Fertility enhancing surgery
Epublication WebSurg.com, Jun 2012;12(06). URL: http://websurg.com/doi/lt03enwatrelot003
Reproductive surgery does not solely include tubal surgery, but also uterine surgery (surgery for malformations and myomas) and treatment for endometriosis. In tubal surgery, distal lesions can either be classified as phimosis (partial obstruction) or hydrosalpinx (complete obstruction). Phimosis requires fimbrioplasty; hydrosalpinx needs a neosalpingostomy. Proximal lesions may be functional (spasm, mucosal plugs) or organic (tubal clips, SIN, PID) which need resection and anastomosis. Tubal surgery does not rival with IVF but it is a complementary tool that may be used in selected cases. To achieve adequate selection of cases suitable for tubal surgery, it is mandatory to accurately evaluate the uterine cavity, the tubal patency, the tubo-peritoneal environment (adhesions) as well as the tubal mucosa. Non-invasive tests (hysterosalpingography, hysterosonography) do not permit to give a precise analysis of the lesions. Endoscopy is the only way to solve this problem. Fertiloscopy allows an exploration of the pelvis and salpingoscopy allows for an adequate and simple evaluation of the mucosal tube (easier than laparoscopy). In case of normal salpingoscopy with abnormal fertiloscopy, surgery is recommended. In other cases, the recommended treatments are intrauterine insemination (IUI) or in vitro fertilization (IVF). In case of surgery, it is necessary to apply microsurgical principles: proper magnification, sufficient light, respect of tube (no touch technique), meticulous hemostasis (bipolar), avoidance of peritoneal desiccation, acute ovaro-salpingolysis, use of microsurgical instrumentation and microsuture, prevention of adhesions. When all of these criteria are respected, good results are obtained in terms of pregnancy rate.