Surgery for tubal infertility
Editorial Group: Cochrane Menstrual Disorders and Subfertility Group
Published Online: 16 JUL 2008
Assessed as up-to-date: 29 AUG 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Pandian Z, Akande VA, Harrild K, Bhattacharya S. Surgery for tubal infertility. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006415. DOI: 10.1002/14651858.CD006415.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 16 JUL 2008
Tubal surgery is a widely accepted treatment for tubal infertility. Estimated livebirth rates after surgery range from 9% for women with severe tubal disease to 69% for those with mild disease, however, its effectiveness has not been rigorously evaluated in comparison with other treatments such as in vitro fertilisation (IVF) and expectant management (no treatment). Livebirth rates have not been adequately assessed in relation to the severity of tubal damage. It is important to determine the effectiveness of surgery against other treatment options in women with tubal infertility because of concerns about adverse outcomes, intra-operative complications and the costs associated with tubal surgery.
The aim of this review was to determine whether surgery improves the probability of livebirth compared with expectant management or IVF in the context of tubal infertility (regardless of grade of severity).
We searched the Cochrane Menstrual Disorders and Subfertility Group's trials register (searched August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) and reference lists of articles. We also handsearched relevant conference proceedings and contacted researchers in the field.
Only randomised controlled trials were considered eligible, with livebirth rate per woman as the primary outcome of interest.
Data collection and analysis
Two review authors independently assessed eligibility and quality of trials.
No suitable randomised controlled trials were identified.
Any effect of tubal surgery relative to expectant management and IVF in terms of livebirth rates for women with tubal infertility remains unknown. Large trials with adequate power are warranted to establish the effectiveness of surgery in these women. Future trials should not only report livebirth rates per woman, but also compare adverse effects and costs of the treatments as outcomes. Factors that have a major effect on these outcomes, such as fertility treatment, female partner's age, duration of infertility, and previous pregnancy history should be considered. Livebirth rates in relation to the severity of tubal damage, and different techniques used for tubal repair including microsurgery and laparoscopic methods should also be reported.
Plain language summary
The effectiveness of fallopian tube surgery to overcome infertility caused by tubal disease cannot be determined at present.
Tubal surgery to overcome infertility caused by tubal disease is becoming popular due to the success rates (livebirths), advances in surgical techniques. including microsurgery, and because of the adverse outcomes and costs related to in vitro fertilisation (IVF), which is another option for overcoming tubal infertility. Tubal surgery, however, is also expensive; it requires additional specialist training for gynaecologists, experience to perform, and can have adverse effects (including ectopic pregnancies), and operative risks. Waiting to become pregnant without treatment (expectant management) is another option for women with tubal infertility. This review could not identify any clinical trials that compared tubal surgery with either IVF or expectant management. The authors conclude that at present the available research is not adequate to determine the effectiveness, or otherwise, of tubal surgery compared to either IVF or expectant management. More research is needed, including information about adverse outcomes and costs.
手術對於輸卵管性不孕是一個被普遍接受的治療方式。手術後的估計活產率從患有嚴重輸卵管疾病婦女的9% 到輕微輸卵管疾病婦女的69% 。但是，手術治療的效果並沒有經過和其他治療方式，包括人工生殖(IVF)及期待療法的比較。活產率與輸卵管疾病嚴重度的關係亦沒有被足夠的討論過。考慮到手術相關的副作用例如術中的併發症及費用的考量，輸卵管性不孕症的手術與其他治療方式效果的比較是相當重要的。
我們搜尋了登記在 enstrual Disorders and Subfertility Group Specialised Register 內的試驗(August 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue, 2007), MEDLINE (1970 to August 2007), EMBASE (1985 to August 2007) 及文獻的相關參考文章。 我們另外搜尋了相關的會議資料及聯絡了此領域的研究者。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。