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Human Reproduction, Vol. 10, No. 1, pp. 155-160, 1995
© 1995 European Society of Human Reproduction and Embryology

Inter-observer variability at laparoscopic assessment of pelvic adhesions

Mark C. Bowman1, Tin-Chiu Li and Ian D. Cooke

University Department of Obstetrics and Gynaecology, Jessop Hospital for Women Leavygreave Road, Sheffield S3 7RE, UK

Correspondence: 1To whom correspondence should be addressed at: Sydney IVF, 187 Macquarie Street, Sydney 2000, Australia

A total of 25 women undergoing videolaparoscopy and a dye test to investigate pelvic adhesions and infertility were evaluated to determine whether applying a score system to pelvic adhesions was reproducible, and its place in determining prognosis or management. The surgeon performing the laparoscopies scored each case using the American Fertility Society (AFS) system, gave an estimate of the likely prognosis from microsurgery and recorded a recommended management [surgery or in-vitro fertilization (IVF)]. The video images and histories were independently reviewed by two other surgeons experienced in tubal surgery, who also scored each case and recorded prognosis from surgery and recommended management. Several differences in adhesion scores for each case were noted. Agreement was present between surgeons regarding estimated prognosis for microsurgery and also in recommending management, particularly when prognosis was considered poor and IVF was recommended. Despite some reproducibility, the AFS score system did not predict outcome or management decisions. However, the surgeons' fundamental impression of the state of the pelvis and recommendation for either surgery or IVF were more consistent and reproducible. Any future proposed system for adhesion classification will need to account for, and be predictive of, the decreasing number of patients for whom surgery (rather than IVF) is the preferred management.

Key words: adhesions/IVF/laparoscopy/tubal surgery

Submitted on June 13, 1994; accepted on October 17, 1994.


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