Surgical Treatment Options for Female Infertility

Yıl 2022, Cilt: 24 Sayı: Special Issue, 68 - 77, 30.10.2022

Mustafa Kemal Özel , M.turan Çetin

https://doi.org/10.18678/dtfd.1194089

Cited By: 1

Öz

Infertility, defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples. An infertility evaluation may be offered to any patient who by definition has infertility or is at high risk of infertility. Hysterosalpingography, hysterosalpingo-contrast sonography, saline infusion sonohysterography, hysteroscopy, laparoscopy, and bacteriological and endocrinological examinations that will be made after these studies aim to focus more on the causes of infertility. With the development of assisted reproductive technology, the need for major reproductive surgery, which may be necessary for the primary treatment of infertility, has decreased over the years. Surgical methods are mainly considered as laparoscopic and hysteroscopic techniques. However, laparotomy is also rarely required and may be needed in cases such as adhesions, mass lesions, unsuccessful surgeries, or emergency surgery. When a surgical treatment is planned for infertile patients who required surgery, it is very crucial that the procedure should be performed by experienced surgeons. In this review, pathologies that require surgery for infertility treatment and surgical methods that can be applied to infertile patients were discussed, rather than medical treatments.

Anahtar Kelimeler

Infertility, laparoscopy, hysteroscopy

Kadın İnfertilitesi için Cerrahi Tedavi Seçenekleri

Öz

İnfertilite 35 yaşın altındaki kadınlarda 12 ay veya 35 yaşın üstündeki kadınlarda 6 ay korunmasız cinsel ilişkiye veya terapötik donör inseminasyonuna rağmen gebe kalamama hali olarak tanımlanıp çiftlerin %15’ini etkileyen durumdur. Tanım gereği infertilitesi olan veya infertilite riski yüksek olan herhangi bir hastaya infertilite değerlendirmesi önerilebilir. Histerosalpingografi, histerosalpingo-kontrast sonografi, salin infüzyon sonohisterografi, histereskopi, laparoskopi ve bu çalışmalardan sonra yapılacak bakteriyolojik ve endokrinolojik incelemeler ile infertilite nedenlerine daha fazla odaklanılması amaçlanmaktadır. Yardımcı üreme teknolojisinin gelişmesiyle birlikte infertilitenin birincil tedavisi için gerekli olabilecek majör üreme cerrahisine olan ihtiyaç yıllar içinde azalmıştır. Cerrahi yöntemler temel olarak laparoskopik ve histeroskopik teknikler olarak kabul edilmektedir. Ancak laparotomi de nadiren de olsa gereklidir ve adezyonlar, kitle lezyonları, başarısız ameliyatlar veya acil ameliyat gibi durumlar söz konusu olduğunda ihtiyaç duyulabilir. Ameliyat gerektiren infertil hastalarda cerrahi bir tedavi planlanırken işlemin deneyimli cerrahlar tarafından yapılması çok önemlidir. Bu derlemede, medikal tedavilerden ziyade infertilite tedavisi için cerrahi gerektiren patolojiler ve infertil hastalarda uygulanabilecek olan cerrahi yöntemler tartışılmıştır.

