An analysis of factors influencing the outcome of 232 consecutive tubal microsurgery cases.

A consecutive series of 232 tubal microsurgical operations performed at the Jessop Hospital for Women, Sheffield, between 1983 and 1989, was analysed. The various contributory factors to tuboperitoneal damage were reviewed. Eighty patients (35%) conceived, resulting in 66 (29%) live births and 14 (6%) miscarriages. A further 12 (5%) had ectopic pregnancies. The overall cumulative conception rate (CCR) was 40% at the end of 50 months. Microsurgery has been most successful in the adhesiolysis group (n = 78) with a CCR of 46% at the end of 50 months. The terminal salpingostomy group (n = 97) had a CCR of 40% at the end of 36 months. There was a significant reduction in the live birth rate for the group with hydrosalpinx greater than 20 mm in diameter compared with the group with less than 20 mm (P = 0.05). The proximal anastomosis group (n = 27) had a CCR of 33%. No pregnancy was reported following reconstructive surgery for multiple occlusion sites. Overall, the extent of pelvic adhesions had a significant influence on the outcome (P = 0.02). The likelihood of conception was significantly influenced by the duration of infertility (P = 0.02) but not affected by the aetiology of tuboperitoneal damage, parity or age of the patient. In our hands, tubomicrosurgery is more cost-effective than in-vitro-fertilization as a primary treatment of infertility due to tubal diseases.