输卵管妊娠不同方法治疗后再次妊娠的探讨

目的:探讨输卵管妊娠用不同方法治疗后再次妊娠的情况。方法:随访562例输卵管妊娠后患者,分析影响治疗选择的因素;用生存曲线方法及多因素COX回归分析其中100例有生育要求患者治疗后宫内自然妊娠率和再次异位妊娠率。结果:100例中行输卵管根治术44例,保守性手术28例,药物保守治疗28例。24个月累积重复异位妊娠发生率分别为6.9%,13.7%,0.04%,差异有统计学意义(P<0.005);累积自然宫内妊娠率分别为31.8%,34.4%,65.3%,用COX回归排除影响治疗选择因素,得出年龄≤30岁,无影响输卵管功能高危因素的患者,药物保守治疗后宫内妊娠率最高,保守性手术次之,根治性手术最低;年龄>30岁,存在影响输卵管功能的因素,3种方法治疗后宫内妊娠率差异无统计学意义。结论:为提高年轻输卵管妊娠患者治疗后的宫内妊娠率,应尽量行药物保守治疗。     

Improved fertility following conservative surgical treatment of ectopic pregnancy

Objective To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy.
Design Retrospective cohort study.
Setting Clinical University Center, Hvidovre Hospital, Copenhagen.
Population Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months.
Methods Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cummulative probabilities of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders.
Main outcome measures Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy.
Results The cumulative intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank   P < 0.05  ) after correction for confounding factors. No difference was found in the recurrence rate of ectopic pregnancy between the treatments (16% vs 17%). In patients with contralateral tubal pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%.
Conclusion Conservative surgery is superior to radical surgery at preserving fertility. Conservative surgery is not followed by an increased risk of repeat ectopic pregnancy, but by the risk of persistent ectopic pregnancy, which should be taken into account when deciding on the operative procedure. Management in case of contralateral tubal pathology is disputed and should ideally be addressed in a randomised clinical trial.     

Three Recurrent Ectopic Pregnancies Case Report and Review of the Literature

EDITORIAL COMMENT: We accepted this case report for publication not solely because of its unusual anecdotal interest, or for its glimpse into reproductive requirements and wishes of women in Saudi Arabia, but for its summary of the literature on repeat ectopic pregnancy which should interest readers. Although preservation of the Fallopian tube by laparascopic salpingostomy is becoming the established treatment of unruptured ectopic pregnancy, we are unaware of a prospective trial comparing subsequent fertility in women with salpingostomy versus partial salpingectomy for unruptured ectopic pregnancy when the opposite Fallopian tube appears normal. In the present case there is no evidence that the preserved tube was useful from the reproductive point of view, although it remained patent. One reviewer of this paper performed a medline search and found that 'there are no prospective studies and only a few retrospective reports comparing fertility rates after salpingostomy and salpingectomy. Three major retrospective studies found no significant difference infertility or incidence of repeat ectopic pregnancy between the 2 procedures, but salpingostomy carries a 5–8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. Fertility after ectopic pregnancy is affected much more by the status of the contralateral tube than by the procedure performed, with fertility rates exceeding 80% after salpingectomy when the opposite tube is normal'(A).
A. Rulin MC. Is salpingostomy the surgical treatment of choice for unruptured tubal pregnancy? Obstet Gynecoi 1995; 86: 1010–1013.
Summary: Further studies on the obstetric performance of women after recurrent ectopic pregnancies are needed to adequately counsel women who are still interested in future fertility, even after their third ectopic pregnancy.     

Fertility after ectopic pregnancy in relation to background factors and surgical treatment

To study the importance of certain background factors and surgical treatment, the obstetric outcome in 205 women consecutively treated for ectopic pregnancy was analyzed by means of questionnaires 4 to 5.5 years after surgery. The response rate was 83.4% and, among women desiring pregnancy (n = 112), the total pregnancy rate was 75.9% and the delivery rate 53.6%. The total incidence of repeat ectopics was 27.3%, and the proportion of women who had a repeat ectopic pregnancy but no delivery was 20.5%. Six of seven women having an ectopic pregnancy with a copper intrauterine contraceptive device in situ had a normal delivery during the follow-up period. The subsequent fertility among nonresponders appeared lower than among responding women. A number of background factors present at the time of surgery were correlated to subsequent infertility, e.g., history of infertility and previous abdominal surgery. Conversely, there was no correlation between the fertility outcome and the type of operative procedure.     

