Laparoscopic reconstructive tubal surgery in a tertiary referral centre--a review of 177 cases

To establish the pregnancy rate (PR) following endoscopic reconstructive tubal surgery in patients with tubal disease presenting to the Reproductive Medicine Unit at Groote Schuur Hospital between January 1994 and December 1997. A prospective descriptive study utilising the Hulka classification system of tubal disease scored at the time of surgery and correlating the findings and procedures carried out with the pregnancy outcome. Patients with infertility referred from level 1 and 2 health care facilities in the Western Cape to the Reproductive Medicine Unit in the Department of Obstetrics and Gynaecology at Groote Schuur Hospital. The main outcome measure was the PR following reconstructive surgery. Secondary outcome measures included the number of patients undergoing assisted reproductive techniques (ART) and the outcome of in vitro fertilisation and embryo transfer (IVF/ET). The results of 177 patients were analysed. The spontaneous PR for these patients was 13.6% per patient, with a live birth rate of 9%. The spontaneous extra-uterine pregnancy rate was 3.4% per patient and accounted for 25% of all spontaneous conceptions. Twenty-five patients (14% of the study population) underwent IVF/ET resulting in a PR of 36% per patient and 33.3% per embryo transfer. The poor PR following endoscopic tubal reconstruction is predominantly attributed to the severity of tubal damage in the study population. Patients undergoing IVF/ET had a favourable PR--indicating that most of these couples are highly fertile but for the mechanical obstruction. The results of our study support ART as first-line therapy in the majority of patients with tubal factor infertility in the setting of this study.