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Background: Patients with intratubal microinsert sterilization later may request reversal.Case: Each patient underwent mini-laparotomy and removal of intratubal microinserts. One patient underwent unilateral tubotubal anastomosis and unilateral tubouterine implantation through a cornual uterine incision. The other patient underwent bilateral tubouterine implantation through a posterior transfundal uterine incision. The first patient became pregnant 4 months after surgery, had an uncomplicated pregnancy, and underwent an elective cesarean delivery at term. The second patient became pregnant 8 months after surgery and had a pregnancy complicated by unexplained abdominal pain at 34 weeks of gestation that resulted in early cesarean delivery.Conclusion: Proximal tubal occlusion from intratubal microinserts can be corrected surgically and can provide patients an alternative to in vitro fertilization. [ABSTRACT FROM AUTHOR]

We conducted this study to determine whether fallopian tube anatomy can predict the likelihood of pregnancy and pregnancy outcomes after tubal sterilization reversal. We built a flexible, non-parametric, multivariate model via generalized additive models to assess the effects of the following tubal parameters observed during tubal reparative surgery: tubal lengths; differences in tubal segment location and diameters at the anastomosis sites; and fibrosis of the tubal muscularis. In this study, population, age, and tubal length-in that order-were the primary factors predicting the likelihood of pregnancy. For pregnancy outcomes, tubal length was the most influential predictor of birth and ectopic pregnancy, while age was the primary predictor of miscarriage. Segment location and diameters contributed slightly to the odds of miscarriage and ectopic pregnancy. Tubal muscularis fibrosis had little apparent effect. This study is the first to show that a statistical learning predictive model based on fallopian tube anatomy can predict pregnancy and pregnancy outcome probabilities after tubal reversal surgery.

Study Question: Is bilateral tubotubal anastomosis a successful treatment in an outpatient patient population?, Summary Answer: For women wanting children after tubal sterilization, bilateral tubotubal anastomosis is an effective outpatient treatment., What Is Known Already: With the current emphasis in reproductive medicine on high technology procedures, the effectiveness of female surgical sterilization reversal is often overlooked. Previous clinical studies of tubal sterilization reversal have been mostly retrospective analyses of small patient populations., Study Design, Size, Duration: A cohort of women who underwent outpatient bilateral tubotubal anastomosis from January 2000 to June 2013 was followed prospectively until December 2014 to determine the proportions of women undergoing the procedure who became pregnant and who had live births. Data were collected at the time of pregnancy. Differences in pregnancy rates and live birth rates associated with age, race and sterilization method were evaluated., Participants/materials, Setting, Methods: A total of 6692 women, aged 20-51 years, underwent outpatient bilateral tubotubal anastomosis., Main Results and the Role of Chance: The crude overall pregnancy rate was 69%. The crude overall birth rate was 35%. Results varied according to age at sterilization reversal and the method of sterilization. Women under 30 years of age at reversal of ring/clip sterilizations had an 88% pregnancy rate and 62% birth rate. Pregnancy and birth rates declined as age increased at sterilization reversal. Coagulation sterilization reversals resulted in the lowest rates of pregnancies and births. Ligation/resection reversals had intermediate success rates., Limitations, Reasons for Caution: Limitations of our study include probable underreporting of pregnancies based on patient-initiated reports; possible errors in the reporting of pregnancies or early miscarriages that may have been based solely on home pregnancy tests; and probable over-reporting of the diagnosis of ectopic pregnancies. We identified age and sterilization method as being associated with subsequent pregnancy, however, in order to be considered predictive, the associations would need to be validated in an independent second prospectively studied group of representative patients. Finally, we also included patients in the study population who had additional surgical procedures performed at the time of tubotubal anastomosis (e.g. uterine myomectomy, fimbrioplasty, ovarian cystectomy and adhesiolysis), factors that could result in differences in pregnancy statistics in our study versus other patient populations., Wider Implications of the Findings: The results of this study can help inform patients and clinicians about this low technology alternative to IVF., Study Funding/competing Interests: None., Trial Registration Number: N/A., (© The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.)

