**3.8. Reversal of sterilization**

Laparoscopic surgery offers greater comfort to the patients and is more economical, with shorter operative and postoperative hospitalization than laparotomy. Laparoscopic procedures limit the risk of postoperative adhesions to. Operative laparoscopy may be an alternative to microsurgery by laparotomy for management of tubal lesions. Many people, including doctors, mistakenly believe that tubal sterilization is permanent and irreversible. Tubal reversal surgery can also be performed laparoscopically. The laparoscopic technique uses magnification and allows much less pain, discomfort, disfigurement and adhesion formation than the traditional open method. Because the laparoscopic approach to tubal ligation reversal surgery is relatively new technique there is a limited amount of experience worldwide. Tubal ligation is performed for birth control. Tubal ligation blocks the fallopian tubes preventing the egg and sperm from passing through the fallopian tubes. Procedures are performed in several different ways including: burning, removal of a piece, placement of a tight surgical band or clip on the fallopian tube. People sometimes change their minds. The removal of this blockage is the tubal reversal. Tubal reanastomosis surgically opens the fallopian tubes to allow the sperm to reach the egg. When the tubes are severely damaged IVF is the first choice. A laparoscopic approach may be recommended especially in overweight patients where the abdominal wall is too thick to do the procedure the more common way by minilaparotomy. Laparoscopy allows the surgeon to inspect the tubes first to see if the reanastomosis can be done. The success of reversal is dependent on the amount of fallopian tube that has been damaged. Some tubes do not work well because of the surgery to block them followed by surgery to reopen them. In other circumstances a woman's age or her husband's sperm count are preventing success following tubal reversal surgery. Tubal reversal has a higher risk of ectopic pregnancy. Tubal reversal surgery is same-day surgery and takes between two and four weeks to recover. The success rate is greater than 75% for pregnancy.

The Role of Endoscopy in Management of Infertility 15

**4. Salpingitis Isthmica Nodosa** 

reanastomosis.

The etiology of salpingitis isthmica nodosa is unknown; however it may be a post infectious reaction. Patients have histological evidence of previous salpingitis and may have high serum Chlamydia antibody titers. The radiological prevalence of SIN is 3.9-7.5%. The disease is usually bilateral (over 50% of cases). In severe cases, it leads to complete obliteration of the tubal lumen. SIN is associated with infertility and ectopic pregnancy. Salpingitis isthmica nodosa is also referred to as tubal diverticulosis. HSG demonstrates multiple small diverticular collections of contrast protruding from the lumen into the wall of the isthmic portion of the fallopian tubes. Histologicaly, the up to 2 mm sized diverticula represent hypertrophied tubal mucosa that penetrates the myosalpinx. There is secondary hyperplasia and hypertrophy of the surrounding myosalpinx, and hence at laparoscopy,

Laparoscopic finding: enlargement of the tubocornual or isthmic portion of the fallopian tube. The condition is associated with infertility and the occurrence of ectopic pregnancy. The appropriate management of the patients with SIN segmental resection with microtubal

**4.1. Salpingectomy in IVF patients with tubal infertility and hydrosalpinges** 

treatment increases the odds of pregnancy and live birth compared to no treatment.

Ectopic pregnancy is a high-risk condition that occurs in 1.9 percent of reported pregnancies. The etiology of ectopic pregnancy remains uncertain although a number of risk factors have been identified**.** Risk factors most strongly associated with ectopic pregnancy include previous ectopic pregnancy, tubal surgery, assisted reproductive technology, genital infection and pelvic inflammatory disease intrauterine contraceptive device. A history of

**4.2. Management of ectopic pregnancy** 

genital infections or infertility and current smoking increase risk.

Hydrosalpinges are dilated and occluded fallopian tubes generally the result of a prior pelvic infection. These are a cause of female infertility in a number of patients IVF the only option for having a child. The accepted theory today is that the hydrosalpinx fluid plays a causative role in the reduced pregnancy rate with ART. Hydrosalpinx fluid may reduce the receptive ability of the endometrium. It is well known that the success of ART for patients with tubal disease with hydrosalpinx is reduced by half compared with patients without hydrosalpinx. A number of studies were published examining the effect of salpingectomy on IVF pregnancy rates. Removing a hydrosalpinx by laparoscopic salpingectomy may to improve pregnancy rates. Surgical treatment should be considered for all women with hydrosalpinges prior to IVF treatment. In cases of sonographically apparent hydrosalpinges, a salpingectomy, rather than a salpingostomy, is the preferred route of treatment. Some couples, however, may prefer a salpingostomy, which offers some potential of a spontaneous pregnancy, but laparoscopic salpingectomy of hydrosalpinges prior to IVF

localized nodular thickening or swelling of the isthmus is identified.

### **3.9. Tubal reversal surgeries:**


Tubal reversal success rates vary widely depending upon many factors. These include the women's ages, methods of tubal ligation that they had performed experience of the surgeon and techniques for repairing the tubes, length of follow-up after reversal surgery among other factors.
