Alain Audebert1, Jean Luc Pouly2, Béatrice Bonifacie3, Chadi Yazbeck4. 1. Institut Robert B. Greenblatt, Bordeaux, France. 2. Department of Obstetrics, Gynecology and Reproduction, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France. Electronic address: jlpouly@chu-clermontferrand.fr. 3. Centre de Fécondation in Vitro, Polyclinique Jean Villar, Bruges, France. 4. Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Bichat, Paris, France.
Abstract
OBJECTIVE: To evaluate the success rate of laparoscopic neosalpingostomy and the factors affecting the results in terms of intrauterine pregnancy (IUP), delivery (DEL), and ectopic pregnancy (EP). DESIGN: Retrospective analysis of prospectively recorded data. SETTING: Private practice. PATIENT(S): A total of 434 consecutive infertile patients from 21 to 42 years old with a follow-up of more than 10 years. INTERVENTION(S): Laparoscopic neosalpingostomy. MAIN OUTCOME MEASURE(S): Intrauterine pregnancy, delivery, and EP rates obtained without requiring IVF. Statistical analysis includes univariate and multivariate analysis and crude and actuarial success rates. RESULT(S): Just over one-quarter (28.8%) of the patients presented an IUP, 24.4% delivered, and 9% presented with an EP. The 5-year actuarial rate of delivery was 37%. This rate was largely dependent on the tubal stage (stage 1: 53.1%; stage 2: 43.1%; stage 3: 24.0%; stage 4: 23.1%). Forty-three percent of the expected IUPs started in the first year, and 75% started in the first two years. Multivariate analysis found some poor-prognosis patterns for tubal stage 3 (odds ratio [OR] 0.24), tubal stage 4 (OR 0.28), repeated neosalpingostomy (OR 0.168), previous EP (OR 0.202), severe adhesion stage (OR 0.211), and positive chlamydial serology (OR 0.515). Eversion with sutures provides nonsignificantly better results (OR 1.63) compared with eversion with coagulation. CONCLUSION(S): Neosalpingostomy must not be proposed in selected cases according to the tubal stage, adhesion stage, and chlamydial serology. When neosalpingostomy is performed, fimbrial eversion with sutures provides slightly better results.
OBJECTIVE: To evaluate the success rate of laparoscopic neosalpingostomy and the factors affecting the results in terms of intrauterine pregnancy (IUP), delivery (DEL), and ectopic pregnancy (EP). DESIGN: Retrospective analysis of prospectively recorded data. SETTING: Private practice. PATIENT(S): A total of 434 consecutive infertilepatients from 21 to 42 years old with a follow-up of more than 10 years. INTERVENTION(S): Laparoscopic neosalpingostomy. MAIN OUTCOME MEASURE(S): Intrauterine pregnancy, delivery, and EP rates obtained without requiring IVF. Statistical analysis includes univariate and multivariate analysis and crude and actuarial success rates. RESULT(S): Just over one-quarter (28.8%) of the patients presented an IUP, 24.4% delivered, and 9% presented with an EP. The 5-year actuarial rate of delivery was 37%. This rate was largely dependent on the tubal stage (stage 1: 53.1%; stage 2: 43.1%; stage 3: 24.0%; stage 4: 23.1%). Forty-three percent of the expected IUPs started in the first year, and 75% started in the first two years. Multivariate analysis found some poor-prognosis patterns for tubal stage 3 (odds ratio [OR] 0.24), tubal stage 4 (OR 0.28), repeated neosalpingostomy (OR 0.168), previous EP (OR 0.202), severe adhesion stage (OR 0.211), and positive chlamydial serology (OR 0.515). Eversion with sutures provides nonsignificantly better results (OR 1.63) compared with eversion with coagulation. CONCLUSION(S): Neosalpingostomy must not be proposed in selected cases according to the tubal stage, adhesion stage, and chlamydial serology. When neosalpingostomy is performed, fimbrial eversion with sutures provides slightly better results.