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The hysteroscopic evaluation of uterine openings in 23 sterile women was described. The attention was paid to morphological features of obliterated uterine openings. The hysteroscopic examination of structural changes located in uterine openings seems to be a reliable method for evaluation of potency of oviducts. This procedure may help in choosing the proper way of therapy--microsurgery or IVF.
To date, the therapy of first choice in case of proximal tubal pathology is resection of the occluded segment and microsurgical reconstruction. Essential disadvantage of this rather successful method consists in the need of a laparotomy. According to the concept of minimal invasiveness a pilot study has been undertaken to evaluate hysteroscopic proximal tube catheterization (HPTC) and balloon dilatation for recanalization. This attempt has proven intraoperatively successful in more than 80% of the cases and the first pregnancy and birth following HPTC can yet be reported.
This paper is in support of balneological rehabilitation in patients operated on due to ectopic pregnancy and still willing to have children. In a group of 203 patients, in which histopathological findings from the material obtained at the time of surgery enabled determination of the cause of ectopic pregnancy, causative pharmacological treatment was established. Than the successive balneological treatment was carried out in 74 out of these 203 patients. Our data shoved that patients who underwent balneological rehabilitation after surgery tended to become pregnant two times more often, number of repeated ectopic pregnancies was just inconspicuous and the preservation of the patency of operated Fallopian tubes was also two times higher.
There has been made an analysis of 45 cases of women's oviductal infertility qualified to surgical treatment. In search of the reasons of infertility these patients underwent hysterosalpingographic examination and 24 of them additionally, diagnostic laparoscopy with chromotubation. Positive intraoperative verification of HSG and laparoscopy, as a confirmation of tubal obstruction, they obtained at 40 women (88.9%) that made possible to carry out microsurgical operations in them. Such a big percentage of correct diagnoses makes sure, that both hysterosalpingography and laparoscopy are indispensable for proper qualification of a patient to microsurgical treatment of oviductal infertility.
If a blocked fallopian tube is initially diagnosed and is cleared by simple means, and there is no clinical evidence of other pathology it is reasonable for the patient to go on and attempt to conceive for a time before any further investigation is required. This might be three to six months. A significant amount of cost and morbidity would be eliminated by this pathway, rather than the current push to laparoscopy.
The authors discuss 47 cases in which the HSG examination showed secondary tubular unpatency, then verified by laparoscopy. The patients were divided in three groups. The patients who belonged to the first group had two-sides tubular unpatency recognized by HSG. In 26 of these patients the HSG result was confirmed by laparoscopy, in 3 cases--it was not. The second group were 14 patients with partial tubular unpatency showed by HSG. In 10 of these cases the laparoscopic examination gave results consistent with HSG, in 4 cases--contradictory. The last group was formed by 6 patients with no tubular unpatency recognized through HSG. 4 of these recognitions were confirmed by laparoscopy, while 2 were not. In the opinion of the authors supported by the results the HSG examination may be considered only as a preliminary element of tubular patency examination. In case of planned microsurgery the only qualifying or disqualifying examination is the laparoscopy with introduction of colour contrast.
During therapy of anovulatory infertility, percentage of pregnancies is lower than the ovulation rate. Cause of this phenomenon is connected as well with the inadequate corpus luteum as others anomalies of the genital tract. Hysterosalpingography was performed in 120 infertile women in whom pregnancy did not occur in spite of effective induction of ovulation. Patency of both tubes was observed in 79 percent of patients. Occlusion of right tube has occurred in 8 percent, left tube in 5 percent, and both tubes in 8 percent of women. Authors suggest that laparoscopy should be obligatory as diagnostic and therapeutic procedure in woman with concomitant ovarian failure and abnormal HSG results.
The authors discuss 84 cases of laparoscopic examination of women with primary or secondary infertility. The patients qualified for this examination had undergone at least 26 weeks of conventional treatment with no effect. In 7 cases the reproductive organ was found to be in order, with fallopian tubes fully patent. In 43 cases tubular inpatency was found. The remaining patients suffered from other reproductive organ disorders. Therefore, the laparoscopic examination made detailed recognition of the causes of infertility possible and thus helped to establish the proper treatment. Additionally, in some cases it enabled the immediate removal of the source of infertility.
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This review focuses on the theoretical backgrounds for tubal gamete and zygote/embryo transfer, as well as the clinical results of gamete intrafallopian transfer (GIFT), which are compared with other non-fertilization procedures in infertile women with patent fallopian tubes. While GIFT and zygote intrafallopian transfer (ZIFT) probably result in a more synchronized entry of embryos into the uterine cavity, prospective, randomized studies have not shown these methods to be preferable to conventional in-vitro fertilization and embryo transfer. Nevertheless, co-culture with various cell types seems to yield more viable embryos with a high rate of implantation. The promising results with co-culture do not seem to be a cell- or species-specific phenomenon. This non-specific positive or negative conditioning effect of co-culture on embryo quality indicates that more optimal culture media for in-vitro fertilization can probably be devised. The requirements of laparoscopy and general anesthesia with GIFT have prompted the development of simpler methods based on fertilization in vivo. Various methods of artificial insemination combined with controlled ovarian hyperstimulation yield comparable results with GIFT in unexplained infertility. In endometriosis, GIFT seems to give better results compared with insemination techniques. Less invasive transcervical gamete and embryo transfer techniques have now been established, obviating the need for operating theater facilities.
