Chapter 44: Pelvic Adhesive Disease

Hilgers TW

Reproductive Surgery Tubal Surgery

Chapter 44: Pelvic Adhesive Disease

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 591-602, 2004

RRM Academy Synopsis

Infertility becomes more common after each repeat pelvic infection

A 2004 textbook chapter reports that infertility follows one episode of pelvic inflammatory disease in about 12 percent of women. It cites over 50 percent after three or more episodes. The chapter adds ultrasound and hormone findings from women with adhesions.

Key Findings

Infertility follows one episode of pelvic inflammatory disease in approximately 12 percent of women, two episodes in 25 percent, and three or more episodes in greater than 50 percent.
Up to 40 percent of women with untreated chlamydia may develop pelvic inflammatory disease. The chapter lists tubal pregnancy at about 9%, chronic pelvic pain at 18%, infertility at 20%.
Among 25 women with complete blockage of the proximal tube, salpingitis isthmica nodosa was the most common cause, found in 10 women (40.0%).
Women with adhesions and regular cycles frequently had ovulation defects on ultrasound. Their luteal-phase progesterone was low, as it was in women with proximal or distal tubal blockage.
The chapter says the 2001 society recommendation of IVF for advanced tubal disease rests predominantly on retrospective analyses. Randomized trials were not done, and reconstructing the distal tube was not compared.

RRM Context

The chapter describes a NaProTechnology evaluation. The evaluation pairs surgical assessment of the tubes with cycle charting, ultrasound and hormone review. Treatment then covers the adhesions and the ovulatory findings. A semen analysis is part of the same evaluation, so both partners are assessed. IVF bypasses damaged tubes and leaves the disease in place.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter covers pelvic adhesive disease arising from infection and from proximal tubal occlusion, including Chlamydia and gonorrhea, salpingitis isthmica nodosa and the classification of adnexal adhesions. In patients with regular cycles and pelvic adhesive disease, serial ultrasonography showed ovulation defects in 56.5 percent of menstrual cycles, most commonly a luteinized unruptured follicle. Targeted hormone evaluation at the Pope Paul VI Institute showed markedly suboptimal luteal-phase progesterone in patients with pelvic adhesive disease and significantly decreased progesterone in those with proximal or distal tubal occlusion. Hilgers questions the professional recommendation of IVF for advanced tubal disease, stating that it rests mainly on retrospective analyses, and states that microsurgical fimbrioplasty with reconstruction of the distal tube has been shown to produce pregnancy rates equivalent to IVF.

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Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.

12 min read

Topics

Reproductive Surgery › Tubal Surgery › Tubal Cannulation · Infertility › Tubal Factor › Distal Tubal Disease

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 44: Pelvic Adhesive Disease

Infertility becomes more common after each repeat pelvic infection

Key Findings

RRM Context

Abstract

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Topics

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