[Fertility-promoting intervention in the Fallopian tubes--is fertility surgery worthwhile?]

A prospective study of 48 cases of microsurgery for infertility caused by tubal occlusion carried out at Odense University Hospital during the years 1989-92 is presented. The follow-up period was between one to five years. The overall term pregnancy rate was 25% and the ectopic pregnancy rate 19%. Based on a simple peroperative scoring system all patients could be allocated to two clearly separated prognostic categories with term pregnancy rates of 42% and 15% and ectopic pregnancy rates of 14% and 21% respectively. In accordance with other recent studies, this study showed that acceptable term pregnancy rates, i.e., about 40-50%, were achieved by salpingolysis and fimbrioplasty/salpingostomy only in cases where the adhesions were few, the tubal wall normal or thin and the endosalpinx appeared macroscopically normal. In cases of medial stenosis/occlusions, irrespective of the occurrence of lateral tubal damage, the results are poor. The only exception to this is reversal of sterilisation. Today the cumulated term pregnancy rate after three IVF-attempts in the same group of patients is about 55-60%. If microsurgical infertility treatment is to be considered an option, it is imperative that the success rate is comparable to that of the IVF success rate. This is only to be expected with stringent preoperative selection using a simple scoring system. It is concluded that microsurgical and certainly macrosurgical treatment of infertility should be abandoned in the vast majority of cases.