Endoscopic Tubal Restorative Surgeries for Tubal Factor Infertility at a Teaching Hospital in North Central Nigeria: A Preliminary Report of a Prospective Longitudinal Study

Abstract

Abstract Background: Tubal surgery is an acceptable treatment option for infertility due to tubal factors. However, in the era of assisted reproductive technology, the use of restorative tubal surgery for the treatment of tubal factor infertility has been reduced. Objectives: This study was conducted to determine the incidence of endoscopic tubal surgery, tubal factor infertility, fertility outcomes, and factors that influence successful or favorable outcomes among women with gynecological endoscopic surgeries for tubal factor infertility. Materials and Methods: This is a preliminary report of a prospective longitudinal study of women with endoscopic tubal restorative surgery for tubal factor infertility at a Federal Teaching Hospital in North Central Nigeria between November 9, 2016, and February 12, 2020. Thirty-four women aged 26–42 years who had bilateral tubal blockage before surgeries were analyzed. The primary outcome measure was clinical pregnancy, whereas secondary outcomes were tubal patency, live birth, miscarriage, and ectopic pregnancy rates. Data were analyzed using Statistical Package for the Social Sciences version 26. Data analysis was descriptive and inferential at a 95% confidence interval, P < 0.05 was considered statistically significant. Logistic regression was carried out to determine independent factors for successful fertility outcomes after endoscopic tubal surgery. Results: There were 1534 gynecological admissions among whom 159 (10.4%) had endoscopy surgeries for infertility. Of the 159 women, 37 (23.3%) had confirmed tubal infertility with bilateral tubal blockage on hysterosalpingography and laparoscopy with a dye test. Thirty-four (women who met the inclusion criteria were analyzed and three women who had salpingectomy and bilateral tubal disconnection and those with AMH of <1.0ng/mL were excluded from the study. The mean age was 34.0 ± 5.2 years, and the majority (67.6%) were nulliparous. Peritubal adhesions were the most common tubal pathology seen on laparoscopy. Hysteroscopic tubal cannulation with selective salpingography (41%), salpingolysis (29%), salpingostomy (21%), and fimbrioplasty (9%) were the interventions performed. Bilateral and unilateral tubal patencies were achieved in 58.8% and 32.5%, respectively. The overall cumulative clinical pregnancy rate was 38.2%, out of which 35.3% conceived spontaneously. Live births (LBs) and miscarriage rates are 20.6% and 17.6%, respectively. There was no ectopic pregnancy. Regression estimates showed that lower age (P = 0.029), lesser duration of infertility (P = 0.038), and treatment of other etiological factors at the same setting (P = 0.019) are independent factors for successful fertility outcome after endoscopic restorative tubal surgery. Conclusions: The high rate of spontaneous intrauterine pregnancy and LBs in this study rekindles the hope of natural conception at a low cost among women with tubal factor infertility.