Objective: To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications., Methods: All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible patients met prespecified criteria for outpatient surgery. Patients underwent outpatient reversal using a transverse suprapubic abdominal incision with tubouterine implantation performed with either bilateral cornual or single transverse posterior-fundal uterine incisions. Patients were evaluated on postoperative day 1, called the following day, and e-mailed at 2 weeks and 12 months. Pregnancy outcomes were assessed through a 12-month questionnaire and self-reporting using an Internet-based patient portal. Univariate analysis of patient and operative characteristics was performed., Results: Seventy patients underwent bilateral tubouterine implantation and completed at least 12 months of follow-up. All surgeries were outpatient without any immediate operative complications. Four patients had complications between 2 and 30 days, none requiring extended hospitalization. Women who became pregnant were younger (mean age 34 years) than those who did not become pregnant (mean age 38 years). Twenty-five patients (36%, 95% confidence interval [CI] 25-47%) reported a total of 31 naturally conceived pregnancies. Twenty-seven percent (19/70, 95% CI 17-37%) of those undergoing surgery subsequently reported live births. A single pregnancy complication of postpartum hemorrhage after cesarean delivery requiring transfusion was reported; no ectopic pregnancies were reported., Conclusion: Hysteroscopic sterilization can be reversed using tubouterine implantation and both pregnancy and live birth rates are promising.

Objective: To demonstrate the feasibility of outpatient correction of Adiana proximal tubal occlusion by surgical implantation of the fallopian tubes., Design: Case study., Setting: Outpatient surgical center., Patient(s): A 36-year-old woman with a history of bilateral proximal tubal occlusion secondary to Adiana sterilization who desired surgical correction and natural conception., Intervention(s): Outpatient surgical correction of proximal Adiana tubal occlusion by use of a minilaparotomy to perform bilateral tubouterine implantation., Main Outcome Measure(s): Natural conception of pregnancy., Result(s): The patient underwent a successful outpatient bilateral tubouterine implantation to correct Adiana sterilization. The procedure was performed through a minilaparotomy abdominal incision by use of a posterior transfundal uterine incision to implant the isthmic sections of each tube into the uterine cavity. The patient's postoperative course was uncomplicated. Natural conceptions occurred at 6 and 9 months after surgery. The first pregnancy was of unknown location and aborted spontaneously. The second pregnancy was uncomplicated and was delivered at 39 weeks' gestation by elective cesarean delivery., Conclusion(s): Adiana hysteroscopic tubal occlusion can be surgically corrected in an outpatient setting through tubouterine implantation and this surgical technique can provide patients with an alternative to in vitro fertilization., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe the methodology used to induce ovulation in a 41-year-old woman with imminent ovarian failure and tubal factor so that in vitro fertilization-embryo transfer (IVF-ET) could be performed., Methods: Ethinyl estradiol was used to suppress elevated serum follicle stimulating hormone (FSH) levels, thus theoretically allowing restoration of down-regulated FSH receptors and response to endogenous gonadotropins., Results: One oocyte was retrieved and fertilized and one embryo was transferred. The patient conceived and is presently in her last trimester., Conclusion: Successful pregnancy following IVF-ET is possible in women with imminent ovarian failure - even in women older than age 40.

A population of generally healthy women underwent a variety of reproductive operations by pelvic laparotomy at an ambulatory surgical center. The techniques and safety of this approach are described. Of the 373 women, one experienced a major complication (ureteral injury), which was treated in the surgicenter. The patient recovered in the hospital, with no late adverse outcome. Two other women were hospitalized for intravenous fluid therapy because of persistent nausea and vomiting. No patients required blood transfusion or reoperation. Four women had minor complications that were treated outside the hospital. The rate of hospitalization was 0.8%; of major complications, 0.3%; of minor complications, 1.6%; and of total complications, 1.9%. In this population, 98% of the patients had no complication, and 99% did not need hospital care. Thus, outpatient pelvic laparotomy was found to be safe and cost effective.

Tubal occlusion through a culdotomy incision offers a method of surgical sterilization acceptable to women in some countries where abdominal sterilization is not acceptable. This technic requires skilled gynecologic surgeons, who are a limited resource in many developing countries. On the other hand, gynecologic surgeons practicing in outlying areas may find it more feasible to perform colpotomy sterilizations than laparoscopic sterilizations with the latter's requirements for specialized instrumentation and additional training. With adequate attention to operator training, patient selection, evaluation of patients for postoperative complications and appropriate care of those with such complications, culdotomy should be included among the various approaches appropriate for female sterilization.

