Page 7 - World Journal of Laparoscopic Surgery

Hysteroscopy and Assisted Reproductive Technology

The reviewers concluded that laparoscopic salpingectomy (9+/– 2.8 versus 24+/– 4.8 minutes, p = 0.0001) and hospital stay
should be considered for all women with hydrosalpinges prior (2+/– 1.8 versus 5+/– 1.1 hour, p = 0.0001). Second-look office
to IVF treatment. 24 hysteroscopy was performed in 8 cases in group B and revealed
Kontoravdis et al in a prospective randomized study to no significant corneal lesions at the site of hysteroscopic
evaluate and compare the clinical impact of proximal tubal occlusion. 7
occlusion and salpingectomy when performed before IVF in This preliminary study demonstrates the feasibility of
patients with hydrosalpinges, concluded that proximal tubal hysteroscopic tubal occlusion of functionless hydrosalpinx in
occlusion, when performed in women with unilateral or bilateral all cases with acceptable efficacy. It has the advantage of adding
hydrosalpinges before their IVF treatment, represents a a valuable evaluation of the endometrial cavity prior to IVF/
potentially beneficial surgical procedure, increasing significantly ICSI. It should be an option for treatment protocol in cases of
the chances for successful implantation and for clinical and functionless hydrosalpinges. 7
ongoing pregnancy. Proximal tubal occlusion may be viewed The recent introduction of the essure microinsert has added
as a valid alternative when salpingectomy is technically difficult impetus to the drive for hysteroscopic management of
or not feasible. One hundred fifteen patients with unilateral or hydrosalpinges.
bilateral hydrosalpinges, who were candidates for IVF treatment, Hiktari et al in a prospective case series of 5 women with
had laparoscopic proximal tubal occlusion or laparoscopic unilateral or bilateral hydrosalpinges on transvaginal ultrasound,
salpingectomy, controlled ovarian stimulation, IVF, and embryo laparoscopy, or hysterosalpingogram who were planning further
transfer. Patients who underwent proximal tubal occlusion before fertility therapy, concluded that hysteroscopic placement of
IVF demonstrated significantly increased implantation, clinical- the essure microinsert is a minimally invasive option for proximal
pregnancy, and ongoing-pregnancy rates compared with those tubal occlusion in patients requiring occlusion of hydrosalpinges
with no surgical intervention and demonstrated implantation, before IVF and with contraindications to abdominal surgery.
clinical-pregnancy, and ongoing-pregnancy rates comparable This technique may offer a safer alternative. 8
to those who underwent salpingectomy. 25 Mijaytovic et al conducted a prospective, single-arm, clinical
There is now a preference for achieving proximal tubal study to investigate the success rate of proximal tubal occlusion
occlusion via hysteroscopy. Darwish and El Saman carried out with essure devices in subfertile women with hydrosalpinges,
a prospective comparative study to determine whether and to observe the results of subsequent treatment with IVF.
hysteroscopic tubal occlusion will produce the same efficacy Ten women with uni- or bilateral hydrosalpinges prior to IVF
as laparoscopic tubal occlusion of functionless hydrosalpinx were involved. In all patients laparoscopy was felt to be
prior to IVF/ICSI. The study phase included 27 patients with contraindicated. Hysteroscopic placement of essure devices
uni- or bilateral functionless hydrosalpinges, who were randomly was carried out in an office setting. All patients had successful
divided into 2 groups. Group A comprised 14 patients who placement of the essure devices without any complications.
were randomly allocated for laparoscopic occlusion. Group B Proximal tubal occlusion was confirmed by hystero-
included 13 patients scheduled for a hysteroscopic approach. salpingography in 9 out of 10 patients. A 40% ongoing
Laparoscopic occlusion of the isthmic part of the fallopian tube pregnancy rate was achieved with 20% life births after one IVF
was carried out using bipolar diathermy in 9 (64%) cases or cycle and/or frozen embryo transfer. They concluded that
clips in 3 (21.4%) cases in Group A. Roller ball electrode of the proximal occlusion of hydrosalpinges with essure devices
resectoscope was utilized for occlusion of the tubal ostium before IVF is a successful treatment for patients with a
under local, spinal, or general anesthesia in group B. Second- contraindication for salpingectomy. 9
look office hysteroscopy was performed in group B whenever
possible. In both groups, hysterosalpingography or Hysteroscopic Myomectomy for Submucous Fibroid

sonohysterography was carried out 1 month later to confirm Uterine fibroids occur in 30% of womenand are associated with
tubal occlusion. The mean number of abdominal scars/patient a degree of subfertility and they interfere with infertility. But,

was 1.4 and 1.5 in both groups, respectively. Unilateral the effect of fibroids on the outcome of assisted reproductive

functionless hydrosalpinx was encountered in 7 (50%) and 5 techniques specifically,has not been investigated extensively.

(38%) cases in both groups, respectively. In group A, the In a study by Hart et al, data were prospectively collected
procedure was possible and successful in 10 cases (76.9%), on 434 women undergoing IVF/ICSI in the assisted conception

while in group B, hysteroscopic access and occlusion were unit of an inner London teaching hospital. During the study

achieved in 12 (85.7%) and 9 (64.2%) cases, respectively. In period, 112 women with (study), and 322 women without

group B, diagnostic hysteroscopy showed fine marginal (controls), intramural fibroids were treated. Patientswere similar

adhesions in 2 cases (15%), and a small polyp in 1 case (7.7%). regarding the cause and duration of their infertility,number of
Hysteroscopic tubal occlusion showed shorter operative time previous treatments, and basal serum FSH concentration.
World Journal of Laparoscopic Surgery, September-December 2009;2(3):1-9 5