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Reconstructive pelvic operations for in vitro fertilization.

J E Garcia, H W Jones, A A Acosta

American Journal of Obstetrics and Gynecology

|September 15, 1985

Summary

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Surgical lysis of adhesions and ovarian suspension improved fertility in women with severe pelvic adhesions. In vitro fertilization resulted in 14 pregnancies, demonstrating a significant improvement for many patients.

Area of Science:

Reproductive Medicine
Surgical Gynecology

Background:

Severe pelvic adhesions often cause long-standing infertility.
Previous surgeries like laparotomies can lead to extensive adhesions, complicating fertility treatments.

Purpose of the Study:

To evaluate the efficacy of surgical lysis of adhesions, bilateral salpingectomy, and ovarian suspension in infertile patients with severe pelvic adhesions.
To assess the success rate of in vitro fertilization (IVF) following these surgical interventions.

Main Methods:

Surgical procedures including lysis of adhesions, bilateral salpingectomy, and ovarian suspension were performed on 54 patients.
Ovulation induction using gonadotropins (human menopausal gonadotropin, pure follicle-stimulating hormone, human chorionic gonadotropin) was administered to 39 patients undergoing IVF.

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Oocyte retrieval, embryo transfer, and pregnancy outcomes were monitored.

Main Results:

Fourteen pregnancies were achieved after in vitro fertilization and embryo transfer.
Significant improvement in fertility was observed in most patients, despite adhesion recurrence in four cases.
The procedures were performed on patients with infertility linked to prior surgeries or endometriosis.

Conclusions:

Surgical intervention for severe pelvic adhesions can improve fertility outcomes.
In vitro fertilization following surgical adhesiolysis and ovarian suspension offers a viable option for achieving pregnancy in selected patients.
While adhesion recurrence is possible, the overall success rate indicates the benefit of these combined approaches.