Fimbrio-ovarian relationship in unexplained infertility

The role of defective fimbrio-ovarian relation in cases of unexplained infertility has not been extensively studied. The aim of the study was to assess the role of fimbrio-ovarian relation as an investigative modality in women with unexplained infertility. We also aimed to evaluate the efficacy of superovulation and freeing the fimbria-ovarica in increasing the conception rate of women with unexplained infertility.

This was a prospective study where out of 80 infertile couples, 19 women with unexplained infertility were recruited as study group. Fifteen fertile women were recruited as control group. During laparoscopy the length of the fimbria-ovarica and the ovulation border was measured. The fimbrio-ovarian accessibility test was demonstrated by holding the tubal fimbria by a non-traumatizing grasper and their ability to reach or cover the ovulation site. The freeing of the fimbria-ovarica was done, if its length was less than 2 cm. All cases were given ovulation induction for consecutive six cycles and were followed up to document any conception.

The mean length of the fimbria-ovarica was significantly less in patients with unexplained infertility (2.5 +/- 0.6 vs. 3.55 +/- 0.8 cm). The mean length of the ovulation border was not significantly different in cases and controls (2.95 +/- 0.6 vs. 3.55 +/- 0.5 cm). The fimbrio-ovarian accessibility test was positive in 6 (31.5%) cases and in 14 (93%) controls. The fimbrio-ovarian accessibility test was negative in 13 (68.4%) cases and in 1 (7%) control. Out of the 13 cases with negative FOAT, 7 had fimbrial length less than 2 cm and in whom the freeing of fimbria-ovarica was done because of severe resistance during stretching. Out of 7 patients in whom freeing of fimbria-ovarica was done 3 conceived (42.8%). Out of the 12 patients who got only ovulation induction 3 conceived (25%).

Fimbrio-ovarian accessibility test appears to be a promising investigative modality to assess ovarian pick-up in patients with unexplained infertility. Correcting fimbrio-ovarian relation (freeing short fimbria-ovarica) improves pregnancy rate in women with unexplained infertility.