IN VITRO FERTILIZATION AFTER LIGATION AND TUBE SECTION
Retrospective study on 37 couples.
The success of in vitro fertilization after tubal ligation and section depends essentially on the age of the woman.
The authors have no conflict of interest
Patients who have been sterilized by sectioning and ligation of their tubes and who wish to achieve a new pregnancy after a failed attempt at tubal reconstruction may resort to in vitro fertilization (IVF), although the success of this assisted reproduction procedure will largely depend of the woman’s age. These conclusions come from a study carried out by the department of gynecology and obstetrics of the Pellegrin hospital in Bordeaux, France, between 1990 and 1998. The protocol contemplated two groups of patients postulated for IVF treatment. The first of them consisted of 37 couples who had undergone 56 IVF-embryo transfer attempts after having performed a ligation and section of the woman’s tubes. The second group was made up of 237 couples, who had made 404 IVF attempts for tubal pathologies that caused them sterility. The inclusion criteria in both groups included a spermogram – from the husband or a donor – with more than 20 X 106 spermatozoa / ml, of which 20% or more had to be motile, and a normal ovarian reserve for which women had of over 40 years of age Ovarian stimulation was performed according to one of the following protocols: 1) a single application of a GnRH analog on day 1, 2) a GnRH analog for 7 days during the luteal phase, or 3) a long protocol with pituitary desensitization for 15 days with GnRH analogs. Human chorionic gonadotropin (HCG) was administered in doses of 10,000 IU when the follicles reached 18 mm in diameter, the oocytes were recovered 36 hours later, and luteal support was performed by administering 1,500 IU of HCG and vaginal progesterone from the day of recovery until pregnancy is certain Depending on the age of the woman, significantly fewer oocytes were obtained in the tubal ligation group than in the control group (for tubal pathology) (P = 0.023 for all patients with ligation; P = 0.02 when patients older than 38 years were excluded). The total number of embryos available for transfer was significantly lower in the group with tubal ligation and section (P = 0.0042), but this was related to age, since when women who were older than 38 years were excluded, no found significant differences between the groups. The rate of progressive pregnancies was similar in the two groups, and the probability of achieving a progressive pregnancy seemed to depend more on the age of the patient than on her previous fertility.