Unilateral laparoscopic tubal reversal versus IVF.

BACKGROUND: Tubal sterilization is one of the most important surgical techniques for sterilization. There is a dilemma for women who wish to undo this procedure in the choice between tubal reversal or in vitro fertilization (IVF). PATIENTS AND METHODS: In this retrospective cohort study, 134 patients who had had tubal sterilization previously and wished to have another child were enrolled in this study. Primary outcome was clinical pregnancy. The outcomes of 58 women who had had laparoscopic unilateral tubal reversal (Group 1) were compared with those of 76 women who had had IVF (Group 2). RESULTS: Clinical pregnancy rates were higher in the tubal reversal group (55.2% in Group 1 and 15.8% in Group 2). Ectopic pregnancy rates were similar (1.7% in Group 1 and 1.3% in Group 2) between the two groups. Clinical pregnancy rates were higher in all age, body mass index, and interval from ligation categories. CONCLUSIONS: Laparoscopic unilateral tubal reversal is an important alternative to IVF. However, this is an advanced laparoscopic operation, and more surgeons skilled in this microsurgical operation are still needed.

Family planning choices in couples using contraception without knowing they are infertile: should newly-wed men undergo a routine spermiogram?

INTRODUCTION: Newly-weds choose to use contraception either to spend the first years of their marriage more freely, because of economic reasons or because of the increase in working career women. We studied the reasons for infertility and the rate of contraception use in the first years of marriage among couples with primary infertility and evaluated the use of a spermiogram as a screening test in newly-wed men. SUBJECTS AND METHODS: In this cross-sectional study, 302 couples with primary infertility who were treated at our infertility clinic were included in the study. The couples were divided into 2 groups: group 1 (infertile couples who have used contraception) consisted of 67 couples and group 2 (infertile couples who did not use contraception) consisted of 235 couples. RESULTS: Sixty-seven (22.5%) infertile couples stated that they had used no contraception in the first years of their marriage. In group 1, 35.8% of couples were diagnosed as having unexplained infertility, while 28.4% of them had male factor, 31.3% female factor and 4.5% a combination of male and female factor infertility. Sixteen men with male factor infertility used coitus interruptus (3-36 months) or condoms (6-12 months) unnecessarily. CONCLUSIONS: Infertility counseling in the early days of marriage and a spermiogram performed at that time could be beneficial for the newly-wed couples even if they do not want a child at the time. To perform a spermiogram as a screening test in all newly-wed men should be discussed.

Effects of methotrexate on the tubal morphology of rabbits: evaluation by electron microscopy.

BACKGROUND/AIMS: To evaluate by electron microscopy the effects of methotrexate on the tubal morphology of rabbits. METHODS: Biopsies were taken from the isthmic portion of both tubes of 4 rabbits in the control group. 1 mg/kg methotrexate was injected in the left tubes and as a control, a 14-gauge fine needle was used to puncture the right tubes of 10 rabbits in the study group. One month later, tubal biopsies were taken from both tubes of every rabbit in the study group. To mimic pregnancy, 100 IU hCG was injected intramuscularly to every rabbit 24 h before every surgery. On examination by electron microscopy, the effects of methotrexate and of the damage with the fine needle on the tubes were compared to the control group. RESULTS: Young epithelial cells of the methotrexate-injected fallopian tubes kept their normal structure, but others contained important ultrastructural changes. These were: nuclear pyknosis, cytoplasmic vacuolization, dilatation of endoplasmic reticulum cisternae, increased cytoplasmic density and compound cilia. CONCLUSION: Degenerative changes on epithelial cells caused by the temporary blockage of mitotic activity associated with local methotrexate injection are reversible through the formation of new epithelial cells.

The effect of tubal ligation scoring and sterilization counseling on the request for tubal reanastomosis.

OBJECTIVE: The aim of this study is to emphasize the role of counseling methods that are meant to decrease the request for tubal ligation reversal, such as tubal ligation scoring. METHOD: This study covers 389 patients who were admitted for tubal sterilization to Cukurova University, Faculty of Medicine, Obstetrics and Gynecology Department, between 1 January 1990 and 31 December 1999. We have used the 'Tubal ligation score' on these 389 patients. Four hundred and seventeen patients who underwent bilateral Pomeroy type tubal ligation during cesarean section without having undergone tubal ligation scoring in the same time interval, were accepted as the control group. RESULTS: Laparoscopic tubal ligation (with a Yoon ring) was performed on 368 patients who had a score of 6 or higher. Twenty-one patients who got a score of 6 or lower were recounseled and another family planning method was prescribed to them. None of the 368 patients to whom tubal ligation scoring was done previous to laparoscopic tubal ligation returned to our clinic for tubal reanastomosis. Fifteen of the 417 patients (3.6%) in the control group returned to our clinic for tubal reanastomosis. CONCLUSION: Tubal ligation scoring may decrease the ratio of patients who request a tubal ligation reversal.

Laparoscopic microsurgical tubal reanastomosis: a preliminary study.

OBJECTIVE: To determine the effect of laparoscopic reversal of tubal sterilization on pregnancy rate. METHODS: Eight patients who underwent laparoscopic tubal reversal between March 1999 and 31 December 2001 were evaluated. RESULTS: Four of eight patients who had had laparoscopic tubal reversal became pregnant. Three have delivered; pregnancy in the fourth woman is ongoing. To date, the other four patients are still not pregnant. Two ofthese four cases have tubal patency but have not achieved pregnancy; in the other two cases, the operation was unsuccessful and tubal patency did not occur. CONCLUSION: In our preliminary study, the pregnancy rate was 50%.