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Human Reproduction, Vol. 9, No. 12, pp. 2339-2341, 1994
© 1994 European Society of Human Reproduction and Embryology

research-article

Surgery: Should lysis of adhesions be performed when in-vitro fertilization and embryo transfer are available?

Gabriel Oelsner1, Eyal Sivan, Mordechai Goldenberg, Howard Carp, Dahlia Admon and Shlomo Mashiach

Department of Obstetrics and Gynaecology, The Chaim Sheba Medical Centre, and Sackler School of Medicine, Tel Aviv University Tel Hashomer 52621, Israel

Correspondence: 1To whom correspondence should be addressed

This study was undertaken to report the results of microsurgical lysis of peri-adnexal adhesions and identify the patients who should be offered surgery and those who should be treated by in-vitro fertilization (IVF). In all, 19 women had filmy adhesions and 32 had dense adhesions; 68.4% of women with filmy adhesions conceived compared with 34.4% of women with dense adhesions (P=0.02). In patients with filmy adhesions, the cumulative pregnancy rate 2 years after operation (47%) is similar to that reported after five cycles of IVF (52%), leading us to conclude that such patients should be offered surgery first. Dense adhesions are best treated by IVF. Lysis of filmy adhesions produces a similar intra-uterine pregnancy rate whether performed by laparotomy (57.9%) or laparoscopy (56.6%). As operative laparoscopy offers the greatest patient comfort, it is the treatment of choice in these patients.

Key words: adhesions/IVF embryo transfer/tuboplasty


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