Fallopian tube anatomy predicts pregnancy and pregnancy outcomes after tubal reversal surgery

We conducted this study to determine whether fallopian tube anatomy can predict the likelihood of pregnancy and pregnancy outcomes after tubal sterilization reversal. We built a flexible, non-parametric, multivariate model via generalized additive models to assess the effects of the following tubal parameters observed during tubal reparative surgery: tubal lengths; differences in tubal segment location and diameters at the anastomosis sites; and fibrosis of the tubal muscularis. In this study, population, age, and tubal length—in that order—were the primary factors predicting the likelihood of pregnancy. For pregnancy outcomes, tubal length was the most influential predictor of birth and ectopic pregnancy, while age was the primary predictor of miscarriage. Segment location and diameters contributed slightly to the odds of miscarriage and ectopic pregnancy. Tubal muscularis fibrosis had little apparent effect. This study is the first to show that a statistical learning predictive model based on fallopian tube anatomy can predict pregnancy and pregnancy outcome probabilities after tubal reversal surgery.

Robotics and Reproductive Surgery

Robotic technology applied to laparoscopy augments the armamentarium of the reproductive specialist. Uterine leiomyomas, adenomyosis, endometriosis, adnexal masses, sterilization reversal, and fertility preservation techniques can all be addressed with a robotic surgery skill set. Additionally, new approaches with single site and natural orifice surgery will continue to maximize advanced opportunities for safe, effective, and cosmetically conscious (patient-centered) approaches to surgical care. Enhanced postoperative recovery pathways are fully adaptable to these robotic procedures and improve patient acceptability while controlling costs.

TUBAL STERILIZATION REVERSAL: IS THERE ANY ROLE IN THIS MODERN ERA OF ART?

Objectives:To determine the clinical pregnancy rate and to evaluate the factors affecting pregnancy rate following tubal recanalization.Study Design:Descriptive case series.Sampling Technique:Consecutive sampling.Setting / Duration of Study:The study was conduc-ted at Lady Willingdon Hospital Lahore, from January 2010 to March 2014.Methodology:Fifty nine women were included who underwent tubal re-anastomosis at Lady Willingdon Hospital Lahore.Inclusion Criteria:Patients undergone tubal ligation, no other female cause of infertility, normal semen ana-lysis.Surgical Procedure:Patients underwent tubal re-anastomosis through laparotomy. 4-quadrant suture technique was used.Data Analysis:Data was collected and entered into SPSS version 20. Descriptive statistics were computed and differences between groups were assessed through Chi square test where it was required. P-value < 0.05 was taken as statistically significant.Results:Out of 59 patients we could follow only 55 patients for clinical pregnancy as rest of 4 were lost for follow-up. Pregnancy rate, intrauterine ongoing pregnancy, miscarriage and ectopic pregnancy were the main outcome measures. Over all pregnancy rate was 34.5% (19/55), intrauterine pregnancy rate was 84.2% (16/19), term viable pregnancy was 68.8% (11/16). Spontaneous abortions were 31.3% (5/16) and ectopic pregnancy rate was 15.8% (3/19).Conclusions:The important prognostic factors for the success of tubal recanalization are age of the patient, sterilization/reversal interval, site of sterilization, method used for sterilization and length of the tube after reanastomosis. The technique is feasible, simple and less time consuming with good intrauterine pregnancy rate. Key Words:Tubal reanastomosis, Tubal recanalization, Pregnancy rate, Tubal sterilization.