[Female infertility due to tubal obstruction--management and clinicopathologic study of 66 cases]

Sixty-six cases of female infertility due to obstruction of fallopian tubes from December 1984 to June 1988 were analysed. A discrepancy of 28.8% existed between hysterosalpingography and operative findings, e. g. X-ray revealed blocked tubes, but during operation the tubes were found to be patent. The abnormal and marked tortuosity giving rise to resistance to the passage of oil at the ampullar portion of tubes in the majority of cases may be the explanation. Pathological examination of 48 specimens revealed the chief cause of obstruction was nonspecific infection (50.0%). The next tuberculous infection (31.3%). The third isthmic nodular salpingitis (6.25%) and the fourth endometriosis (4.2%). Operative procedures were done for the purpose of ovum pick-up and to treat the diseased tubes. Three cases of clinical pregnancy as the result of intra-operative ovum pick-up in a program of IVF/ET occurred after 1987 when our IVF technology gradually improved. This result suggests that operation on the tubes did not jeopardize the process of implantation. Among the 14 cases followed up for more than one year 3 cases became pregnant. Operations to relax and straighten up the tortuous part of the tubes or instillation of fluid into the tubes and transplantation of the healthy tube into the single horn uterus were effective. To do an anastomosis on the chronically inflamed and thickened tubes was not helpful.