The fimbrio-ovarian relation and its role on ovum picking in unexplained infertility: the fimbrio-ovarian accessibility tests.

OBJECTIVE

To study the ovum pickup mechanism and the fimbrio-ovarian relation in fertile women and cases of unexplained infertility and to design a method for investigation and anticipation of the state of ovum pickup.

DESIGN

Prospective clinical study.

SETTING

Department of Obstetrics and gynecology Kasr El Aini Hospital, Cairo University, Egypt.

PATIENTS: Fifty fertile and 25 cases of unexplained infertility.

INTERVENTIONS: In all of cases the fimbrio-ovarian relation is studied by determining the length of the free ovarian border between the ovarian ligament and the fimbria ovarica that contains the corpus luteum (the ovulation border), the site of ovulation on that border and the length of the fimbria ovarica. It is also determined by a simple test "The fimbrio-ovarian accessibility test." The fimbriae are held by non-traumatizing grasper and their ability to reach and/or to cover the ovulation site are taken as a prove for successful ovum pickup. In addition, cases having suspected failed ovum picking are treated by controlled superovulation, also by drilling of the ovary at an accessible site to the fimbria ovarica and by freeing short fimbria ovarica with or without its advancement on the ovulation border.

RESULTS

The ovulation site is found to be usually accessible to the fimbrial end of the tube (94%) in the fertile cases and not accessible (92%) in the infertile cases. Correction of the fimbrio-ovarian relation in the infertile cases was associated with a cumulative ongoing pregnancy rate of 68%.

CONCLUSION

Failed ovum pickup should be considered one of the important causes of unexplained infertility. The suggested "fimbrio-ovarian accessibility" test may be useful for the elucidation of the state of ovum pickup in infertile cases. Correction of the fimbrio-ovarian relation, to make ovum pickup possible, should be considered a method for treating such cases.