Fertility after ectopic pregnancy. Effects of surgery and expectant management

OBJECTIVE: To evaluate the effects of different management strategies for ectopic pregnancy on fertility. STUDY DESIGN: Retrospective cohort study of 180 consecutive patients who were diagnosed with ectopic pregnancy between September 1988 and December 1995. The fertility rate after ectopic pregnancy treated with surgery was compared with that after expectant treatment. Statistical analysis took into consideration the following confounding variables: history of sterility, infertility, ectopic pregnancy, use of intrauterine device, endometriosis, pelvic inflammatory disease or pelvic surgery prior to ectopic pregnancy, and type of therapy for ectopic pregnancy. RESULTS: Of the 180 women enrolled in the study, 97 desired conception. The intrauterine conception rate was similar in those initially treated expectantly as in those allocated to primary surgery (63% [31/49] vs. 51% [19/37], P = .37). Successful completion of expectant management was associated with rates of subsequent intrauterine pregnancy similar to those of surgical treatment (including primary surgery and surgery after failure of expectant management) (65% [22/34] vs. 54% [28/52], P = .44). Women undergoing delayed surgery due to failure of expectant management had rates of subsequent intrauterine conception similar to those who underwent primary surgery (9/15 vs. 19/37, P = .79). Several anamnestic factors had a significant and adverse effect on reproductive outcome: history of infertility (P = .01), history of ectopic pregnancy (P = .02) and previous pelvic surgery (P = .001). CONCLUSION: Expectant and surgical management of ectopic pregnancy had similar subsequent intrauterine conception rates, even when failure of expectant management led to secondary surgery. Gynecologic history can identify the subgroup of patients at higher risk of a poor reproductive outcome.     

Factors determining fertility after conservative or radical surgical treatment for ectopic pregnancy

Objective: To examine factors determining choice of radical or conservative surgical procedure for tubal ectopic pregnancy and subsequent pregnancy rates.Design: A retrospective study collating information from the operative notes and previous gynecologic history associated with the choice of procedure and pregnancy rates and outcome over 3 years after a primary tubal ectopic pregnancy.Patient(s): Thirty-four women who had undergone conservative (tube sparing) and 56 who had undergone radical (salpingectomy) surgical treatment for tubal ectopic pregnancy at least 3 years before the study.Main Outcome Measure(s): The main outcome measure was the occurrence of a pregnancy (live birth, miscarriage, or ectopic pregnancy) over 3 years after the ectopic pregnancy.Result(s): The type of surgery performed was not affected by a previous history of infertility, known pelvic inflammatory disease, the presence of tubal adhesions, or abnormalities on the contralateral tube. Intrauterine pregnancy was not more likely after conservative treatment of ectopic pregnancy but, equally important, the risk of a further ectopic pregnancy was not increased. The single factor that was clearly associated with future fertility problems was a past history of infertility.Conclusion(s): Better results may be obtained by careful selection of operative procedure based on history and findings at the time of surgery.     

