Author(s): Novy MJ, Hickok LR, Patton PE, Craemer MJ, Wolf DP
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Abstract In this study, fimbriectomy reversal resulted in a 43\% intrauterine PR and a fecundability of 6.6\%. The cumulative PR and the fecundability were 57\% and 7.8\%, respectively, when microsurgery was augmented by GIFT and embryo cryopreservation during the same treatment cycle and by subsequent embryo thaw and transfer. PIP: Between 1986-1988, physicians at Oregon Health Sciences University in Portland, Oregon induced ovary hyperstimulation in 7 patients then performed a fimbriectomy reversal augmented by a simultaneous gamete intrafallopian tube transfer (GIFT) and embryo cryopreservation during the same treatment cycle to improve fecundability and the cumulative pregnancy rate in a cost effective way. 2 patients received 2 embryo thaw and transfers (ETTs) each (2-3 embryos/ETT) within 16-25 months after fimbriectomy. The physicians determined pregnancy rates (PRs) based on only the 1st conception that resulted from fimbriectomy, GIFT, or ETT. PRs included 14\% for GIFT, 25\% for ETT, and 43\% for fimbriectomy. The combined PR was 57\%. Fecundability matched the PRs for augmented GIFT and ETT. Monthly fecundability for just fimbriectomy stood at 6.6\% whereas it stood at 7.8\% when fimbriectomy, GIFT, and ETT were combined. Average ampullary width was 1.03 cm (.7-1.5 cm). 67\% had distal tubal patency which was lower than reported in earlier research (83\%). The lower tubal patency rate may have been due to hyperemia and edema of the tube. The 3 women who did not conceive had either bilateral tubal occlusion or abnormal spill. No one experienced an ectopic pregnancy. The fertilization rate for the 4 women who underwent in vitro fertilization and ETT stood at 90\% which indicated that laparotomy did not adversely affect fertilization. Mean exposure before 1st conception following fimbriectomy was 10.5 months when the 2 women who had postoperative tubal occlusion are excluded from the analysis. The combination of microsurgery, GIFT, and embryo cryopreservation during the same treatment cycle saved the patient around 40\% when compared to the cost of separate treatments in different cycles.
This article was published in Fertil Steril
and referenced in Journal of Clinical Case Reports