25.11.2015

Pregnancy rates after laparoscopy infertility

Tubal factor infertility is often caused by pelvic infection, such as pelvic inflammatory disease (PID), or endometriosis, or scar tissue that forms after pelvic surgery. In cases of relatively minor tubal damage it can be difficult to be certain that the infertility problem is solely due to the tubal damage. In general, the standard infertility testing is performed on all couples and if no other cause of infertility is found, the presumptive diagnosis can be tubal factor. As IVF success rates have improved dramatically over the last 20 years, IVF has become the mainstay of treatment for tubal infertility. The diagnosis of tubal factor infertility is initially investigated in most cases with a hysterosalpingogram.
Open but scarred tubes may not be able to perform the necessary functions to result in establishment of a normal pregnancy. If egg pickup, transport, and fertilization occur properly, but the tubal damage does not allow proper transport of the embryo to the uterus, implantation may occur in the tube resulting in a tubal pregnancy. The treatment for tubal factor infertility is usually either tubal surgery to repair some of the damage or in vitro fertilization (IVF). The decision to have one of these therapies for tubal infertility should be based on several factors which your reproductive endocrinologist (fertility specialist) should discuss with you. The most significant issues are success rates, the degree of tubal damage, the age of the female, and whether other infertility factors (male or female) are present. Success rates with in vitro fertilization for tubal factor infertility in women under 39 years old are usually very good because these women are relatively unlikely to have additional infertility problems. There is no single cause of infertility in endometriosis but rather several factors that decrease the chances for conception. There is no question that chances for pregnancy in endometriosis are significantly decreased. After laparoscopic resection of endometriosis, cycle fecundity rate in Stage I-II disease increases to about 4-5% but only to 1-2% in Stage III-IV. When pregnancies with cryopreserved embryos were considered and when couples with a significant male-factor were excluded, both cycle and cumulative fecundity rates were higher. Cycle and cumulative fecundity rates in the COH and IVF groups analyzed according to the stage of endometriosis are demonstrated in Figure 3 and according to the age of the wife in Figure 4.


Since 2004, our IVF pregnancy rates in women with endometriosis younger than 35 are upwards of 50%.
Women with rapidly progressing endometriosis who are not in position to begin their families may benefit from cryopreservation of eggs for future fertilization and pregnancy. A laparoscopy forms the cornerstone for the surgical evaluation of the pelvis of an infertile woman after a basic infertility investigation is completed. The laparoscope (a telescope with a strong light and camera) is introduced through the navel.
Many pelvic disorders can be treated safely and even the most distorted pelvis can be reconstructed using operative laparoscopy, always performed at the time of the diagnostic procedure. Operative laparoscopy is a delicate undertaking requiring not only advanced training but also great skill and dedication. Once the diseased tissue is removed, sutures may be placed, via the laparoscope, in order to reconstruct the pelvic organs.
The only way to be sure whether a woman has endometriosis is to perform a surgical procedure called laparoscopy that allows us look inside the abdominal cavity with a narrow scope. Although mild endometriosis is associated with infertility in some women, many fertile women also have mild endometriosis. Treatment for endometriosis associated with infertility needs to be individualized for each woman.
However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of the infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.
Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment.
Unfortunately, the infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.


However, if the degree of tubal scarring is very minimal, a diagnosis of unexplained infertility could be warranted. The rate of ectopic pregnancy in women with previous known PID is about 10 times higher than in women with no previous history of PID. Women with Stage I or II endometriosis have an approximately 2% chance for conceiving in any given menstrual cycle (cycle fecundity rate).
Medical treatment of Stage I-II endometriosis increases cycle fecundity rate to about 4-5% but is less effective in the advanced disease.
A cause and effect relationship between mild endometriosis and infertility has not been established. There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the age of the woman, length of infertility, and the presence of pain or other symptoms. However, pregnancy rates remain low after surgery - some studies have reported pregnancy rates of 1.5-2% per month. In early endometriosis (Stage I-II), the mechanism of infertility is less clear and more complex.
There was a plateau effect after five cycles and there were no pregnancies during the sixth cycle.
If an adverse effect of prolonged ovarian stimulation on the progression of endometriosis is considered and if there is an intent to limit the number of the stimulation cycles, this recommendation may be extended to all women with endometriosis and infertility. It might be that infertility and delayed pregnancy predisposes women to developing endometriosis, rather than the endometriosis causing the infertility. By comparison, age-dependent cycle fecundity rates in healthy fertile women range between 15 and 25%. Consequently, infertility in women with endometriosis is relative, which means that some women are able to conceive.



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Comments to «Pregnancy rates after laparoscopy infertility»

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