|Prognostic Significance of Diagnostic Laparoscopy for Spontaneous Fertility|
|Authors:||Ben W. J. Mol, M.D., Patricia Swart, M.D., Patrick M. M. Bossuyt, Ph.D., and Fulco van der Veen, M.D., Ph.D.|
OBJECTIVE: To determine the prognostic significance of laparoscopy results for
STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and
laparoscopy for subfertility in our department between May 1985 and November
1987 were identified from medical records. The impact of tubal occlusion, hydro-
salpinx and adhesions as detected at laparoscopy was studied. Kaplan-Meier
curves for the occurrence of spontaneous intrauterine pregnancy were constructed
for patients without tubal pathology, with mild tubal pathology (unilateral
pathology or adhesions) and with severe tubal pathology (bilateral pathology).
Fecundity rate ratios (FRR) were calculated to express the association between
laparoscopy and the occurrence of spontaneous intrauterine pregnancy.
RESULTS: Of the 200 cases that could be analyzed, 129 (65%) showed no tubal
occlusion on laparoscopy, 40 (20%) had unilateral tubal occlusion, and 31 (15%)
had bilateral tubal occlusion. Unilateral hydrosalpinx was present in 13 (7%)
patients, whereas 19 (10%) patients had bilateral hydrosalpinx. Adjusted FRRs
were 0.65 and 0.20 for unilateral and bilateral tubal occlusion, and 0.46 and
0.32 for unilateral and bilateral hydrosalpinx. Peritubal adhesions were
detected in 43% of patients and seemed to have no prognostic significance.
CONCLUSION: Severe tubal pathology detected at laparoscopy affects fertility
prospects strongly. However, since spontaneous intrauterine pregnancies occurred
even in patients with bilateral tubal occlusion at laparoscopy, this technique
should not be considered the gold standard in the diagnosis of tubal
infertility. (J Reprod Med 1999;44:81-86)
|Keywords:||infertility, female; laparoscopy; prognosis|
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