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Tubal Occlusion Type Affects Fertility Treatment Outcome

Outcome better in unilateral proximal tubal occlusion than mid-distal or distal tubal occlusion

TUESDAY, Aug. 28 (HealthDay News) -- In women with unilateral proximal tubal occlusion, pregnancy rates resulting from ovarian hyperstimulation and intrauterine insemination are similar to those in women with unexplained infertility. But outcomes are worse in patients with mid-distal or distal tubal occlusion, according to a report published in the August issue of Fertility and Sterility.

Jacob Farhi, M.D., of the Rabin Medical Center in Petach Tikva, Israel, and colleagues compared characteristics and pregnancy rates in 62 women who were treated for isolated unilateral tubal occlusion diagnosed by hysterosalpingography and 115 women with unexplained infertility. All patients were treated primarily with three consecutive cycles of controlled ovarian hyperstimulation and intrauterine insemination.

The researchers found that cumulative pregnancy rates were similar in the study and control groups (30.9 percent versus 42.6 percent). But they found that the rates were lower, although not of greater statistical significance, in women with mid-distal or distal tubal occlusion than in women with proximal tubal occlusion (19 versus 38.2 percent). Rates in those with mid-distal or distal tubal occlusion were significantly lower than women with unexplained infertility (19 versus 42.6 percent).

"Controlled ovarian hyperstimulation with intrauterine insemination should be suggested as the initial treatment of choice in patients with unilateral proximal tubal occlusion," the authors conclude. "However, the outcome of controlled ovarian hyperstimulation with intrauterine insemination is worse in patients with mid-distal or distal tubal occlusion on hysterosalpingography, who should be referred for laparoscopic assessment or in vitro fertilization."

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