An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for infertility.

We evaluated 81 women with adnexal adhesions and no male factor who underwent microsurgical (n = 59) and laparoscopic (n = 22) adhesiolysis for infertility. The cumulative conception rates for all 81 patients at 12 and 24 months were 41 and 44% respectively. The impact of the following variables on cumulative conception rates for all patients was examined: age, duration of infertility, type of infertility, ovulatory status, presence and stage of endometriosis, adhesion grade, adnexal status (bilateral or unilateral disease, unilateral tubal absence), history of previous surgery, history of pelvic inflammatory disease and treatment modality (microsurgical versus laparoscopic). The results of independent comparisons of subgroups within each of these variables may be biased because of the interrelationships between the variables. To overcome this problem, a stepwise Cox's proportional hazards regression analysis was employed. Our analysis showed that the single most significant variable influencing the cumulative conception rates was the duration of infertility (P < 0.005). For every additional year of infertility, the probability of pregnancy after adhesiolysis (microsurgical or laparoscopic) was reduced by approximately 20%. Cumulative conception rates at 12 and 24 months after microsurgical adhesiolysis were 36 and 40% respectively, while after laparoscopic adhesiolysis they were 57% at 12 and 24 months. When imbalances were adjusted between the two treatment groups, there was no statistically significant difference between the cumulative conception rates for microsurgical and laparoscopic adhesiolysis.