Surgery: Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?

This study was undertaken to report the results of microsurgicallysis of peri-adnexal adhesions and identify the patients whoshould be offered surgery and those who should be treated byin-vitro fertilization (IVF). In all, 19 women had filmy adhesionsand 32 had dense adhesions; 68.4% of women with filmy adhesionsconceived compared with 34.4% of women with dense adhesions(P=0.02). In patients with filmy adhesions, the cumulative pregnancyrate 2 years after operation (47%) is similar to that reportedafter five cycles of IVF (52%), leading us to conclude thatsuch patients should be offered surgery first. Dense adhesionsare best treated by IVF. Lysis of filmy adhesions produces asimilar intra-uterine pregnancy rate whether performed by laparotomy(57.9%) or laparoscopy (56.6%). As operative laparoscopy offersthe greatest patient comfort, it is the treatment of choicein these patients.