A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.

The hospital and operative records of 318 women with a discharge diagnosis of tuboovarian abscess (TOA) were reviewed to evaluate the possible relationship between contraceptive usage and the occurrence of TOA. A significantly higher (p < 0.10) proportion of the intrauterine contraceptive device (IUD) users had acute pelvic inflammatory disease and a significantly lower proportion (p < 0.10) compared to users of other contraceptive methods were surgically treated. The proportions of women with unilateral and bilateral TOAs were similar, regardless of the contraceptive method used. This was true whether diagnosis was based on physical examination alone or confirmed at operation.

Five hundred eighty-eight women who were delivered of twins at 13 hospitals affiliated with the Northwestern University Medical School or its outreach institutions between 1971 and 1975 were studied. Eighty-six of the infants did not survive the pregnancy, delivery, or the first week post partum. Maternal demographic and obstetric characteristics are outlined. Infants are categorized by birth order and by birth weight. The mean weight (and standard deviation) of first twins was 2,388 gm (+/- 742 gm) and that of second twins was 2.314 gm (+/- 766 gm). The rate of pregnancy wastage was highest in mothers who were under 20 years of age, who were of low parity, and who were delivered prior to the physiologic maturation of the fetus. The crude mortality rate of twin 1 was 6.1/100 versus 8.5/100 for twin 2. The causes of death in all infants over 2,000 gm are listed. All pregnancy losses are categorized into unavoidable deaths (26.6%), probably not avoidable deaths (59.4%), and possibly avoidable deaths (13.9%).

This review of 20 years of medical literature on the occurrence of congenital defects among offspring of women who ingested "progestational" or contraceptive hormones during pregnancy emphasizes the need for additional studies with carefully selected control groups. Other problems encountered in interpreting the existing literature, including the use of imprecise definitions, confusing nomenclature and inadequate clinical information, are also discussed.

To evaluate whether removal of the amniotic fluid prior to the instillation of 200 ml of 20% hypertonic saline has any effect on the success, speed, and safety of the abortion process, 192 patients at 15-20 weeks' gestation were aborted according to one of the following procedures: 1) instillation of 200 ml saline without removal of the amniotic fluid (92 subjects), 2) removal of 100 ml of amniotic fluid prior to saline instillation (46 subjects), and 3) removal of 150 ml of amniotic fluid prior saline instillation (54 subjects). The study indicated that there are no apparent advantages to the removal of the amniotic fluid prior to the instillation of 200 ml of hypertonic saline. The median times from instillation to abortion and rates of incomplete abortion were similar for the three groups of patients. Rates of specific complications, except for fever, were similar for the three groups.

To address the issue of detection bias among endometrial cancer cases and controls, women admitted to the North Carolina Memorial Hospital for dilatation and curettage (D&C) during 1970-1976 were selected as one of three control groups in a study of endometrial cancer and exogenous estrogen. Study subjects included 256 cases, 316 D&C controls, 224 gynecology controls and 321 community controls. The D&C controls had a higher frequency of estrogen use than either of the other control groups or the cases. These differences existed for both blacks and whites. When white cases were compared to either gynecology or community controls, relative risks were increased for long duration estrogen use and for recent use prior to diagnosis. With D&C controls, relative risks were not significantly different from unity irrespective of duration or recency of estrogen use. Exclusion of hyperplasias from the D&C controls had no substantive effect of these results. Bleeding was a presenting complaint for 92% of cases, 82% of D&C controls and 22% of gynecology controls. Both among cases and gynecology controls, there was no statistically significant association between bleeding and estrogen use, whereas this association was evident among D&C controls, and specifically among those who did not have pathologic evidence of endometrial hyperplasia. These data support the presence of detection bias among D&C controls but they do not provide evidence of this bias among endometrial cancer cases.

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

The Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of pelvic inflammatory disease. Classically it consists of adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface. Two recent changes have been made in the assessment of this syndrome. One, the syndrome was originally thought to be caused solely by Neisseria gonorrhoeae. Recent studies using tissue cultures and serum antibody titers have documented a major etiologic role for Chlamydia trachomatis as well. Two, the condition has recently been reported to exist in men, whereas previously it was believed to be limited to sexually active women in their reproductive years.