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Fifty-two patients with 84 proximal Fallopian tube obstructions underwent Fallopian tube recanalization (FTR). The successful catheterization rate for Fallopian tubal ostia was 100%, and the successful recanalization rate was 64%. After FTR, hysterosalpingography or selective tubography showed no evidence of adhesion (without adhesion) in 31 tubes, perifimbrial adhesion in 17 tubes, hydrosalpinx in six tubes, and intratubal adhesion in 30 tubes (unsuccessful recanalization). Six patients (11%) achieved intrauterine pregnancies and two had extrauterine pregnancies. Follow-up studies in seven patients without adhesion showed patency in one patient and reocclusion in six patients who obtained repatency after a second FTR. Fallopian tube catheterization was useful for the exact diagnosis of Fallopian tube occlusion. The higher incidence of adhesion in patients' background caused the low incidence of pregnancy.
The authors analyse the results of direct (cervical, urethral, tubal) and serological research of Chlamydia trachomatis in a sample population of 420 women undergoing celioscopy due to sterility and pelvic pain, paying particular attention to a group of 193 who were found to be suffering from PID (acute, sequelae). In terms of absolute numbers the correlation between chlamydial contact-PID-sterility is confirmed, whereas in an analysis of the levels of direct positivity it is only significant for acute PID, and in cases of sequelae and in sterility with chronic infection with or without tubal damage the direct identification of Chlamydia trachomatis does not differ much from controls. Salpingo-peritoneal isolation was found to be completely lacking in significance.
Ectopic pregnancy (EP) treated by traditional methods, signifies an approximate lose of fertility capacity of the patient, of 50%. The early diagnosis allows conservative treatment with metotrexate (MTXE), with the objective of preserving the affected tube (salpynx) and its function. Early detection of EP, intact, was done, in 11 cases, with the following parameters: clinical picture, ultrasonography (Us) (empty uterus, adnexial mass and free fluid; adnexial ring or extrauterine embryo); quantitative determination of beta fraction of chorionic gonadotropin (CGH b) and laparoscopic observation, when the following characteristics were met: tubal pregnancy, no greater than 30 mm, intact tubarian serosa, lack of active bleeding and visualization of all pelvic cavity. MTXE 12.5 mg, intrasacularly via laparoscopy in eight patients, and three by laparotomy. The ulterior control of the procedure was: careful surveillance during eight days, Us daily and CGH b in two occasions; ten patients evolutionated satisfactorily, two of them required additional dosis of MTXE, parenterally, 0.5 mg/kg and citovorum factor, 0.1 mg/kg/4 days. The obtained conclusions are: 1. Conservative treatment with MTXE may be carried out provided the conditions established before, are met. 2. The patient's follow up must be precise and because of the high cost of the determination every third day of CGH b, Us may be used. Hysterosalpingography was done in five patients after six months of the procedure, and tubal permeability was seen.(ABSTRACT TRUNCATED AT 250 WORDS)
From 700 laparoscopies performed, in 600 of them (85.7%) the tuboperitoneal factor was altered. Surgery included: termino-terminal plastia 70 cases (36%), (3 patients had previous plastia); adhensiolysis 62 (31%), salpingostomy 48 (24%), neoimplantation 10 (5%), and mixed surgery 9 (4%). After surgery, desertion was present in 78 patients. Of the 121 remaining, 34 (28.1%) had primary sterility and 87 (71.9%) secondary sterility. 74 patients (61.2%) obtained pregnancy, 62 (83.8%) reached term, seven were abortions of first trimester (9.5%) and were five ectopic pregnancies (6.7%). The interval between surgery and pregnancy achievement was 1 to 48 months, 12.8 months average. We emphasize the 47 patients analysis who didn't has pregnancy, through: remark time after surgery, histerosalpingography, new laparoscopy and reevaluation of sterility factors; the results were: 19 cases (40.5%) have a 5 to 60 months time after surgery, 19.5 months average, 18 (38.3%) had new tubary obstruction, three (6.4%) with endometriosis treatment, three (6.4%) have tuberculosis genital treatment, two (4.2%) with falling again endocrine-ovarian factor, and two (4.2%) with masculine relapse. A decease was present because anesthetic complication. We underline selection surgery criterion and a strictly evaluation, such as an antiadhesion pre, trans and postoperative regime, ligamentopexya of rounds ligaments and a conscious education of the patients in their strictly pursuit.
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The authors present their observations on the uterine os and signs of patency of the Fallopian tubes based on 240 cases of infertility examined by hysteroscopy. The shape of the cornual region, the adjacent pathological structures, ie., adhesions, polyps, fibroids etc., the outflow of the distending medium towards the Fallopian tubes and the movement of the tubal os were visualised. Intrauterine pressure and flow data were recorded in order to judge tubal patency. The funnel-shaped (in contrast with the flat type) cornual region, rhythmic contraction of the tubal os, the outflow of distending medium, intrauterine pressure under 100-120 Hgmm and standard 25-50 ml/min medium flow were evaluated as characteristic diagnostic signs of tubal patency.