Ovulatory disorders and inflammatory adnexal damage: a neglected cause of the failure of fertility microsurgery.

Failure of reconstructive tubal surgery is usually attributed to pre-existing endosalpingeal damage, recurrent adhesion formation or progressive inflammatory disease. We studied ovarian follicle development and ovulation by ultrasound in 25 infertile patients with laparoscopically proven sequelae of pelvic inflammatory disease. Failure of the follicle to rupture was seen in 13, although luteinization occurred. The mean mid-luteal progesterone concentration in cycles with an unruptured follicle was significantly lower than the concentrations both in ovulatory cycles in the same patients and in a comparison group of 45 normally ovulating women (P less than 0.01). Microsurgical adhesiolysis did not seem to influence the occurrence of the ovulation disorder.