Anahtar Kelimeler

İnfertilite, laparoskopi, histeroskopi

Kaynakça

• American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Infertility workup for the women’s health specialist: ACOG committee opinion, number 781. Obstet Gynecol. 2019;133(6):e377-84.
• American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014;101(3):633-4.
• Luciano AA, Peluso J, Koch EI, Maier D, Kuslis S, Davison E. Temporal relationship and reliability of the clinical, hormonal, and ultrasonographic indices of ovulation in infertile women. Obstet Gynecol. 1990;75(3 Pt 1):412-6.
• American College of Obstetricians and Gynecologists. ACOG technology assessment in obstetrics and gynecology, number 4, August 2005: hysteroscopy. Obstet Gynecol. 2005;106(2):439-42.
• Karande VC, Gleicher N. Resection of uterine septum using gynaecoradiological techniques. Hum Reprod. 1999;14(5):1226-9.
• Gardner DK, Weissman A, Howles CM, Shoham Z. Textbook of assisted reproductive techniques, 5th ed. volume 2: clinical perspectives. Boca Raton, FL: CRC Press; 2018.
• Honoré GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril. 1999;71(5):785-95.
• Yildizhan B, Durmusoglu F, Uygur M, Erenus M. A new technique for the diagnosis of fallopian tube patency by using hysteroscopy with ultrasound compared with hysterosalpingography in infertile women. Arch Gynecol Obstet. 2009;280(4):543-7.
• Practice Committee of the American Society for Reproductive Medicine. Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril. 2012;97(3):539-45.
• Borrero SB, Reeves MF, Schwarz EB, Bost JE, Creinin MD, Ibrahim SA. Race, insurance status, and desire for tubal sterilization reversal. Fertil Steril. 2008;90(2):272-7.
• Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol. 2003;101(4):677-84.
• Yoon TK, Sung HR, Cha SH, Lee CN, Cha KY. Fertility outcome after laparoscopic microsurgical tubal anastomosis. Fertil Steril. 1997;67(1):18-22.
• Rock JA, Guzick DS, Katz E, Zacur HA, King TM. Tubal anastomosis: pregnancy success following reversal of Falope ring or monopolar cautery sterilization. Fertil Steril. 1987;48(1):13-7.
• Boeckxstaens A, Devroey P, Collins J, Tournaye H. Getting pregnant after tubal sterilization: surgical reversal or IVF? Hum Reprod. 2007;22(10):2660-4.
• Cha SH, Lee MH, Kim JH, Lee CN, Yoon TK, Cha KY. Fertility outcome after tubal anastomosis by laparoscopy and laparotomy. J Am Assoc Gynecol Laparosc. 2001;8(3):348-52.
• Hawkins J, Dube D, Kaplow M, Tulandi T. Cost analysis of tubal anastomosis by laparoscopy and by laparotomy. J Am Assoc Gynecol Laparosc. 2002;9(2):120-4.
• Harb H, Al-Rshoud F, Karunakaran B, Gallos ID, Coomarasamy A. Hydrosalpinx and pregnancy loss: a systematic review and meta-analysis. Reprod Biomed Online. 2019;38(3):427-41.
• Gomel V, Wang I. Laparoscopic surgery for infertility therapy. Curr Opin Obstet Gynecol. 1994;6(2):141-8.
• Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G. Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril. 2006;86(6):1642-9.
• Van Voorhis BJ, Mejia RB, Schlaff WD, Hurst BS. Is removal of hydrosalpinges prior to in vitro fertilization the standard of care? Fertil Steril. 2019;111(4):652-6.
• Şahin Y. İnfertilitede Başarıyı Artıran Endoskopik Girişimler. In: Fıçıcıoğlu C, editor. Üreme Endokrinolojisi, İnfertilite ve Yardımcı Üreme Teknikleri. İstanbul: Nobel; 2019. p.101-16. Turkish.
• Guan J, Watrelot A. Fallopian tube subtle pathology. Best Pract Res Clin Obstet Gynaecol. 2019;59:25-40.
• Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73(1):1-14.
• Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol. 2013;20(1):22-42. Erratum in: J Minim Invasive Gynecol. 2013;20(6):917-8.
• Ludwin A, Ludwin I. Comparison of the ESHRE-ESGE and ASRM classifications of Müllerian duct anomalies in everyday practice. Hum Reprod. 2015;30(3):569-80.
• Rikken JF, Kowalik CR, Emanuel MH, Mol BW, Van der Veen F, van Wely M, et al. Septum resection for women of reproductive age with a septate uterus. Cochrane Database Syst Rev. 2017;1(1):CD008576.
• Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline. Fertil Steril. 2016;106(3):530-40.
• Yang JH, Chen MJ, Chen CD, Chen SU, Ho HN, Yang YS. Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries. Fertil Steril. 2013;99(7):2092-6.e3.
• Ludwin A, Ludwin I, Pityński K, Banas T, Jach R. Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty. Hum Reprod. 2014;29(7):1420-31.
• Stamatellos I, Apostolides A, Stamatopoulos P, Bontis J. Pregnancy rates after hysteroscopic polypectomy depending on the size or number of the polyps. Arch Gynecol Obstet. 2008;277(5):395-9.
• Shokeir TA, Shalan HM, El-Shafei MM. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res. 2004;30(2):84-9.
• Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod. 2002;17(6):1424-30.
• Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215-23.
• Litta P, Vasile C, Merlin F, Pozzan C, Sacco G, Gravila P, et al. A new technique of hysteroscopic myomectomy with enucleation in toto. J Am Assoc Gynecol Laparosc. 2003;10(2):263-70.
• Bettocchi S, Di Spiezio Sardo A, Ceci O, Nappi L, Guida M, Greco E, et al. A new hysteroscopic technique for the preparation of partially intramural myomas in office setting (OPPIuM technique): A pilot study. J Minim Invasive Gynecol. 2009;16(6):748-54.
• Deans R, Vancaillie T, Ledger W, Liu J, Abbott JA. Live birth rate and obstetric complications following the hysteroscopic management of intrauterine adhesions including Asherman syndrome. Hum Reprod. 2018;33(10):1847-53.
• Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril. 2017;107(1):289-96.e2.
• Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):773-88.
• Costello MF, Misso ML, Wong J, Hart R, Rombauts L, Melder A, et al. The treatment of infertility in polycystic ovary syndrome: a brief update. Aust N Z J Obstet Gynaecol. 2012;52(4):400-3.