Obrzut, B., & Obrzut, M. (2022). Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease? Journal of clinical medicine. https://doi.org/10.3390/jcm11123278
Obrzut B, Obrzut M. Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease? Journal of clinical medicine. 2022. doi:10.3390/jcm11123278
Obrzut, Bogdan, and Marzanna Obrzut. "Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease?" Journal of clinical medicine, 2022.
Live Birth After Distal Tubal Surgery Is Estimated at 9% to 69%
A 2022 review estimates that live birth after tubal surgery ranges from 9% in severe to 69% in mild damage among women with distal tubal disease. The review draws on observational studies. It reports no randomized trials comparing surgery with IVF or expectant management.
About 3 in 10 women with hydrosalpinx had a natural clinical pregnancy after salpingoneostomy. Source: Obrzut B et al., 2022, PMID 35743348.Study at a glance, observational studies of 2810 patients: Live Birth After Distal Tubal Surgery Is Estimated at 9% to 69%. Source: Obrzut B et al., 2022, PMID 35743348.
Key Findings
Tubal factor infertility makes up 25–40% of female infertility, and about 80% of tubal disease sits in the distal segment of the tube.
Pooled across 22 observational studies of 2810 patients, salpingoneostomy for hydrosalpinx was followed by natural clinical pregnancy in 27% and live birth in 25%.
In one study, live births followed salpingostomy in 39% of women with stage I tubal disease and 9% with stage III.
A retrospective study of 3254 patients found an intrauterine pregnancy rate of 72.8% and a live-birth rate of 66.8% with neosalpingostomy and salpingo-ovariolysis.
Ectopic pregnancy risk after salpingoneostomy was 2.0–17.4%, against 2.1–11% for patients with tubal factor after ART.
Interpretation
The review gathers observational studies of distal tubal disease. The studies use different classifications and inclusion criteria, and surgical techniques vary. Surgery results are mostly reported per patient over a set observation period. ART results are reported per cycle, such as 28.2% live births per cycle initiated across all ages in a 2020 registry extrapolation for tubal factor infertility. The authors name this mismatch as a main reason no adequate trials compare outcomes. Surgical ranges depend on damage severity and describe selected patients.
RRM Context
Restorative reproductive medicine aims to repair the tube and restore its function. The authors state that IVF does not restore tubal function. An infertile couple remains infertile after the procedure. The authors report that many gynecologists no longer perform corrective tubal procedures. They call prevention of secondary adhesions crucial in reproductive surgery. Adhesion prevention carries the same weight in RRM surgical care.
Our editorial summary of this paper, not the article's abstract.
Abstract
Tubal diseases account for 25-40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area.