Ruptured tubal ectopic pregnancy: risk factors and reproductive outcome: results of a population-based study in France

OBJECTIVE: The aim of this study was to investigate the determinants of tubal rupture and to describe its treatment and effect on subsequent fertility. STUDY DESIGN: The data were taken from a population-based register from Auvergne (France). All women aged between 15 and 45 years residing permanently in this area and treated for ectopic pregnancy by surgical or medical procedures have been registered since 1992. They are then followed up prospectively until the age of 45 years. This study is an analysis of 849 tubal ectopic pregnancies registered between January 1992 and December 1996. Women with tubal rupture were compared with those in whom no tubal rupture occurred. The risk factors for tubal rupture were identified by calculating crude and adjusted odds ratios. The effects of tubal rupture on subsequent fertility were assessed by calculating cumulative intrauterine pregnancy rates and were analyzed by log-rank tests and Cox regression. RESULTS: The rate of rupture for this population was 18%. Four factors were identified that increased the risk of rupture (results of the multivariate analysis): never having used contraception (odds ratio 1.7 [1.0 to 3. 3]), a history of tubal damage together with infertility (odds ratio 1.6 [0.9 to 2.7]), induction of ovulation (odds ratio 2.5 [1.1 to 5. 6]), and a high level of beta-human chorionic gonadotropin (at least 10,000 IU/L) when ectopic pregnancy was suspected (odds ratio 2.9 [1. 5 to 5.6]). The overall cumulative frequency of intrauterine pregnancy was not significantly lower after tubal rupture (adjusted risk ratio 0.85 [0.53 to 1.38]). CONCLUSION: Although tubal rupture seriously affects the immediate health of the women concerned, it seems to have no independent effect on subsequent fertility. Better knowledge of the risk factors should make it possible to identify those women who will not benefit from nonsurgical treatment.     

Reproductive outcome after methotrexate treatment of tubal pregnancies

OBJECTIVE: To evaluate reproductive outcome after ectopic pregnancy (EP) treated with methotrexate (MTX) and to assess the relative contribution of various risk factors to future fertility. DESIGN: Telephone follow-up interviews in a cohort of patients treated for EP. SETTING: University hospital. PATIENT(S): A cohort of 158 patients treated with MTX for tubal pregnancies between April 1991 and March 1999. INTERVENTION(S): Assessment of fertility outcomes. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rates for intrauterine and ectopic pregnancies. RESULT(S): Thirty-two patients (20.2%) were lost to follow-up. Of 126 patients, 93 (73.8%) sought to become pregnant, and of these 93 women, 76 (81.7%) did. Sixty-four pregnancies were spontaneous, and 12 resulted from in vitro fertilization (IVF). No pregnancies occurred in the group not trying to become pregnant. Of the 64 spontaneous pregnancies, 52 (81.2%) were intrauterine, with 12 (18.7%) resulting in miscarriages, and 12 (18.7%) were recurrent ectopic pregnancies. The cumulative intrauterine pregnancy rate was 57.5% after 1 year and 66.9% after 2 years. The cumulative ectopic pregnancy rate was 15.4% after 1 year and 23.7% after 2 years. After adjusting for factors associated with fertility with a Cox regression, only one factor was associated with poor reproductive performance: previous history of infertility. CONCLUSION(S): Within 1 year of seeking to become pregnant, more than half the women previously treated medically for EP conceived and had ongoing pregnancies. Our analysis indicates that fertility depends more on the patients' previous medical history than on her treatment for EP.     

Fertility after ectopic pregnancy: the population-based register of the urban area around Lille, Northern France

The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment's strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occurred with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment.     

A study comparing previous induced abortion rates in populations of newly delivered women and infertile women