Four used intrauterine contraceptive devices and two new control devices were studied by scanning electron microscopy. All intrauterine contraceptive devices were found to have surface deposits that differed not only from site to site on a given device but between devices. A finding of this study not previously described in the literature was the observation of a euhedral crystal rosette of an apatite mineral group [Ca5(PO4)3(F,Cl,OH)] on the Lippes Loop that had been in situ for 15 years.

This study examines the relationships between fetal size (biparietal diameter and crown-rump length) and gestational age among subjects aborted by hypertonic saline in the second trimester of pregnancy. With a confidence of 90 per cent, biparietal diameter can be used to predict gestational age within plus or minus 2 weeks, and crown-rump length can be used to predict gestational age within plus or minus 3 weeks.

This is an analysis of changes in menstrual cycle length and regularity occurring for a group of 211 women who had discontinued use of oral contraceptives. The analysis is based on prospectively recorded histories from the Menstruation and Reproduction History Program. Post-pill menstrual cycle length and regularity are compared with pre-pill averages. In the first post-pill cycle, there was an average increase of 6 days in cycle length. In subsequent cycles, however, cycle length and regularity were comparable to pre-pill norms in most cases.

Clinical experience with prevention of Rh-immunization is reviewed. The pathogenesis of hemolytic disease and the chemistry of prophylaxis is explained. The factors which effect antigenic expression are delineated. The clinical indications for prevention of AMIS are reviewed. International data pertaining to Rhesonativ are presented from postpartum trials and antepartum trials. A protocol for antepartum administration of anti-Rh immunoglobulin is given.

A review of data from various large-scale studies reveals as much variation between studies as between devices. Many factors clearly unrelated to the IUD design undoubtedly influence their efficacy and continued use. Thus, the conclusions of the 1968 FDA report on effectiveness and utility still appear valid at this time. They are: A. "The Committee finds adequate scientific data attesting to the effectiveness and utility of the intrauterine devices." B. "The intrauterine devices are highly effective in preventing pregnancy, although they are not quite as reliable as the hormonal contraceptives if the latter are taken according to instructions." C. "The rate of continuation of use is similar to that of the oral contraceptives and is far higher than that of traditional methods, at least among the socially and economically deprived."

The relationship of endometrial cavity length to intrauterine contraceptive device (IUD) performance was evaluated in 319 patients wearing three types of devices. The rate of events, defined as pregnancy, expulsion, or medical removal, increased significantly when the length of the IUD was equal to, exceeded, or was shorter by two or more centimeters than the length of the endometrial cavity. Total uterine length was found to be a less accurate prognostic indicator of IUD performance than endometrial cavity length alone.

Among 4,069 healthy gravidas undergoing saline abortion, patients administered intravenous oxytocin had a significantly shorter instillation-to-abortion time (median, 25.5 hours) than did patients not administered oxytocin (median 33.3 hours). The instillation-to-abortion time was independent of the rate of oxytocin administration, which ranged from 1 to 4 U. per hour (17 to 67 mU. per minute), but was associated with the time at which oxytocin infusion was begun. When oxytocin infusion was started within eight hours after instillation, a shortened time from instillation to abortion was observed. Although oxytocin augmentation may result in a lower proportion of patients being exposed to the risk of infection associated with prolonged intervals from instillation to abortion, this potential advantage appears counterbalanced by an increased incidence of clinical consumptive coagulopathy associated with instillation-to-abortion intervals of less than 24 hours.

Medical directors of clinics must monitor three aspects of service to ensure high-quality care in abortion clinics: (1) physician training and selection, (2) patient selection, and (3) abortion outcome monitoring as a means of providing an ongoing audit of clinic performance standards. Methods and criteria for monitoring and evaluating these parameters are discussed, and the importance of such monitoring is emphasized.

A survey, conducted in the summer of 1974, to determine the extent of regionalized perinatal care in the United States revealed 28 states to have programs in operation. Evaluation was a common concern of these programs. A model for the evaluation of Regionalized Perinatal Care Programs is presented here with the North Carolina program used as an example. Evaluation was mandated as an integral component of the program in North Carolina, and this model has been developed in response to that mandate.