Franjoine, S. E., Bedaiwy, M. A., AbdelHafez, F. F., Geng, C., & Liu, J. H. (2015). Clinical Effectiveness of Modified Laparoscopic Fimbrioplasty for the Treatment of Minimal Endometriosis and Unexplained Infertility. Minimally invasive surgery. https://doi.org/10.1155/2015/730513
Franjoine SE, Bedaiwy MA, AbdelHafez FF, Geng C, Liu JH. Clinical Effectiveness of Modified Laparoscopic Fimbrioplasty for the Treatment of Minimal Endometriosis and Unexplained Infertility. Minimally invasive surgery. 2015. doi:10.1155/2015/730513
Franjoine, Sarah E., et al. "Clinical Effectiveness of Modified Laparoscopic Fimbrioplasty for the Treatment of Minimal Endometriosis and Unexplained Infertility." Minimally invasive surgery, 2015.
Fimbrioplasty linked to more pregnancies in women 35 and younger
Women 35 and younger got pregnant more often with modified fimbrioplasty than with laparoscopy alone. About 5 out of 10 got pregnant, against about 3 out of 10. This cohort study followed 137 women with minimal endometriosis or unexplained infertility at one center, from 2006 to 2012.
Pregnancy, women 35 and younger: Modified fimbrioplasty, 51.5 in 100; Laparoscopy alone, 28.8 in 100. Source: Franjoine SE et al., 2015, PMID 26064680.Study at a glance, cohort study of 137 women: Fimbrioplasty linked to more pregnancies in women 35 and younger. Source: Franjoine SE et al., 2015, PMID 26064680.
Key Findings
Overall, 40.0% of the 50 women who had modified laparoscopic fimbrioplasty (MLF) became pregnant, against 28.7% of the 87 who had diagnostic laparoscopy alone (p = 0.13).
Among women 35 and younger, 51.5% (17 of 33) of the MLF group and 28.8% (19 of 66) of the control group became pregnant (p = 0.02).
Among women over 35, pregnancy rates were 17.6% with MLF and 28.6% with laparoscopy alone (p = 0.45).
Average time to pregnancy was 13.4 weeks with MLF and 18.4 weeks with laparoscopy alone (p = 0.27).
Surgical complications were minimal in both groups: 0% with MLF and 3.5% with laparoscopy alone (p = 0.29).
Interpretation
This cohort study compared modified fimbrioplasty added to laparoscopy against laparoscopy alone, at one center from 2006 to 2012. More women got pregnant with the added procedure. The gain was clearest in women 35 and younger. Time to pregnancy was also shorter with modified fimbrioplasty. The findings support larger studies of this approach.
RRM Context
The authors note that minimal endometriosis can be missed at laparoscopy, so some women are labeled with unexplained infertility. That fits the RRM view that unexplained infertility is undiagnosed. MLF targets subtle problems of the fimbria, the fringed tube end that catches the egg. The authors propose it only as an add-on when laparoscopy is already planned.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To study the reproductive outcomes of modified laparoscopic fimbrioplasty (MLF), a surgical technique designed to increase the working surface area of the fimbriated end of the fallopian tube. We postulated that an improvement in fimbrial function through MLF will improve reproductive outcomes.
Design
Retrospective cohort study.
Setting
Academic tertiary-care medical center.
Patients
Women with minimal endometriosis or unexplained infertility, who underwent MLF during diagnostic laparoscopy (n = 50) or diagnostic laparoscopy alone (n = 87).
Intervention
MLF involved gentle, circumferential dilatation of the fimbria and lysis of fimbrial adhesions bridging the fimbrial folds.
Main Outcome Measures
The primary outcome was pregnancy rate and the secondary outcome was time to pregnancy.
Results
The pregnancy rate for the MLF group was 40.0%, compared to 28.7% for the control group. The average time to pregnancy for the MLF group was 13 weeks, compared to 18 weeks for the control group. The pregnancy rate in the MLF group was significantly higher for patients ≤35 ys (51.5% versus 28.8%), but not for those >35 ys (17.6% versus 28.6%).
Conclusion
MLF was associated with a significant increase in pregnancy rate for patients ≤35 ys.
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.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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