Spontaneous pregnancy rates after reproductive surgery

Abstract

With the development of IVF procedures, the role of reproductive surgery in the management of infertile couples has been questioned. Pregnancy rates (PR) after IVF procedures are well known, but recent data on spontaneous PR after reproductive surgery are scarce. This study aimed to prospectively evaluate how often fertility is restored by reproductive surgery and to identify which independent factors influence spontaneous pregnancy after reproductive surgery. Eight hundred eighty-eight infertile women who underwent surgery for infertility were prospectively included. Women who were referred to IVF after surgery, ceased to plan pregnancy and were lost to follow-up were excluded. Spontaneous PR was analysed for 519 women. A total of 252 (48.6%) women, including 30 treated with clomiphene citrate, conceived spontaneously in the 12-18 months observation period following surgery. Multivariate logistic regression showed that woman's age (OR 0.95, 95% CI 0.90-0.99) and duration of infertility (OR 0.86, 95% CI 0.74-0.99) significantly influence spontaneous PR. Each year of infertility lowers spontaneous PR following surgery by 14% and each year of woman's age by 5%. The study shows a relatively high percentage of women conceived spontaneously after reproductive surgery. The role of reproductive surgery in the management of infertility should be re-evaluated.

Spontaneous pregnancies and determinant factors in infertility: A cross-sectional study

“…They also reported that SPs mostly occurred in 2-4 years of successful or unsuccessful IVF attempts (11). Similar to our findings, another study determined that the younger women and also shorter duration of infertility had higher rate of spontaneous pregnancy after surgery (12). Another study showed that SP occurred after the management of autoimmune disorders (13).…”

Preterm delivery in infertile women after reproductive surgery: should we encourage spontaneous conception?

“…Still, there are few reports on an outcome of spontaneous conception after reproductive surgery due to an opinion that reproductive surgery should only be performed as an initial part of infertility treatment before proceeding to IVF/ICSI 9 . Nevertheless, encouraging reports on a high spontaneous pregnancy rate after reproductive surgery, as in this study, emerged in the last years 8,10 . Similar to our finding, Boyle et al 8 have found the low preterm delivery rate in women who conceived spontaneously after restorative reproductive medicine after failed IVF.…”

“…The data included in databases are collected during the hospital stay by attending doctors, nurses, and midwives. The Computerized database of reproductive surgery was described in detail elsewhere (10). The NRART was introduced in 1983 at the Ministry of Health of Republic of Slovenia, and from 1999 the data are also sent to the IVF Monitoring (EIM) Consortium of the European Society of Human Reproduction and Embryology regularly.…”

“…The main reason exists in the opinion that reproductive surgery should only be performed as an initial part of infertility evaluation to increase implantation and pregnancy rates after IVF 9 . However, evidence shows that careful selection of patients for reproductive surgery enables couples to conceive spontaneously and yields high cumulative pregnancy rates and good outcomes [8][9][10] .…”

“…Thus, every woman without any clear indication for IVF/ICSI undergo diagnostic or operative laparoscopy and, in the case of pathology found on transvaginal ultrasound, also a hysteroscopy. The usual overall pregnancy rate after reproductive surgery has been around 50% 10 . Women, who do not conceive spontaneously after reproductive surgery are advised to undergo IVF procedure.…”