani M1, Vena F1 and Aragona C1 1Department of Gynecologic-Obstetrical and Urologic Sciences, University of Rome “Sapienza”, Rome, Italy 2Department of Feto-Maternal Medicine, Obstetrics and Gynecology, Portogruaro Hospital, Venice, Italy 3Department of Experimental Medicine, University of Rome “Sapienza”, Rome, Italy *Corresponding author: Riganelli Lucia, MD, Department of Gynecologic-Obstetrical and Urologic Sciences, University of Rome “Sapienza”, Umberto I Policlinico of Rome, Viale del Policlinico 155, 00161 Rome, Italy, Tel: +39 3928994062; E-mail: [email protected] Rec Date: September 24, 2017, Acc Date: September 29, 2017, Pub Date: September 30, 2017 Citation: Piccioni MG, Riganelli L, Donfrancesco C, Savone D, Caccetta J, et al. (2017) Ectopic Pregnancy of The Tubal Stump in ART Patients, Two Case Reports and A Review of The Literature. Med Case Rep Vol.3 No.3:32. Introduction Abstract Ectopic pregnancy represents a potentially serious medical and surgical condition for women during the reproductive age, Background: An ectopic pregnancy (EP) is the with the possibility to evolve in an emergency obstetrical development of an embryo outside of the uterus. A situation caused by the rupture and internal bleeding leading heterotopic pregnancy (HP) is a multiple pregnancy with to hypovolemic shock and maternal death during the first different sites of implantation, where one is intrauterine.
    [Show full text]
  • What Is the Effectiveness of Salpingectomy Compared with Salpingotomy in Improving Outcomes in Women with Tubal Ectopic Pregnancy?
    Ectopic pregnancy and miscarriage What is the effectiveness of salpingectomy compared with salpingotomy in improving outcomes in women with tubal ectopic pregnancy? Study details Participants Interventions Methods Outcomes and Results Comments Full citation Sample size Interventions Details Results Limitations Tahseen,S., Wyldes,M., A N=150 Salpingectomy This is a retrospective study Spontaneous intrauterine Retrospective comparative case- (n=97) carried out in the East pregnancy rate (number/total controlled study of Characteristics Birmingham Hospitals (%)) Not reported whether women laparoscopic vs Salpingotomy (Teaching) NHS Trust, UK. were trying to conceive laparotomy management (n=25) All patients operated on Salpingectomy: 38/97 (39.2) of ectopic pregnancy: an Not reported separately for laparoscopically for EP Salpingotomy: 12/25 (48) Outcome of intrauterine evaluation of reproductive salpingectomy and during the study period were pregnancy is not reported performance after radical salpingotomy groups identified. A control group vs conservative treatment was selected randomly from Unclear how fertility data was of tubal ectopic pregnancy, Inclusion criteria those operated on by obtained Journal of Obstetrics and laparotomy. Hospital case Gynaecology, 23, 189-190, Ectopic pregnancy notes were reviewed for Generally poor methodological 2003 details. An attempt was reporting made to contact all patients Ref Id Exclusion criteria regarding contraceptive use. No baseline characteristics Only one spontaneous IUP reported for salpingectomy vs. 69637 Not reported or EP was included per salpingotomy groups patient in the analysis. Country/ies where the Subsequent fertility was Unexplained missing data from study was carried out analysed in relation to initial 28/150 women treatment method and the UK state of the contralateral Blinding of participants and/or tube.
    [Show full text]
  • Salpingectomy Before Assisted Reproductive Technologies
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Springer - Publisher Connector Noventa et al. Journal of Ovarian Research (2016) 9:74 DOI 10.1186/s13048-016-0284-1 REVIEW Open Access Salpingectomy before assisted reproductive technologies: a systematic literature review Marco Noventa1, Salvatore Gizzo1, Carlo Saccardi1, Shara Borgato1, Amerigo Vitagliano1, Michela Quaranta2, Pietro Litta1, Michele Gangemi1, Guido Ambrosini1, Donato D’Antona1 and Stefano Palomba3* Abstract Salpingectomy is largely used in case of hydrosalpinx in infertile women scheduled for assisted reproductive technologies (ART), whereas there is no consensus on its role in absence of hydrosalpinx. The current is a systematic literature review to collate all available evidence regarding salpingectomy as fertility enhancement procedure before ART in infertile patients. Our primary endpoint was to assess the impact of the surgical procedure on ovarian reserve, and secondary outcomes were to evaluate its benefits and harms on ART outcomes. We identified 29 papers of which 16 reporting data on the impact of tubal surgery on ovarian reserve and 24 (11 previously included) on ART outcomes. Available data suggested an absence of variation in ovarian reserve markers after unilateral salpingectomy while contradictory results were reported for bilateral surgery. Considering ART outcomes, data reported a significant improvement in ongoing pregnancy/live-birth rate in treated subjects without significant reduction in ovarian response to gonadotropin stimulation. In case of tubal disease, a surgical approach based on unilateral salpingectomy may be considered safe, without negative effects on ovarian reserve and ovarian response to controlled ovarian stimulation whilst having a positive effect on pregnancy rate.
