Laparoscopy and the Era of ART in Unexplained Primary Infertility: Randomized Clinical Trial

• 作者: Adel E. El-Gergawy Sheren B. Elbohoty
• 来源期刊: 妇产科期刊(英文)
• 学科: 医学
• 关键词: INFERTILITY UNEXPLAINED LAPAROSCOPY ART
• 年，卷（期）: 2019,（12）
• 页码范围: 1586-1594
• 页数: 9页
• 分类号: R71

摘要

OBJECTIVES: To compare the outcomes (effectiveness and safety) of laparoscopic surgery as a treatment option of unexplained primary infertil-ity with ART. DESIGN: Randomized prospective clinical trial. PATIENTS AND METHODS: 536 patients with primary unexplained infertility diag-nosed by normal hormonal profile and ovulatory at ovulation testing, nor-mal HSG, and normal semen analysis were randomized according to com-puter based system into: group I, 267 patients were managed with laparos-copy with aim of diagnosis and treatment. While in group II, 269 patients were treated by controlled ovarian stimulation and IUI up to 3 trials, if failed ICSI was performed. We calculated cumulative pregnancy outcome after two years for each group. RESULTS: In group I, Laparoscopic find-ings were as follow: minimal to mild endometriosis was found in 83 cases (31.1%), moderate to severe endometriosis 44 cases (16.5%) managed by adhesiolysis and ablation-excision of endometriotic implants. The preg-nancy rate after two years was 55.4% (46 cases), 38.6% (17 cases) in both respectively, significant periadnexal and pelvic adhesions 41 cases (15.3%) managed by adhesiolysis with pregnancy occurred in 22 cases (53.7%), while laparoscopy revealed hypo plastic tubes 33 cases (12.4%), and 66 cases (24.6%) remained unexplained. With the expectant manage-ment, pregnancy rate was 21.2% (7 cases), and 15.2% (10 cases) respec-tively. The overall pregnancy rate in group I is 102 cases (38.2%). In group II, 114 cases (42.3) got pregnant as 27 cases (8.78%) by IUI, and 87 cases (33.52%) by ICSI. OHSS occurred in 3 cases, multiple pregnancy occurred in 13 cases, abortion and miscarriage 6 cases in group II, while 2 cases of ectopic pregnancy in group I, and the patients of both groups did not suffer any significant operative complications. CONCLUSION: Laparoscopy is safe and effective as a treatment option in unexplained infertility and its performance provides diagnostic findings which are valuable in manage-ment of the unidentified causes, enabli