OBJECTIVE: For years, induced abortions (IA) have been deemed responsible for altered fertility. The implication of various mechanisms including tubal infertility, intra-uterine adhesions, spontaneous abortion, ectopic pregnancy, cervical incompetence, shortened gestations, and any psychological trouble leading to anovulation has been raised. Though many authors find no evidence of an increased risk on fertility for women, whose IA is not complicated by infection, it might sometimes be insinuated that infertility is the consequence of previous abortion. Thus, we compared the rate of patients with any prior IA in a population of newly delivered women and in women ongoing IVF. PATIENTS AND METHODS: A retrospective study was conducted at Sèvres hospital, comparing two populations of women, newly delivered women (n=1738) between January 1st and December 31st 2005, and women ongoing IVF at the same period (n=430). We reported the number of previous medical or surgical induced abortions and compared it in both groups. Another analysis compared these rates, among two subgroups of women with one or more prior pregnancy (secondary infertility (n=148), and secondary gestation (n=1088). RESULTS: The rate of prior IA was not different in the two populations. In the IVF group, 13% (n=56) had undergone one or more IA, versus 16.7% (n=291) in the newly delivered group (P=0.06). Among women with previous pregnancy, 37.8% (56) women of the IVF group had undergone one or more previous IA, versus 26.7% (291) of the newly delivered women (P=0.007). DISCUSSION AND CONCLUSION: As expected by literature data on IA and fertility, rates of prior induced abortions were not different in the population of fertile women versus infertile. However, women with one or more previous pregnancy are more likely to have undergone previous IA in the IVF group than in the newly delivered group, possibly due to a bias of age. More data are requested to eliminate linkage between IA and infertility.     

Survival analysis of fertility after ectopic pregnancy

OBJECTIVE: To evaluate the reproductive outcome after ectopic pregnancy and to assess the contribution of risk factors to future fertility. DESIGN: Prospective follow-up in a population-based sample. SETTING: Register of ectopic pregnancies established in an urban area around Lille, France. PATIENT(S): Three hundred and twenty-eight women treated between April 1994 and March 1997 who had not been using an IUCD at the time of the ectopic pregnancy and were trying to become pregnant. INTERVENTION(S): Interviews by telephone every 6 months for 2 years and once yearly thereafter. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rate. RESULT(S): Two hundred fifteen (65.5%) women became pregnant after a mean of 5 months. One hundred eighty-two (84.7%) pregnancies were intrauterine; 22 (10.2%) were recurrent ectopic pregnancies; and in 11 women (5.1%), it was too early to define implantation. The cumulative intrauterine pregnancy rate was 56% at 1 year and 67% at 2 years. After applying Cox regression, three factors associated with fertility seemed to decrease reproductive performance: age > 35 years, history of infertility, and anterior tubal damage .CONCLUSION(S): More than half of the women treated for ectopic pregnancy spontaneously conceived and had a normally progressive pregnancy at 1 year. Fertility depends more on established patient characteristics than characteristics of ectopic pregnancy itself or treatment thereof.     

Conservative laparoscopic treatment of 321 ectopic pregnancies

From 1974 to 1984, 321 tubal pregnancies were treated conservatively with laparoscopic techniques. Fifteen cases (4.8%) required a subsequent laparotomy or second laparoscopic procedure because of retained trophoblastic tissue. Of 118 patients desiring subsequent pregnancy, 76 had an intrauterine pregnancy (64.4%) and 26 had a second ectopic pregnancy (22%). Eleven of 24 (45.8%) women attempting conception following conservative laparoscopic removal of an ectopic gestation from the sole remaining fallopian tube established an intrauterine pregnancy. In this same group, seven patients (29.2%) had a second ectopic pregnancy. The fertility results were also analyzed according to the previous history. The postoperative intrauterine pregnancy rate was 85.5% among 62 patients without a history of infertility (group I), compared with 41.1% among 56 patients with a history of infertility or a previous ectopic pregnancy (group II). The subsequent ectopic pregnancy rate in group I was 16.1% versus 28.6% in group II. This large series clearly demonstrates the relative safety and efficacy of conservative laparoscopic treatment of tubal pregnancies.     

Salpingotomy or salpingectomy in tubal ectopic pregnancy: What do women prefer?

