PELVISCOPIC TREATMENT OF FEMALE STERILITY

In 1988 and 1989 176 patients underwent pelviscopy at the Kiel University Hospital of Gynaecology for primary or secondary sterility of at least 12 months duration. 120 patients (68 %) filled in a questionnaire on the therapeutic results after 2 to 3 years. Following peripheral salpingostomy in 18 patients, an intrauterine pregnancy developed in 22 % of these cases, while an ectopic pregnancy occurred in 11 % of the cases. After fimbrioplasty in 37 cases, the intrauterine pregnancy rate amounted to 43 %, whereas the mte was 50 % following salpingoovariolysis. 4 patients with a subserous or intramural myoma, measuring 2.5 to 8 cm in diameter, but no other pathological signs of disturbed fertility, became pregnant after enucleation of the myoma. 2 patients delivered at full term, the other two miscarried. 5 out of a total of 10 patients became pregnant after endometriosis foci had been coagulated or endometriomas enucleated. In these cases, the adnexa did not require additional surgical treatment. Pelviscopy revealed an untreatable intratubal block in 9 cases. 10 patients could not be included in the study, either because of a successful in vitro fertilisation or a pregnancy following heterologous insemination or because a hysterectomy or tubectomy had been performed in the meantime. In cases, where inspection under magnification had shown at least one non-pathological adnexa and tubal patency of at least one of the tubes, 35 % of the patients conceived after pelviscopy and chromopertubation within the follow-up period. The therapeutic action of the chromopertubation and the psychological effect of finding no pathological signs during the genital examination remains speculative. Sterility of at least 12 months duration had also preceded surgery in these cases. The average period of sterility had been 3.7 years. The results concerning postoperative pregnancies are comparable to those obtained in microsurgical procedures by laparotomy. Since pelviscopy is less stressful for the patient, one should use this procedure rather than the microsurgical one through laparotomy, for the indications mentioned, if this is surgically feasible.