    [Show full text]
  • In Vitro Fertilization and Embryo Transfer As a Treatment for Infertility
    Alberta Heritage Foundation for Medical Research In vitro fertilization and embryo transfer as a treatment for infertility Paula Corabian March 1997 HTA 3 In vitro fertilization and embryo transfer as a treatment for infertility Paula Corabian March 1997 © Copyright Alberta Heritage Foundation for Medical Research, 1997 This Health Technology Assessment Report has been prepared on the basis of available information of which the Foundation is aware from public literature and expert opinion, and attempts to be current to the date of publication. It has been externally reviewed. Additional information and comments relative to the Report are welcome, and should be sent to: Director, Health Technology Assessment Alberta Heritage Foundation for Medical Research 3125 ManuLife Place, 10180 - 101 Street Edmonton Alberta T5J 3S4 CANADA Tel: 403-423-5727, Fax: 403-429-3509 ISBN 0-9697154-3-9 Alberta's health technology assessment program has been established under the Health Research Collaboration Agreement between the Alberta Heritage Foundation for Medical Research and the Alberta Health Ministry. Acknowledgments The Alberta Heritage Foundation for Medical Research is most grateful to the following persons for their comments on the draft report and for provision of information. Dr. K. J. Collier, Manitoba Health, Winnipeg. Dr. D. Cow, Health Insurance and Related Programs, Ministry of Health, Kingston, Ontario. Professor S. Daya, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario. Dr. J. Jarrell, Foothills Hospital, Calgary, Alberta. Dr. M. van Leeuwen, Health Council of the Netherlands, Rijswijk. Professor D. G. Moores, Faculty of Medicine, University of Alberta, Edmonton, Dr. M. Y. Pelletier, Régie de l’assurance-maladie du Québec, Montreal.
    [Show full text]
  • Renaissance of Surgical Recanalization for Proximal
    Original Article Renaissance of Surgical Recanalization for Proximal Fallopian Tubal Occlusion: Falloposcopic Tuboplasty as a Promising Therapeutic Option in Tubal Infertility Yudai Tanaka, MD, PhD*, Hiroto Tajima, MD, PhD, Shino Sakuraba, MD, Rise Shimokawa, MD, and Kazuhiko Kamei, MD From the Department of Obstetrics and Gynecology, Shonan IVF Clinic, Kanagawa, Japan (all authors). ABSTRACT Study Objective: To assess the clinical effectiveness of falloposcopic tuboplasty in tubal infertility. Design: Retrospective cohort study (Canadian Task Force classification II-3). Setting: Infertility clinic. Patients: Three hundred forty-five infertile patients (R2y) with a diagnosis of proximal tubal occlusion, either bilateral or unilateral, between January 2005 and January 2011. Intervention: Falloposcopic tuboplasty. Measurements and Main Results: Medical records for 345 patients with a diagnosis of proximal tubal occlusion were re- viewed. Of the 345 patients, 304 underwent falloposcopic tuboplasty, with successful recanalization achieved in 248 patients (81.6%). Ninety-one of the 304 patients (29.9%) became pregnant. Of these, 18 patients (19.8%) miscarried, and 4 (4.4%) had ectopic pregnancies in the recanalized tube. At 1-, 3-, 6-, and 9-month follow-up, the cumulative probability of conception was 23.1%, 50.6%, 73.6%, and 82.4%, respectively. Related complications included postsurgical infection (0.3%), perforation of the fallopian tube (1.3%), and accidental breakage of the catheter (4.9%) or the falloposcope (1.3%). Conclusions: Falloposcopic tuboplasty is safe and effective for treatment of tubal infertility. The pregnancy rate after fallo- poscopic tuboplasty is comparable to that after in vitro fertilization, which suggests that it can be an alternative to in vitro fertilization in women with tubal infertility.
