Comparison of Reproductive Outcome of Falloposcopic Tuboplasty for the Proximal Tubal Obstruction with or without Chlamydia Trachomatis Infection

ABSTRACT

Chlamydia trachomatis (CT) infection is a common cause of tubal factor infertility, and is considered a contraindication for tubal surgery. In vitro fertilization with embryo transfer (IVF/ET) is the most widely used treatment for tubal factor infertility, including that caused by CT infection. Falloposcopy to re-canalize occluded tubes may also be useful therapeutically. It is unclear, however, what effect CT infection has on its efficacy. We examined the relationship between the efficacy of Falloposcopic tuboplasty (FT) and CT infection, retrospectively. Of 38 patients with tubal obstruction in which the surgery was performed, with follow-up, 21 patients had CT infections while 17 patients were not infected. In the Chlamydia positive group (CT+), 38 tubes were treated with FT and 29 tubes were treated in the Chlamydia negative group (CT-). Re-canalization rates per tube was 60% in the CT+ group and 79% in the CT- group. The success rate per case was 90% in the CT+ group and 94% in the CT- group. Cases were followed-up using either hysterosalpingography or second look laparoscopy, and a post-operative patency rate of 56% in the CT+ group and 75% in the CT- group was observed. In patients in followed for two years or more, the CT+ group had 5 spontaneous pregnancies (36%) and the CTgroup had 9 spontaneous pregnancies (60%). There was a trend to better outcome in the CT- group, but there was no significant statistical difference between the two groups. In Conclusion, CT infection decreases fertility after FT. Despite CT infection having a negative impact on FT, the CT+ group had a post-operative pregnancy rate of 35.7%, which was comparable to IVF-ET. Given this, we recommend FT for patients who have isolated tubal occlusion before beginning IVF/ET, even if the patients were previously infected with CT

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