Surgical correction of female infertility. An analysis of results and failures in 101 cases.

During the 1970s, surgery undertaken to remedy infertility at Sabbatsberg Hospital in Stockholm involved macrosurgical techniques. The patients described here had the same pathology on either side. Sixty-three underwent different procedures for the correction of tubal pathology at laparotomy, while 20 patients had lysis of adhesions performed at laparoscopy. A further 18 patients were operated on for ovarian endometriosis. The results in terms of conceptions (ranging from 43 to 60%, depending upon the type of operation) were similar to those reported from microsurgery, but the incidence of ectopic pregnancy was higher. Second-look laparoscopy revealed the presence of adhesions and tubal block in a significant number of patients, though less often in those who ultimatively conceived. There was no difference in semen findings between patients who conceived and those who did not. Postoperative adhesions are responsible for many surgical failures, but refined methods of surgery may reduce the risk of future ectopic gestation. Only a limited number of cases remain where persistence of infertility may be due to minor anatomical or functional defects not amenable to present-day clinical evaluation.