[Surgical advancements in reproductive medicine with emphasis on tubal disorders]

Achieving patency of the Fallopian tubes by selective transcervical hysterosalpingography, transcervical tuboplasty using PTCA-balloon catheters and microsurgical techniques has a success rate in excess of 90%, however, the pregnancy rates following these procedures is still less than 50%. Thus, the surgical approach for the treatment of tubal infertility which may improve post therapeutic pregnancy rates remain as yet unsolved problems. Modalities proposed include tubal transplants and prosthetic functional tubes. The purpose of surgical approaches to treat tubal infertility is to regain the physiologic ability to become pregnant without further clinical intervention. This has the advantage of reducing both economic and psychologic stress in the previously infertile couple, thus is clinically highly desirable, when achievable. However as there are limits for the indications of these procedures, for instance in occluded tubes, where disease has caused irreversible damage to the tubal endothelium, physical restoration of patency may not restore fertility. Thus, this discussion covers the limitations of surgical procedures and alternate procedures when surgical procedures are inadequate. We further investigated the tubal influences on the establishment and development of the zygote, and the tubal influences such as pressure and exudate dynamics on their transport within the tube. Thus, the advances in enhanced fertility studies, including in vitro fertilization have led more definitive understanding of fertilization, development of the zygote and its nidation, necessitating more intensive investigation of tubal physiology. In conclusion, where possible, surgical procedures which may allow physiologic pregnancies without additional clinical intervention are an attractive approach which should be utilized maximally when acceptable pregnancy rates can be expected.