Reproductive Surgery · Tubal Surgery
RRM Academy Synopsis
One woman conceived naturally after tube repair surgery
A case report finds that a 33-year-old woman with blocked tubes conceived naturally ten weeks after robotic fimbrioplasty, surgery that reopens the fringed end of a tube. She had three years of infertility after two earlier births. Pelvic infection had mildly blocked the ends of both tubes.
Key Findings
- The patient was 33 with three years of secondary infertility. Her hysterosalpingogram (an X-ray dye test of the tubes) found mild hydrosalpinx and distal occlusion in both tubes.
- Her ovarian reserve and hormone evaluation were normal. Ultrasound was normal.
- Surgeons found Fitz-Hugh-Curtis changes, bilateral filmy adhesions and distal occlusion. They freed the adhesions and repaired both tube ends. Repeat chromotubation confirmed patency on both sides.
- Recovery was uncomplicated. She conceived spontaneously ten weeks later, and early ultrasound confirmed an intrauterine pregnancy.
Interpretation
This is a single-patient case report. A case report shows that an outcome can happen. The design cannot show how often it happens, or that the surgery caused the pregnancy. The authors chose a patient with favorable findings: filmy adhesions, intact fimbrial lining, mild hydrosalpinx and normal ovarian reserve. Her partner's semen analysis was not checked, though she had two earlier normal pregnancies with her husband. No operative photographs were taken. The authors credit their microsurgical technique for the quick conception, a claim one case cannot test. They state that success depends on careful patient selection and minimal tubal damage.
RRM Context
Restorative reproductive medicine repairs the underlying problem. Fimbrioplasty does that for a damaged tube. The authors note that hydrosalpinx can harm embryos and lower pregnancy rates even with IVF. IVF bypasses the tubes without repairing them. The authors also cite reviews, a Cochrane analysis among them, that support considering reconstructive surgery in well-selected patients.
Abstract
Pelvic inflammatory disease (PID) remains a major cause of tubal factor infertility. Although in vitro fertilization (IVF) has largely replaced reconstructive surgery, selected patients with mild tubal damage may still achieve natural conception after surgical repair. This case highlights a spontaneous conception following bilateral fimbrioplasty in a patient with mild post-PID distal tubal occlusion. A 33-year-old, gravida 4 para 2, woman presented with three years of secondary infertility. Hysterosalpingogram (HSG) showed mild bilateral hydrosalpinx and distal tubal occlusion, with normal ovarian reserve and hormonal evaluation. The patient underwent robotic fimbrioplasty on July 23, 2025. Operative findings included Fitz-Hugh-Curtis changes, bilateral filmy adhesions, and grade-I distal occlusion. Bilateral adhesiolysis and fimbrioplasty were performed with restoration of tubal patency on chromotubation. The postoperative course was uncomplicated. Ten weeks after surgery, the patient conceived spontaneously with a normal intrauterine pregnancy. Tubal reconstructive surgery remains a valuable fertility-preserving option for selected patients who decline or lack access to IVF. Success depends on careful patient selection, minimal tubal damage, and meticulous microsurgical technique. Tubal reconstruction can offer selected women an affordable, fertility-preserving option, especially in low-resource settings where IVF is inaccessible.
