Le drilling ovarien, par la realisation d’une multiperforation ovarienne bilaterale, permet d’obtenir 50 % de grossesses spontanees chez des patientes presentant un syndrome des ovaires micropolykystiques (SOPK). L’analyse de 80 patientes traitees pour un SOPK par drilling et fertiloscopie montre un taux cumulatif de grossesse de 59 % sans grossesse multiple ni syndrome d’hyperstimulation. Le temps moyen de conception apres traitement chirurgical est de 3,9 mois. Le drilling ovarien apparait comme une procedure mini-invasive efficace, reproductible, dont la place dans la strategie therapeutique est probablement avant toute hyperstimulation par les gonadotrophines et peut etre avant meme l’instauration d’une stimulation par le citrate de clomiphene.
Fertiloscopy is performed as an ambulatory technique. There are five steps in this procedure: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. One of the prerequisite of operative fertiloscopy was to be as effective as the same procedure practiced during laparoscopy. Compared to laparoscopy, fertiloscopy has also some advantages like the facility to perform salpingoscopy and microsalpingoscopy. Fertiloscopy was first designed to avoid diagnostic laparoscopy. Operative possibilities were developed later. The complication rate is low, almost always avoidable if contraindications are strictly respected. Endometriosis may also be treated by operative fertiloscopy, when minimal or moderate. If the lesions are extensive or severe, then laparoscopy has to be the preferred option. Some techniques like fertiloscopic ovarian drilling in polycystic ovarian syndrome (PCOS) patients have already demonstrated its interest in the pregnancy rate obtained without the risks of ovarian hyperstimulation syndrome (OHSS).
The transvaginal approach for NOTES has been used for visceral procedures and is today the only approach validated in humans. However, applied to gynecologic operations, very few applications exist today. Among them, fertiloscopy was probably the first gynecologic NOTES procedure and has been useful to evaluate the endoscopic transvaginal approach. Access being the key in surgery, if gynecologic NOTES has a future it should probably consider alternative route like transgastric or hybrid or combined techniques
This systematic review and meta-analysis were aimed to summarize the body of evidence on the prognosis after laparoscopic surgeries for pathological conditions on distal oviducts, then, furthermore, to evaluate prognostic factors for pregnancy outcomes. We conducted a systematic review and meta-analysis to summarize the body of evidence on this topic, with the review question formulated as "what is the prognosis after the laparoscopic fimbrioplasty, salpingostomy, or salpingoneostomy for patients with pathologic conditions on the distal oviducts." We searched Medline and EMBASE on June 1st, 2020. Two investigators (HH and ZY) independently screened the references of all retrieved records for potentially eligible studies by firstly, through titles and abstract, and then full-text. A study would be included if it was a primary study reporting pregnancy outcomes of patients after laparascopic surgery. A meta-analysis of the rates of pregnancy, ectopic pregnancy, live birth, and miscarriage was performed using a random effect model. We identified 3861 records and included 21 reports with 2473 participants. The pooled estimate for the pregnancy rate was 35.1% (95% CI: 30.7%–39.7%, I2 = 78%, low certainty). The pooled estimates for the live birth rate, ectopic pregnancy rate, and miscarriage were 24.4% (95% CI: 20.2%–28.8%, I2 = 58%; 1154 participants; low certainty), 6.2% (95% CI: 4.4%–8.2%, I2 = 61%; 2363 participants; low certainty), and 4.6% (95% CI: 2.8%–6.9%, I2 = 10%; 544 participants; low certainty). Our analyses suggested that the more damaged tubal was associated with a decreased pregnancy rate, and patients with moderate or severe adhesion had lower pregnancy rates compared with patients with mild pelvic adhesion. We estimated the pregnancy rate, ectopic pregnancy rate, and miscarriage rate of patients with distal tubal pathology after the laparoscopic fimbrioplasty or salpingostomy. Low certainty evidence suggested that laparoscopic surgery can restore the tubal function and cure infertility and should be considered as an alternative to in vitro fertilization. Tubal damage stage and adhesion are associated with worse pregnancy outcomes.
Jusque dans les années 1990, tout bilan d'infertilité se terminait, lorsqu'aucune pathologie n'avait été découverte, par une coelioscopie dite «de fin de bilan».
O-030 Subtle tubal lesions Get access A Watrelot A Watrelot Hospital Natecia, Lyon, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Human Reproduction, Volume 36, Issue Supplement_1, July 2021, deab126.016, https://doi.org/10.1093/humrep/deab126.016 Published: 06 August 2021
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