There is an ongoing debate whether tubal ectopic pregnancy should be treated by salpingotomy or salpingectomy. It is unknown which treatment women prefer in view of the potentially better fertility outcome but disadvantages of salpingotomy. This study investigated women surgically treated for tubal ectopic pregnancy and subfertile women desiring pregnancy and their preferences for salpingotomy relative to salpingectomy by means of a web-based discrete choice experiment consisting of 16 choice sets. Scenarios representing salpingotomy differed in three attributes: intrauterine pregnancy (IUP) chance, risk of persistent trophoblast and risk of repeat ectopic pregnancy. An ‘opt out’ alternative, representing salpingectomy, was similar for every choice set. A multinomial logistic regression model was used to analyse relative importance of the attributes. This study showed that the negative effect of repeat ectopic pregnancy was 1.6 times stronger on the preference of women compared with the positive effect of the spontaneous IUP rate. For all women, the risk of persistent trophoblast was acceptable if compensated by a small rise in the spontaneous IUP rate. The conclusion was that women preferred avoiding a repeat ectopic pregnancy to a higher probability of a spontaneous IUP in the surgical treatment of tubal ectopic pregnancy.An ectopic pregnancy occurs when a fertilized egg gets stuck inside the Fallopian tube where it starts growing instead of passing on to the uterus. This may lead to serious problems, such as internal bleeding and pain. Therefore, in the majority of women, it is necessary to remove the ectopic pregnancy by means of an operation. Two types of surgery are being used in removing the ectopic pregnancy. A conservative approach, salpingotomy, preserves the tube but bears the risk of incomplete removal of the pregnancy tissue (persistent trophoblast), which then needs additional treatment, and of a repeat ectopic pregnancy in the same tube in the future. A radical approach, salpingectomy, bears no risk of persistent trophoblast and limits the risk of repeat tubal pregnancy, but leaves only one tube for reproductive capacity. It is unknown which type of operation is better, especially for future fertility. We investigated women’s preferences between these two treatments for ectopic pregnancy, i.e. does a better fertility prognosis outweigh the potential disadvantages of persistent trophoblast and an increased risk for ectopic pregnancy in the future? The study results show in the surgical treatment of tubal ectopic pregnancy that women preferred avoiding a repeat ectopic pregnancy to gaining a higher chance of a spontaneous intrauterine pregnancy. The risk of additional treatment in the case of persistent trophoblast after salpingotomy was acceptable if compensated by a small rise in intrauterine pregnancy rate.     

Laparoscopy for the treatment of unexplained infertility

Aim:  To determine the best treatment for unexplained infertility.
Methods:  A retrospective study was used to examine Japanese women with unexplained infertility that had undergone laparoscopy. The main outcome measure of the study was the rate of pregnancy after laparoscopy.
Results:  One hundred and thirty-eight women diagnosed with unexplained infertility received laparoscopy and as a result 55 women had their diagnosis of unexplained infertility confirmed. There were no statistically significant differences between the women who became pregnant after laparoscopy in terms of duration of infertility, duration of treatment or age. The pregnancy rate of women with unexplained infertility was 56.4%, with 90% of these pregnancies achieved within the first 6 months. There were 64 women with minor endometriosis considered to be suffering from unexplained infertility before laparoscopy. The characteristics of the patients in the unexplained infertility group and in the minor endometriosis group were similar, but patients with minor endometriosis were found to have a lower pregnancy rate compared to those with unexplained infertility (35.9% vs 56.4%; P  = 0.02).
Conclusions:  The effective period after laparoscopy appears to be 6 months. Assisted reproductive technology should be considered after that time. Pregnancy rates were low in women with minor endometriosis compared with unexplained infertility. It is important to clarify the cause of infertility using laparoscopy. (Reprod Med Biol 2006; 5 : 59–64)     

Endometriosis and infertility

Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20–25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.     

Pregnancy rates after laparoscopy for infertility

To obtain prognostic data on the likelihood of pregnancy in infertile women with no observable abnormalities at diagnostic laparoscopy, the occurrence of pregnancy was studied in a series of 229 patients. The cumulative conception rate during a follow-up period of at most 5 yr was 50%. The probability of pregnancy proved to decline with age and duration of infertility. The cumulative conception rate during the first year after laparoscopy was approx. 30%, and there was no significant difference between the patients that were treated with respect to other sub-optimal fertility factors (subfertile group) and the patients in whom no rational treatment could be instituted (unexplained infertility group). Implications of these findings with respect to the treatment of long-term infertility are discussed. Knowledge of pregnancy rates after infertility laparoscopy seems important for the evaluation of results of therapy in unexplained infertility.     

