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First and subsequent pregnancies after tubal microsurgery: evaluation of the fertility index
W R Gillett1, R H Clarke, G P Herbison
1Department of Obstetrics and Gynaecology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. wayne.gillett@stonebow.otago.ac.nz
Objective:
To determine the number of children born after a tubal microsurgical operation and to evaluate the fertility index, a long-term measure of reproductive potential.
Design:
A case series involving a follow-up questionnaire.
Setting:
A tertiary care university hospital.
Patient(S):
Three hundred twelve women undergoing microsurgery for tubal disease.
Interventions:
A range of open microsurgical procedures including reversal of sterilizations.
Main Outcome Measure(S):
Cumulative pregnancy rates to the first and second normal pregnancies and calculation of the fertility index.
Result(S):
The 2-year cumulative pregnancy rates (probability +/- SE) for a first normal pregnancy for proximal disease, distal disease, tubal reanastomoses, and tubal adhesions were 0.51 +/- 0.05, 0.29 +/- 0.06, 0.47 +/- 0.06, and 0.30 +/- 0.07, respectively. Of the 288 (92%) women responding to the questionnaire, 142 women had at least one child. Of the 100 women who wanted a second child, 68 succeeded, the proportions being similar in each surgery category. The fertility index described restoration of normal fertility in 30%, 12%, 34%, and 23% for women with proximal disease, distal disease, anastomotic procedures, and adhesion disease, respectively.
Conclusion(S):
The fertility index is a useful measure of long-term reproductive potential. The high recurrent pregnancy rate emphasizes the value of microsurgery in restoring normal fertility to some women.