Effect of Tubal and Pelvic Pathology on Uterine Receptivity and Success in Intracytoplasmic Sperm Injection

Objective:To evaluate the effect of pelvic pathology on pregnancy outcome of couples with male factor infertility undergoing intracytoplasmic sperm injection (ICSI) and tubal embryo transfer (TET). Design: Clinical study of patients who underwent ICSI for poor sperm parameters. Setting: Tertiary care academic center. Patients: Twenty-six women with normal pelvis (group A) were matched according to age, stimulation protocol, number of transferred embryos, and number of cycles with 26 patients treated for stage 1 endometriosis (group B), and 26 patients with pelvic disease and at least one patent tube (group C). Main Outcome Measure: Pregnancy/cycle, pregnancy/patient, implantation rate and miscarriage rate. Results: Patients with normal pelvis undergoing ICSI and those with treated mild endometriosis demonstrated significantly better embryo implantation and miscarriage rates than ICSI patients with minimal tubal disease. Ongoing pregnancy rate was 50% for patients with normal pelvis and treated endometriosis groups and 30% for women with tubal pathology. The miscarriage rate of patients with tubal disease (33%) was significantly higher than that of the other two groups (14%). Conclusion: Treated mild endometriosis does not affect the outcome in ICSI patients undergoing TET when compared to women with normal pelvic findings, but the presence of tubal disease might affect the pregnancy outcome.