Radical or conservative surgery for ectopic pregnancy? A follow-up study of fertility of 323 patients

The fertility of 323 patients desiring pregnancy after operation for ectopic pregnancy was analyzed after a follow-up period of 1 to 11 years (mean 5.1 years). The conception rate was 82%. Full-term delivery was obtained in 79% of the pregnant patients and repeat ectopic pregnancy in 13%. Nulliparous women had a significantly lower (P less than 0.01) conception rate (74%) than parous women (86%). The operation method had no influence on subsequent fertility in women with an intact contralateral tube. The women with intact contralateral tubes had a significantly higher pregnancy (P less than 0.001) and full-term birth (P less than 0.01) rates (87% and 83%, respectively) but significantly lower (P less than 0.001) repeat ectopic pregnancy rate (9%) than the women with affected contralateral tube (51%, 56%, and 52%, respectively). Compared with the parous women (9%), the risk of repeat ectopic pregnancy was significantly (P less than 0.01) higher for nulliparous women (22%). Of the nulliparous women with repeat ectopic pregnancy only 16% had a full-term pregnancy.     

Laparoscopic ovarian drilling as first line of treatment in infertile women with polycystic ovary syndrome.

Laparoscopic ovarian drilling (LOD) is used as a first line of treatment, as a second line of treatment after patients have proved resistant to clomiphene or as a third line of treatment after failed ovulation induction with gonadotropins. We present the postoperative pregnancy rates of 57 women to evaluate a potential optimal time of LOD together with the other treatment regimens of infertile women with polycystic ovary syndrome (PCOS). Data on the preoperative and operative treatment, and background data were evaluated for their influence on pregnancy rates. The pregnancy rate was 61% among women with PCOS who had LOD. No difference was found in the clinical data between the women who became pregnant and those who did not. Likewise, no difference was found between the women who had pre- and/or postoperative medical ovulation treatment and those who had none. The median time to pregnancy after LOD was 135 days. LOD alone resolves infertility within 4-6 months in 50-60% of couples. A strategy with diagnostic laparoscopy and LOD as the first line of treatment of infertility in women with PCOS will shorten the time to pregnancy for many women, reduce the need for medical ovulation induction and enable diagnosis of those women with anatomic infertility, who can achieve pregnancy only by in vitro fertilization treatment.     

After the FLUSH trial: a prospective observational study of lipiodol flushing as an innovative treatment for unexplained and endometriosis-related infertility

OBJECTIVES: To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. DESIGN: Prospective observational study. SETTING: Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. POPULATION: The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. METHODS: Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. MAIN OUTCOME MEASURES: Clinical pregnancy at 6 months post-treatment; and live birth or ongoing pregnancy. RESULTS: The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. CONCLUSION: This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.     

Caesarean section and tubal infertility: is there an association?

Rising Caesarean section (CS) rates have fuelled concerns about the effect of abdominal delivery on female fertility due to post-surgical complications affecting the Fallopian tubes. The association between exposure to CS and subsequent tubal infertility was explored by means of a case-control study. This study compared 220 women with secondary infertility due to tubal factor with 1244 women with secondary infertility due to non-tubal causes and 18,376 fertile women (women with a previous live birth followed by another live birth during the time period when the infertile cases were trying to conceive) in terms of exposure to CS. Exposure to CS in women with secondary tubal infertility was similar to other infertile women (21.4% versus 21.6%) but lower in fertile controls (14.5%). After adjusting for confounding factors, CS does not appear to be significantly associated with tubal infertility [adjusted odds ratio (95% confidence interval) for previous CS for infertile and fertile controls were 1.06 (0.73-1.52) and 1.2 (0.9-1.7), respectively]. However, other factors that were found to be predictive of secondary tubal infertility include history of intrauterine device use, pelvic inflammatory disease, ectopic pregnancy, endometriosis and previous pelvic surgery.