Infertility evaluation via laparoscopy and hysteroscopy after conservative treatment for tubal pregnancy.

OBJECTIVE Evaluate the cause of infertility and impairment of tubal reproductive functions in infertility patients, who suffered tubal pregnancy after conservative treatment, using laparoscopy, hysteroscopic tubal catheterization, and hydrotubation. METHODS Seventy-five infertility patients treated for tubal pregnancies were divided into two groups based on past treatment methods of their tubal pregnancies, conservative-medical group and conservative-surgical group. The severity of pelvic adhesions, tubal morphology, tubal fimbria, and other infertility factors were observed via laparoscopy. Additionally, hysteroscopic tubal catheterization and hydrotubation was used to diagnose tubal patency and evaluate the intrauterine cavity. RESULTS There were one or more factors associated with infertility in the 75 patients, among which abnormal tubal was an absolutely important factor. In conservative-medical group, 92.11% (35/38) of the patients were with bilateral or unilateral oviduct exceptions, such as adhesion around or distorted tubal, closure or adhesion in umbrella end, lumen block. In conservative-surgical group, all of the patients were with bilateral or unilateral fallopian tube lesions. As two fallopian tubes per patient, 80.26% (61/76) of the tubes in conservative-medical group was damaged, 95.95% (71/74) in conservative-surgical group. The differences between the two groups was significant (P < 0.05). However, differences between these two groups in morphology of damaged tubes, anomaly of umbrella end and occlusion of lumen were not significant (P > 0.05). Incidence of pelvic adhesions in conservative-medical group was 76.32% (29/38), which was lower than 100% (37/37) of conservative-surgical group. The difference was significant (P < 0.05), which suggested that conservative-medical treatment was more effective than surgical treatment in preventing pelvic adhesion. CONCLUSION Factors associated with tubal infertility affect patients who accepted conservative treatment for tubal pregnancy. In patients with a history of a tubal pregnancy, it may be less likely to compromise future reproductive function for conservative-medical treated patients than that for conservative-surgery treated patients.