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Techniques for pelvic surgery in subfertility.

G Ahmad, A Watson, P Vandekerckhove

    The Cochrane Database of Systematic Reviews
    |April 21, 2006
    PubMed
    Summary
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    Limited data show no clear benefit of tubal surgery over no treatment or alternative therapies for tubal infertility. Further randomized controlled trials are needed to establish the efficacy of various surgical techniques and approaches.

    Area of Science:

    • Reproductive Medicine
    • Surgical Innovation
    • Evidence-Based Medicine

    Background:

    • Tubal surgery, once a primary fertility treatment, is less common due to in-vitro fertilisation (IVF).
    • Various surgical techniques exist for repairing damaged fallopian tubes.

    Purpose of the Study:

    • To evaluate the role of tubal surgery in managing tubal infertility.
    • To assess different surgical techniques for treating tubal infertility.

    Main Methods:

    • Systematic review of randomized controlled trials (RCTs) identified through Cochrane registers and databases (MEDLINE, EMBASE).
    • Searched for RCTs comparing tubal surgery versus no treatment, alternative treatments, magnification, CO2 laser, operative laparoscopy, and other surgical techniques.
    • Extracted data on pregnancy outcomes, expressed as odds ratios with 95% confidence intervals.

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    Main Results:

    • Seven RCTs were identified; no RCTs compared surgery versus no treatment or alternative treatments.
    • No evidence supported or refuted the use of CO2 laser, magnification, or prostheses in salpingostomy.
    • Laparoscopic surgery showed no significant benefit over laparotomy for tubal patency or pregnancy rates.

    Conclusions:

    • Current limited data do not demonstrate a benefit of tubal surgery over no treatment or alternative therapies.
    • No evidence supports microsurgery over standard techniques, laparoscopy over laparotomy, CO2 laser, or electrocoagulation over thermocoagulation.
    • High-quality RCTs are recommended to clarify the role and optimal techniques for tubal surgery in infertility management.