First and subsequent pregnancies after tubal microsurgery: evaluation of the fertility index

• Published in: Fertility and sterility Vol. 68; no. 6; pp. 1033 - 1042
• Main Authors: Gillett, Wayne R, Clarke, Rachel H, Herbison, G.Peter
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1997; Elsevier Science
• Subjects: adhesions; Adult; Biological and medical sciences; Birth control; Fallopian Tube Diseases - surgery; Female; Fertility; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Microsurgery; Pregnancy; Prognosis; prognostic factors; reversal of sterilization; salpingostomy; Sterility. Assisted procreation; Surveys and Questionnaires; survival analysis; Time Factors; tubocornual anastomosis; reversal of sterilization; survival analysis; adhesions; Microsurgery; salpingostomy; tubocornual anastomosis; prognostic factors; Human; Prognosis; Surgery; Female genital duct; Female; Female sterility; Fallopian tube; Fecundity; Reproductive potential; Female genital diseases; Fallopian tube pathology
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(97)00396-8

Objective: To determine the number of children born after a tubal microsurgical operation and to evaluate the fertility index, a long-term measure of reproductive potential. Design: A case series involving a follow-up questionnaire. Setting: A tertiary care university hospital. Patient(s): Three hundred twelve women undergoing microsurgery for tubal disease. Interventions: A range of open microsurgical procedures including reversal of sterilizations. Main Outcome Measure(s): Cumulative pregnancy rates to the first and second normal pregnancies and calculation of the fertility index. Result(s): The 2-year cumulative pregnancy rates (probability ± SE) for a first normal pregnancy for proximal disease, distal disease, tubal reanastomoses, and tubal adhesions were 0.51 ± 0.05, 0.29 ± 0.06, 0.47 ± 0.06, and 0.30 ± 0.07, respectively. Of the 288 (92%) women responding to the questionnaire, 142 women had at least one child. Of the 100 women who wanted a second child, 68 succeeded, the proportions being similar in each surgery category. The fertility index described restoration of normal fertility in 30%, 12%, 34%, and 23% for women with proximal disease, distal disease, anastomotic procedures, and adhesion disease, respectively. Conclusion(s): The fertility index is a useful measure of long-term reproductive potential. The high recurrent pregnancy rate emphasizes the value of microsurgery in restoring normal fertility to some women.