Intervention Review

Surgery for tubal infertility

  1. Zabeena Pandian1,*,
  2. Valentine A Akande2,
  3. Kirsten Harrild3,
  4. Siladitya Bhattacharya4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 29 AUG 2007

DOI: 10.1002/14651858.CD006415.pub2


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.

Author Information

  1. 1

    Aberdeen Maternity Hospital, Obstetrics & Gynaecology, Aberdeen , UK

  2. 2

    Directorate of Women's Health, Obstetrics & Gynaecology, Bristol, England, UK

  3. 3

    University of Aberdeen, Dugald Baird Centre, Aberdeen, Scotland, UK

  4. 4

    Aberdeen Maternity Hospital, Department of Obstetrics and Gynaecology, Aberdeen, UK

*Zabeena Pandian, Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen , AB25 2ZD, UK. ogy211@abdn.ac.uk. z.pandian@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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).

Search methods

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.

Selection criteria

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.

Main results

No suitable randomised controlled trials were identified.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

輸卵管性不孕症之手術治療

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。

目標

本篇的目標在於決定對於輸卵管性的不孕症,無論嚴重度,手術治療是否比期待療法或人工生殖有更好的活產率。

搜尋策略

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。

選擇標準

只有隨機對照試驗(RCT)被納入,主要的結果為每個婦女的活產率。

資料收集與分析

由兩位作者獨立評估研究的品質及可信度。

主要結論

並沒有搜尋到適當的RCT。

作者結論

對於輸卵管性的不孕症,手術治療是否比期待療法或人工生殖有更好的活產率,目前並不詳。需要更多大型的研究才能判定手術的療效。未來的研究除了比較活產率外,更該要比較副作用及費用。會影響到這些結論的因素,包括不孕症的治療,女性的年齡,不孕的時間及之前懷孕的病史都需納入考量。活產率與輸卵管破壞的程度及不同的輸卵管修補方式,包括顯微手術及腹腔鏡手術都應該接受比較。

翻譯人

本摘要由高雄醫學大學附設醫院張慧名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

手術對於輸卵管因素不孕的療效在目前並沒有定論。用於克服輸卵管因素不孕症的手術因為成功率(活產率)及手術技能的進步,如顯微手術及人工生殖(另一種克服輸卵管性不孕症方式)的副作用及費用昂貴,所以近來越來越普遍。但其實輸卵管手術也是相當昂貴的,並且需要特殊的訓練。輸卵管手術的副作用包括子宮外孕及其他手術相關的危險。靜觀其變(期待療法)也是另一種方法。本篇回饋無找出比較輸卵管手術和其他治療方式包括試管嬰兒及期待療法的臨床試驗作者們的結論是目前現有的研究皆無法決定輸卵管手術相對於人工生殖或期待療法的效果。更多的研究,包括針對副作用及費用的資訊,是必要的。