NEWS FROM REPRODUCTIVE PARTNERS

Laparoscopic Tubal Reversal
By David R. Meldrum, M. D.

Traditionally, most women desiring fertility after tubal sterilization have been advised to have major surgery to repair the tubes. Since the success rate with surgery is higher than with one cycle of IVF, it is more cost-effective despite having required "open" major surgery. Surgery also avoids the risks associated with multiple pregnancy, which are more common with IVF.

More recently, despite those advantages of surgical reversal, more women are choosing IVF because it avoids major surgery, which until recently was required for tubal repair. In 1997, Dr. T.K. Yoon from Korea reported his preliminary results with laparoscopic tubal reanastomosis in 54 women achieving a 78% pregnancy rate. In December 1999, Dr. Yoon published follow-up on 202 procedures with an 83% pregnancy rate at 18 months after surgery. Even in women over age 40, a 71% pregnancy rate was achieved. These results match those achieved with open abdominal surgery.

Since we originally helped Dr. Yoon refine his techniques for microsurgical repair by laparotomy, as well as sharing our IVF expertise with his group over the years, Dr. Yoon invited three of our physicians (Drs. Meldrum, Rosen and Yee) to travel to Korea to learn his techniques for laparoscopic reversal. The technique is quite similar to those we have used for many years by laparotomy.

RPMG now offers laparoscopic tubal reanastomosis, which allows patients to have outpatient "band-aid" surgery to reverse their sterilization procedure. "It is important for surgeons to have had extensive experience with microsurgical tubal repairs to be able to perform such a delicate procedure by this minimally-invasive technique," says Dr. Meldrum. (The three RPMG surgeons doing the procedure have experience with over 500 tubal microsurgical cases) The advantages of using minimally invasive surgery to 'untie' the tubes are so clear that we are seeing a definite shift towards tubal surgery and away from IVF in this group of patients. In addition, the minimally invasive approach, which can be achieved without the need for prolonged hospitalization, is even more cost-effective than "open" surgery.

"Besides, getting pregnant the good old-fashioned way is a whole lot more fun," Dr. Meldrum noted.

Drs. Meldrum, Rosen or Yee can evaluate candidates for tubal reversal and discuss whether surgical repair makes the most sense in each individual case.
 

New Study Shows No Link between Antiphospholipid Antibody Status and IVF Success

A recently published study provides evidence that although women referred for IVF have a high rate of positive tests for antiphospholipid antibodies (aPL), the presence of these antibodies does not influence the rate of success.

When these antibodies are present and the individual has recurrent early pregnancy loss, inappropriate formation of blood clots or a low platelet count without any specific disease, they are considered to have antiphospholipid antibody syndrome. In the recent past there has been considerable interest in the prevalence of aPL in IVF patients and claims of better outcomes when these individuals were treated with the blood thinner, heparin, and low-dose aspirin. Studies that have examined the role of treatment of aPL in IVF patients have been contradictory.

The current study (Fertility & Sterility 73: 526-530, March 2000) found that 23.4% of 380 IVF candidates tested had positive results for aPL. However the pregnancy rate, live birth rate, length of the pregnancies and birth weight were not affected by the aPL status. On the basis of these findings, the authors felt that aPL screening for women undergoing IVF is not justified.

This study reinforces the general feeling of Reproductive Partners physicians that aPL status is not a factor in infertility, but may play a role in certain cases of recurrent early pregnancy loss.