The information presented regarding endoscopic surgery and IVF outcome is necessary in order to practice clinical reproductive endocrinology. There are effects upon indications for assisted reproductive technologies as well as outcomes, which will be presented.
A majority of the 20th century pelvic surgery was the only treatment available for tubouterine factor infertility. There was considerable success in reversing the iatrogenic tubal occlusion from ampullary isthmic tubal ligations. Endoscopic technology vastly improved the diagnostic and therapeutic modalities available. However, improved IVF results and consistently poor term pregnancy rates from distal tubal reconstructive surgery has relegated reconstructive surgery to less frequently utilized therapeutically by reproductive endocrinologists.
Adverse as well as positive influences of reproductive surgery upon IVF pregnancy rates are reviewed. Myomectomy and ovarian cystectomy remain the most commonly performed procedures, creating adverse consequences specific to the incidence of postoperative adhesion formation. However, the limiting effect of patent hydrosalpinges upon implantation rates from embryo transfers are reviewed. The options of laparoscopic and/or hysteroscopic occlusion techniques are described. The implications of hysteroscopic evaluation of the endometrial cavity on IVF patients are explored. The relationship between assisted reproductive technologies and endoscopic surgery should in fact be complementary. |
