The fallopian tube plays a critical role in conception as the site of ovum transport, sperm capacitation, fertilization, and embryo transport.1 The tube measures an estimated 9 to 11 cm, and narrows from the ciliated infundibulum and ampulla to the medial one-third of isthmus before funneling into the interstitial segment of the myometrium. The ampulla measures 5 to 9 cm and is necessary for fertilization and early embryogenesis.
Tubal disease is identified in up to 30% of couples undergoing an infertility investigation, and both reconstructive surgery and in vitro fertilization (IVF) are treatment options. In the past decade, IVF success rates have increased from 10% in the 1980s to more than 30% according to national data banks. In contrast, success rates for most forms of tubal surgery have remained relatively constant during the same interval. Given improvements in IVF, it is now the treatment of choice for many types of tubal injury, particularly for couples with multiple infertility diagnoses. Surgery, however, remains a necessary reproductive choice for couples with ethical, religious, or financial concerns associated with the IVF process. The purpose of this review is to clarify the evaluation for and contemporary role of reconstructive surgical techniques in the management of infertility secondary to tubal disease.
For most forms of tubal surgery, a limited preoperative evaluation is necessary. Diagnostic tests include a semen analysis and documentation of ovulation (using basal body temperature records, urine luteinizing hormone [LH] predictor kits, or luteal serum progesterone assays). In women older than age 35 years, basal follicle-stimulating hormone (FSH) testing is recommended to identify those who may have a decreased ovarian reserve that would make them poor candidates for surgery. Hysterosalpingography and laparoscopy can be used to define the location, extent, and degree of tubal damage