Tubal Surgery (Neo Salpingostomy) for Infertility

  • Reading time:3 mins read
  • Post last modified:March 5, 2024
  • Post category:IVF

A 25 year old married female for two years, anxious to conceive, with irregular cycles since menarche, with history of Poly Cystic Ovarian Disease (PCOD), came for evaluation of infertility. On evaluation, Ultrasound is suggestive of bilateral polycystic ovarian disorder with right ovarian volume being 10.5cc and left ovarian volume of 20.3cc. Hysterosalpingogram revealed right cornual block. Other necessary investigations were done to know the ovarian reserve and male factor evaluated which was found normal. Clinical examination revealed no abnormalities.

Her cycles were regularized and planned for Diagnostic Hysterscopy with ovarian drilling and tubal cannulation if required. On Hysteroscopy, endometrial cavity is normal with no space occupying lesions, endometrium appears healthy and bilateral tubal ostia seen.

On Laparoscopy, uterus is normal in size, bilateral ovaries were enlarged and polycystic, with normal left fallopian tube. Right fallopian tube appears normal except for a small fimbrial cyst of 1.5 x 1 cm. Bilateral Tubo-Ovarian relationship is normal.

On Chromopertubation, left peritoneal spillage of the dye is seen which is suggestive of patent left fallopian tube and no peritoneal spillage seen through the right tube with block seen at fimbrial end. Fimbrial cyst excised and a new fimbrial opening created by giving a cruciate incision at the distal end of the tube (Neo-salpingostomy done).

Chromopertubation repeated and peritoneal spillage seen from the right fimbrial end. Bilateral Ovarian drilling done. Hemostasis secured. Peritoneal wash given. Endometrial biopsy taken and sent for Histopathology (HPE).

Clinical discussion:

Tubal factor infertility accounts for about 20 – 25% of all cases of infertility, often caused by pelvic infection (pelvic inflammatory disease) or endometriosis or scar tissue after pelvic surgery.

Diagnostic HysteroLaparoscopy (DHL) has emerged as the essential tool for the evaluation of female infertility and is the gold standard investigation for tubal patency. The importance of DHL lies in the fact that it gives a detailed, direct visualization and analysis of the uterine cavity, endometrium, tubal morphology and patency, uterine, ovarian, and adnexal pathology. These pathology findings are often missed in routine clinical examination and ultrasound scan. In addition to diagnosis, DHL also provides the additional benefit of therapeutic interventions in few conditions.

Conclusion:

The development of invitro fertilization (IVF) techniques has diminished the importance of tubal infertility but recent discoveries shed new light on reproductive tubal surgeries with the objective of restoring the normal procreation in couples with tubal factor infertility prior to any IVF cycle. There is still a need for Randomized Control Trials comparing the benefits and costs for IVF versus Reproductive tubal surgeries.

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