    [Show full text]
  • Infertility Services
    Medical Coverage Policy Effective Date ............................................. 6/15/2021 Next Review Date ....................................... 6/15/2022 Coverage Policy Number .................................. 0089 Infertility Services Table of Contents Related Coverage Resources Overview .............................................................. 1 Acupuncture Coverage Policy ................................................... 1 Genetic Testing for Reproductive Carrier Screening General Background ............................................ 5 and Prenatal Diagnosis Medicare Coverage Determinations .................. 21 Hyperbaric Oxygen Therapy, Systemic & Topical Coding/Billing Information .................................. 21 Infertility Injectables References ........................................................ 29 Recurrent Pregnancy Loss: Diagnosis and Treatment Testosterone Therapy INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary
    [Show full text]
  • Reproductive Surgery in the Era of ART (Didactic)
    Reproductive Surgery in the Era of ART (Didactic) PROGRAM CHAIR William W. Hurd, MD G. David Adamson, MD Victor Gomel, MD Keith B. Isaacson, MD Sponsored by AAGL Advancing Minimally Invasive Gynecology Worldwide Professional Education Information Target Audience Educational activities are developed to meet the needs of surgical gynecologists in practice and in training, as well as, other allied healthcare professionals in the field of gynecology. Accreditation AAGL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AAGL designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS As a provider accredited by the Accreditation Council for Continuing Medical Education, AAGL must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course chairs, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Learners are able to assess the potential for commercial bias in information when complete disclosure, resolution of conflicts of interest, and acknowledgment of commercial support are provided prior to the activity.
    [Show full text]
  • Falloposcopy--A Prerequisite to the Proper Assessment of Tubal Infertility
    Wong et al REVIEW ARTICLES Falloposcopy—aprerequisitetotheproperassessment oftubalinfertility AYKWong,SMWalker Objective. To review the technique and results of falloposcopy, and the classification and management of fallopian tube disease. Data sources. Medline and non-Medline search of the relevant English literature, and personal experience. Study selection. Studies involving the use of falloposcopy to assess tubal status were selected for review. Data extraction. The procedure of falloposcopy and its possible problems and complications were studied. Results from falloposcopy were compared with those from conventional investigations of tubal status, and their correlation with pregnancy was evaluated. Data synthesis. Falloposcopy gives a better assessment of tubal status than conventional methods and can also predict the subsequent pregnancy rate. By falloposcopy, the decision of the mode of therapy for subfertility can be changed in more than 60% of patients. Conclusion. Examination of the fallopian tube using falloposcopy allows an accurate assessment of the tubal status to be made and is a prerequisite to deciding the most appropriate mode of assisted reproductive therapy. HKMJ 1999;5:76-81 Key words: Fallopian tube diseases/diagnosis; Fallopian tube disease/therapy; Infertility, female Introduction outcome of treatment such as tubal surgery is related to tubal status.4 By the more accurate assessment of Fallopian tube disease accounts for more than 30% of the endotubal status using transcervical falloposcopy, female subfertilities.1 In the investigation of tubal infer- patients can be triaged to the most appropriate mode tility, the goal must be to test the function of the fallo- of therapy to maximise pregnancy rates. This review pian tubes rather than to demonstrate their patency.1 describes the pitfalls of the conventional methods of Conventional methods used in tubal assessment, assessing tubal patency, and the technical aspects of such as hysterosalpingography (HSG) or laparoscopic and results from transcervical falloposcopy.
