Surgery for tubal infertility

Zabeena Pandian, Valentine A. Akande, Kirsten Harrild, Siladitya Bhattacharya

Research output: Contribution to journalLiterature review

18 Citations (Scopus)

Abstract

Background

Tubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management ( no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.

Objectives

The aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).

Search strategy

We searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials ( The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.

Selection criteria

Only randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.

Data collection and analysis

Two review authors independently assessed eligibility and quality of trials.

Main results

No suitable randomised controlled trials were identified.

Authors' conclusions

Any effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.

Original languageEnglish
Article numberCD006415
JournalCochrane Database of Systematic Reviews
Issue number3
Early online date16 Jul 2008
DOIs
Publication statusPublished - 2008

Keywords

  • in-vitro fertilization
  • invitro fertilization
  • embryo-transfer
  • microsurgery
  • occlusion
  • management
  • diagnosis

Cite this

Surgery for tubal infertility. / Pandian, Zabeena; Akande, Valentine A.; Harrild, Kirsten; Bhattacharya, Siladitya.

In: Cochrane Database of Systematic Reviews, No. 3, CD006415, 2008.

Research output: Contribution to journalLiterature review

Pandian, Zabeena ; Akande, Valentine A. ; Harrild, Kirsten ; Bhattacharya, Siladitya. / Surgery for tubal infertility. In: Cochrane Database of Systematic Reviews. 2008 ; No. 3.
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title = "Surgery for tubal infertility",
abstract = "BackgroundTubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9{\%} for women with severe tubal disease to 69{\%} for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management ( no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.ObjectivesThe aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).Search strategyWe searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials ( The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.Selection criteriaOnly randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.Data collection and analysisTwo review authors independently assessed eligibility and quality of trials.Main resultsNo suitable randomised controlled trials were identified.Authors' conclusionsAny effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.",
keywords = "in-vitro fertilization, invitro fertilization, embryo-transfer, microsurgery, occlusion, management, diagnosis",
author = "Zabeena Pandian and Akande, {Valentine A.} and Kirsten Harrild and Siladitya Bhattacharya",
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T1 - Surgery for tubal infertility

AU - Pandian, Zabeena

AU - Akande, Valentine A.

AU - Harrild, Kirsten

AU - Bhattacharya, Siladitya

PY - 2008

Y1 - 2008

N2 - BackgroundTubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management ( no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.ObjectivesThe aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).Search strategyWe searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials ( The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.Selection criteriaOnly randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.Data collection and analysisTwo review authors independently assessed eligibility and quality of trials.Main resultsNo suitable randomised controlled trials were identified.Authors' conclusionsAny effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.

AB - BackgroundTubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management ( no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.ObjectivesThe aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).Search strategyWe searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials ( The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.Selection criteriaOnly randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.Data collection and analysisTwo review authors independently assessed eligibility and quality of trials.Main resultsNo suitable randomised controlled trials were identified.Authors' conclusionsAny effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.

KW - in-vitro fertilization

KW - invitro fertilization

KW - embryo-transfer

KW - microsurgery

KW - occlusion

KW - management

KW - diagnosis

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DO - 10.1002/14651858.CD006415.pub2

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 3

M1 - CD006415

ER -