Laparoscopic Fimbrioplasty as an Alternative to In-Vitro Fertilization - Embryo Transfer (IVF-ET)

The introduction of IVF-ET resulted in a worldwide decline of tubal reconstructive surgery.

A “why bother” attitude towards surgery has unfortunately resulted in scores of patients not being given the chance to achieve pregnancy through more traditional, cost-effective, and highly successful treatments.

Couples that cannot afford the expense and time commitment required by IVF are often left without any options.

The nearly exclusive use of IVF-ET has also resulted in generations of young physicians not being trained or exposed to basic and very useful surgical techniques.

Our group’s experience over the last 25 years with both IVF-ET and tubal reconstructive surgery has definitely taught us that the first approach to tubal factor infertility should be surgical, at which time the tubes can be either repaired or removed.

There is no benefit to leaving behind non-functioning tubes, which can decrease the success rate of IVF-ET attempts and possibly lead to serious complications.

Cases of hydrosalpinges¹ should be treated by fimbrioplasty², preferably laparoscopically, in all cases where preservation of mucosal integrity is demonstrated during surgery, irrespective of size, anatomic distortion, or presence of extensive pelvic adhesions.

Laparoscopic fimbrioplasty, in properly selected cases, consistently produces pregnancy rates that equal or exceed those attained by IVF-ET.

Our group is now approaching a 50% pregnancy rate, and contrary to traditional teachings, most of these take place within the first few months following surgery.

Because of the success rate and cost-effectiveness of this procedure, we believe that the preferred choice for the management of infertility secondary to fimbrial occlusion should be laparoscopic fimbrioplasty.

The video below demonstrates our technique.

Laparoscopic Fimbrioplasty Video

1. Plural of hydrosalpinx: a condition wherein the fallopian tubes are blocked at the distal (ovarian) end and filled with serous (clear) fluid, commonly leading to infertility. The major cause is pelvic inflammatory disease (PID), often due to ascending infection by chlamydia or gonorrhea, but post-surgical adhesions, endometriosis, cancer, and other conditions may contribute.

2. Reconstruction of the fimbria, the fringe of fallopian tube tissue near the ovary that serves to sweep the egg into the fallopian tube.

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