Concurrent tuboplasty and assisted reproduction.

OBJECTIVE

To review and summarize the role of combining assisted reproductive technologies (ART) with lysis of adhesions and microsurgical tuboplasty in selected groups of patients.

DESIGN

A retrospective analysis of the available literature and a review of the results of concurrent fimbriectomy reversal and ART.

CONCLUSION

In a relatively few and highly selected patients, the concurrent use of ART and laparotomy or laparoscopy for lysis of adhesions and tuboplasty can more safely access the ovaries for oocyte retrieval and address associated problems such as pelvic pain while reducing cost. Examples of such cases include patients with ovaries in abnormal locations, on a congenital basis or after extensive bowel or urogenital reconstructive surgery. Because some procedures such as fimbriectomy reversal have a relatively low fecundity, there is potential for increasing cumulative pregnancy rates when ART and microsurgery are combined. The advantages of increased fecundity and cost-effectiveness must be weighed against the disadvantages of operating room scheduling and the potential surgical and anesthetic risks.