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Intra-fallopian transfer of ovocytes and sperm, of zygotes at the two pronuclei stage or of embryos is a possible alternative to in vitro fertilization, at least when a fallopian tube is permeable. Its principle indications are unexplained or male infertility.
This report describes the results of gamete intra-fallopian transfer (GIFT) in 102 treatment cycles for male infertility and in 202 cycles for unexplained infertility. Twenty-one pregnancies out of 102 GIFT replacements (20.6 p. 100) were obtained in male infertility and 74 pregnancies out of 202 GIFT replacement (36.6 p. 100) were established. One hundred and forty-five pregnancies were obtained out of 348 zygote intra-fallopian transfers (ZIFT) (41 p. 100).
The first hundred laparoscopies carried out in the "Hospital Parroquial de San Bernardo", between november 1986 and june 1988; were evaluated. The indications for the procedure were: 38% study of infertility, in which a 78% of tubal obstruction or adherencial syndrome was demonstrated; 37% because of ectopic pregnancy, with a diagnostic correlation of 48.6%. The remainder cases were adnexal masses or pelvic pain study. A 42% of the patients had previous pelvic or abdominal surgery. As complications there were two "pre-pneumoperitoneaum", one pelvic inflammatory process and one anesthetic accident, hospitalization time and costs, justifies completely the acquisition of the necessary equipment and technical ability.
Twenty-one patients undergoing laparoscopy and chromotubation were investigated for the dissemination of endometrial cells into the pelvic cavity. Prechromotubation fluid and postchromotubation fluid from the posterior cul-de-sac were aspirated and subjected to cytological assessment. Four patients (15.4%) showed evidence of endometrial cell dissemination into the pelvic cavity.
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The most important factors are presented which cause that surgical treatment of tubal obliteration is not giving fully satisfactory results. The selection of patients for tubal reconstruction and the choice of operation term are discussed. The modern diagnostic methods in tubal obliteration are described with particular reference to USG and laparoscopy. The most important suggestions for the surgeon in preoperative, intraoperative and postoperative management are made, discussing the problems of macroscopic and microscopic surgery. Particular attention is called to prevention of postoperative obliterative syndrome (intraperitoneal infusion of dextran and local and systemic glycocortico-therapy). Pregnancy developing after surgical treatment of tubal obliteration requires careful monitoring and should be regarded as high risk pregnancy.
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A World Health Organization-sponsored multicentered trial comparing the efficacy of gaseous tubal insufflation with hysterosalpingography (HSG) and/or laparoscopy plus dye hydrotubation in the assessment of tubal patency was undertaken. Three hundred ninety-three women in eight centers were involved (365 insufflations, 289 HSG, 189 laparoscopy). Patency was proven positive in 56% of insufflation, 45% of salpingography, and 52% of laparoscopy cases. Laparoscopy showed some women to have fibroids and a number of others to have ovarian abnormalities, endometriosis, pelvic adhesions, and/or congenital uterine malformation. Comparison of insufflation and HSG showed a false-positive rate of 42% and false-negative rate 24% in 363 cases. The false-positive rate of insufflation versus laparoscopy was 35% and the false-negative rate 38% of 180 cases. Only 55% of 125 women undergoing both HSG and laparoscopy had similar findings. The results suggest that gaseous tubal insufflation should not be employed as a method of investigating tubal patency. Diagnostic reliability of HSG is poor, but it is useful as a primary screening procedure, particularly when complimented with laparoscopy plus dye hydrotubation, which is the optimum method not only for assessing tubal patency but for discovering other hitherto unsuspected disease.
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