By Mostafa Metwally, Tin-Chiu Li
To many sufferers and certainly wellbeing and fitness care execs, IVF is the final word therapy for infertility. besides the fact that in lots of instances IVF isn't really possible and should now not be indicated. IVF continues to be a mostly inefficient method that frequently doesn't reach a attaining a being pregnant.
There is still a robust position for different fertility interventions, lots of them surgical in nature. Surgical interventions can be utilized as a stand-alone fertility therapy or as an adjuvant remedy utilized in conjunction with different assisted perception remedies. regardless of the continued use of such innovations through reproductive surgeons, there continues to be a transparent hole within the literature relating to assets to complement formal education within the box or to supply a reference for confirmed and aspiring practitioners.
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Extra resources for Reproductive Surgery in Assisted Conception
In the absence of endometriotic lesions, proximal tubal block associated with peri-tubal and peri-hepatic adhesions strongly suggests previous chlamydial infection as the underlying cause of the tubal damage. If there is evidence of both proximal and distal tubal disease, for example, nodular thickening of the isthmic region of the tube along with fimbrial occlusion, tubal surgery is contraindicated. However, if there is no evidence of distal tubal disease, hysteroscopic tubal cannulation should be attempted under laparoscopic guidance.
20 a b c d Fig. 3 Laparoscopy guided hysteroscopic tubal catheterization. (a) A catheter is being inserted into the interstitial segment of the tube; (b) Backflow of methylene dye was observed prior to successful cannulation; (c) A guide wire was inserted into the interstitial segment of the tube under hysteroscopic guidance; (d) Laparoscopic inspection confirmed that the cannulation was successful with the guide wire coming out of the fimbrial end of the tube (From Hou et al. , with permission) two most popular methods used are tubal cannulation guided by fluoroscopy or laparoscopy.
Reports of conservative resection of rectovaginal endometriosis have shown variable fertility improvement with cumulative pregnancy rates ranging from 30 to 53 % [3, 32–34]. Prospective studies of colorectal resection have demonstrated similar pregnancy rates of 35–48 % [27, 29, 30]. Post-operative fertility rates for women with stage III-IV endometriosis and bowel involvement have been reported as half that of women with the same stage of endometriosis but no bowel involvement (pregnancy rate 35 vs.