    [Show full text]
  • Hydrosalpinx and IVF: a Randomized Study (192 Cases)
    Togas Tulandi Department of Obstetrics and Gynecology McGill University Montreal, Quebec, Canada Declared receipt of honoraria or consultation fees by Ethicon Inc. What is left of Reproductive Surgery? Togas Tulandi MD, MHCM Professor of Obstetrics and Gynecology & Milton Leong Chair in Reproductive Medicine McGill University Redefining Reproductive Surgery Togas Tulandi MD, MHCM Professor of Obstetrics and Gynecology & Milton Leong Chair in Reproductive Medicine McGill University Vi ringrazio per avermi invitato a Milano What is Reproductive Surgery? • Surgery to correct anatomical disorders of the reproductive tract. • In practice, it has been limited to primary treatment of infertility for women with tubal disorders or endometriosis. Case 1 A 26 year old woman 5 IVFs and one miscarriage I. Reproductive Surgery as a primary treatment Pregnancy rate 12 mths after surgery • Adhesiolysis: 40% • Salpingostomy: 30.% • Endometriosis: 30.7% • Tubal anastomosis: 79.4% • IVF: 40.6% per cycle, ectopic rate 1.8% Procedure Authors No. Intra-uterine Ectopic rate rate Neo-salpingostomy Canis et al 87 33.3% 6.9% Fimbrioplasty Saleh & Dlugi 88 35% 1% Tubal anastomosis Yoon et al 186 79.4% 3.2% Ablation of state I & II Marcoux et al 172 30.7% 4% endometriosis Parazzini 51 23.5% 0% Excision of Beretta et al 32 50%* NA endometrioma Alborzi et al 52 59.4%* NA Fenestration Beretta et al 32 15%* NA Alborzi et al 48 23.3%* NA IVF Authors No. PR per transfer Ectopic rate SART 2007 67,922 40.6% 1.8% Reproductive Surgery as a primary treatment 1. The place of reproductive surgery as a primary treatment of infertility is limited 2.
    [Show full text]
  • Management of Tubal Obstructions
    ______________________________________________________________________________ Management of Tubal Obstructions Diaa M. El-Mowafi Professor, Department of Obstetrics and Gynaecology, Benha Faculty of Medicine, Egypt Researcher and Educator, W ayne State University, MI, USA Fellow and Lecturer, Geneva University, Switzerland Consultant and Head of Obstetrics & Gynecology Department, King Khalid General Hospital, Hafr El-Batin, Saudi Arabia Nkele Ndeki Ngoh Registrar, Geneva University, Switzerland Direct Correspondence To: Dr. Diaa El-Mowafi Consultant and Head Department of Obstetrics & Gynecology King Khalid General Hospital Hafr Al-Batin 31991 Saudi Arabia dmowafi@ yahoo.com How to cite this article: El Mowafi DM, Ngo NN. Management of Tubal Obstructions. Geneva Foundation for Medical Education and Research. 15 Nov. 2006. Available from: http://www.gfmer.ch/Presentations_En/Pdf/Tubal_obstruction_Mowafi_2006.pdf 2 BSTRACT Management of the tubal factor could have the most difficult and debatable role in infertility management. The methods used ranged from gaseous insufflation, hydrotubation, laparotomy, and traditional microsurgery to the more recent tactile or hysteroscopic catheterization, and laparoscopic surgery. Results of the in-vitro-fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI) were compared to the surgical procedures' results and the debate continues: shall we proceed directly to assisted reproductive techniques or should surgery be tried first in tubal obstructions? 3 INTRODUCTION Fallopian tube disease is responsible for more than 20% to 30% of female infertility worldwide (1). The lesions range from intrinsic intraluminal malformation of cilia, mucosa, or muscularis, to gross occlusion of the lumen. Tubal obstruction has preoccupied many gynaecologists for centuries. Its importance as a major cause of infertility was recognised by Burns in 1809 (2).
    [Show full text]
  • IFFS Guidelines: Tubal Surgery
    International Federation of Fertility Societies Global Standards of Infertility Care Standard 9 Tubal Surgery Recommendations for Practice Name Tubal surgery Version number 9.1/IFFS/Standards Author Standards and Practice Committee, Lead author - Ossie Petrucco. Date of first release 20th October 2011 Date approved by IFFS 16th October 2011 Date of review October 2015 Introduction The goal of IFFS Practice Standards are to provide policy- and decision-makers and the clinical and scientific community with a set of recommendations that can be used as a basis for developing or revising institutional or national guidelines on selected practice recommendations for infertility practice. The document addresses minimal standards of practice but does not provide rigid guidelines but rather gives recommendations that provide the basis for rationalizing the provision of infertility services in view of the most up-to-date information available. Because country situations and programme environments vary so greatly, it is inappropriate to set firm international guidelines on infertility practice. However, it is expected that institutional and national programmes will use these guidance documents for updating or developing their own infertility guidelines in the light of their national health policies, needs, priorities and resources. The intent is to help improve access to, quality of, and safety of infertility and assisted conception services. These improvements must be made within the context of users’ informed Tubal Surgery 9.1/IFFS/Standards and Practice/July 2014 Page 1 choice and medical safety. Adaptation is not always an easy task and is best done by those well-acquainted with prevailing health conditions, behaviours, and cultures.
    [Show full text]