Role of tubal surgery in the era of assisted reproductive technology: a committee opinion
Practice Committee of the American Society for Reproductive Medicine
Committee members:Samantha Pfeifer, Richard Reindollar, Rebecca Sokol, Clarisa Gracia, Robert Rebar, Andrew La Barbera, Randall Odem, Daniel Dumesic, Margareta Pisarska, Samantha Butts, Eric Widra, Gregory Fossum, Jay Sandlow, Mitchell Rosen, Michael Vernon, …
Practice Committee of the American Society for Reproductive Medicine (2015). Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertility and Sterility, 103(6), e37-e43. https://doi.org/10.1016/j.fertnstert.2015.03.032
Practice Committee of the American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril. 2015;103(6):e37-e43. doi:10.1016/j.fertnstert.2015.03.032
Practice Committee of the American Society for Reproductive Medicine. "Role of tubal surgery in the era of assisted reproductive technology: a committee opinion." Fertility and Sterility, vol. 103, no. 6, 2015, pp. e37-e43.
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RRM Academy Synopsis
Tubal reversal had higher cumulative pregnancy than IVF under age 37
A 2015 committee opinion reports that among women under 37, tubal ligation reversal had more pregnancies over time than IVF. It cites one retrospective cohort. The opinion also reviews surgery at each site of tubal blockage.
Study at a glance, committee opinion: Tubal ligation reversal had more pregnancies than IVF under age 37. Source: Practice Committee of the American Society for Reproductive Medicine, 2015, PMID 25958255.
Key Findings
In a meta-analysis of women with bilateral proximal tubal occlusion, cannulation opened approximately 85% of tubes, approximately half of patients conceived, and approximately one-third of the opened tubes closed again.
After neosalpingostomy for mild hydrosalpinges, pregnancy in the uterus occurred at rates from 58% to 77% and ectopic pregnancy from 2% to 8%. For severe disease they were 0%–22% and 0%–17%, respectively.
In two meta-analyses, IVF pregnancy, implantation, and delivery rates were approximately 50% lower with hydrosalpinges. Randomized trials reported salpingectomy restored pregnancy and live birth rates to levels similar to women without hydrosalpinx.
For women under 40, microsurgical reversal of tubal sterilization reached a cumulative intrauterine pregnancy rate above 90% by 2 years, against 70% with non-microsurgical technique.
A retrospective cohort found tubal anastomosis had significantly higher cumulative pregnancy than IVF in women under 37, no significant difference at 37 or older, and almost half the average cost per delivery.
Interpretation
This committee opinion reviewed published outcomes for tubal surgery and IVF. The authors rated the evidence as good for microsurgical reversal, and fair for tubal cannulation and for fimbrioplasty and neosalpingostomy in mild hydrosalpinges, in young women with no other major infertility factor. IVF showed a higher per-cycle pregnancy rate. The authors note that surgery results are counted per patient while IVF results are counted per cycle. The American Society for Reproductive Medicine wrote the opinion. The findings support further study that compares the two approaches directly.
RRM Context
Tubal repair works on the blocked or damaged tube itself. The committee lists one-time surgery as an advantage, after which patients may try to conceive every month and may conceive more than once. The committee also advises a semen analysis early in the work-up, which keeps the male partner in the evaluation. IVF goes around the tubes without repairing them. Restorative reproductive medicine starts with the cause of the tubal damage.
Our editorial summary of this paper, not the article's abstract.
Abstract
This document reviews surgical options for achieving patency in obstructed fallopian tubes and the factors that must be considered when deciding between surgical repair and IVF. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;97:539–45).
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.
Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Reproductive Surgery › Tubal Surgery › Tubal Cannulation · Infertility › Tubal Factor › Distal Tubal Disease
Samantha Pfeifer, Richard Reindollar, Rebecca Sokol, Clarisa Gracia, Robert Rebar, Andrew La Barbera, Randall Odem, Daniel Dumesic, Margareta Pisarska, Samantha Butts, Eric Widra, Gregory Fossum, Jay Sandlow, Mitchell Rosen, Michael Vernon
Sam Pfeifer, S Pfeifer, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, Becky Sokol, R Sokol, C Gracia, Bob Rebar, Rob Rebar, Bobby Rebar, R Rebar, Andy Barbera, Drew Barbera, A Barbera, R Odem, Dan Dumesic, Danny Dumesic, D Dumesic, M Pisarska, Sam Butts, S Butts, E Widra, Greg Fossum, G Fossum, J Sandlow, M Rosen, Mike Vernon, M Vernon
PMID 25958255 25958255 DOI 10.1016/j.fertnstert.2015.03.032 10.1016/j.fertnstert.2015.03.032 Practice Committee of the American Society for Reproductive Medicine et al. 2015, Practice Committee of the American Society for Reproductive Medicine 2015
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