Pregnancy after fimbriectomy reversal: Results of microsurgery augmented by gamete intrafallopian tube transfer and embryo transfer

Between 1986-1988, physicians at Oregon Health Sciences University in Portland, Oregon induced ovary hyperstimulation in 7 patients then performed a fimbriectomy reversal augmented by a simultaneous gamete intrafallopian tube transfer (GIFT) and embryo cryopreservation during the same treatment cycle to improve fecundability and the cumulative pregnancy rate in a cost effective way. 2 patients received 2 embryo thaw and transfers (ETTs) each (2-3 embryos/ETT) within 16-25 months after fimbriectomy. The physicians determined pregnancy rates (PRs) based on only the 1st conception that resulted from fimbriectomy, GIFT, or ETT. PRs included 14% for GIFT, 25% for ETT, and 43% for fimbriectomy. The combined PR was 57%. Fecundability matched the PRs for augmented GIFT and ETT. Monthly fecundability for just fimbriectomy stood at 6.6% whereas it stood at 7.8% when fimbriectomy, GIFT, and ETT were combined. Average ampullary width was 1.03 cm (.7-1.5 cm). 67% had distal tubal patency which was lower than reported in earlier research (83%). The lower tubal patency rate may have been due to hyperemia and edema of the tube. The 3 women who did not conceive had either bilateral tubal occlusion or abnormal spill. No one experienced an ectopic pregnancy. The fertilization rate for the 4 women who underwent in vitro fertilization and ETT stood at 90% which indicated that laparotomy did not adversely affect fertilization. Mean exposure before 1st conception following fimbriectomy was 10.5 months when the 2 women who had postoperative tubal occlusion are excluded from the analysis. The combination of microsurgery, GIFT, and embryo cryopreservation during the same treatment cycle saved the patient around 40% when compared to the cost of separate treatments in different cycles.