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This study was carried out to test the general belief that fimbriae should be considered almost indispensable to ovum capture. Surgical procedures, including resection of the mesotubarium superius and infundibulum tubae together with the creation of a fistula, are described. An attempt to enhance tubal patency by temporarily using estrogens is discussed. Ovum pickup was determined by flushing both tubes and the uterus 2 days following ovulation induction. The prior use of estrogens did not appear to have increased subsequent ovum pickup in control animals; on the contrary, it even seems possible that estrogens had negatively influenced pickup by the fistulas. With five fistulas, however, three recovered ova represented a pickup rate of 7% to 14% of all ova available following one human chorionic gonadotropin-induced ovulation. These figures suggest that ovum pickup by terminal ampullary fistulas is not negligible; they might indicate that absence of fimbriae offers neither good protection against pregnancy following sterilization nor a hopeless prognosis for fimbriectomy reversal when a distal patent tube is present.

From 1970 through 1973, 388 bilateral fimbriectomies were performed. By the end of 1974, seven pregnancies had occurred, and in four of these patients a resterilization laparotomy was performed. All four cases showed a unilateral tuboperitoneal fistula. These fistulas were examined and compared morphologically with congenital tuboperitoneal fistulas. This proved that all four fistulas were acquired and that they were probably caused by the catgut ligatures used for ampullary ligation. The rather frequent occurrence of hydrosalpinx after fimbriectomy is mentioned. Finally, it seems of questionable advantage to resect the infundibulum as part of a fimbriectomy using the three-ligature technique.

In 1977 we reported on seven patients who presented with intrauterine pregnancy in spite of previous fimbriectomy; in a detailed morphologic study one tuboperitoneal fistula was documented in each of four patients. In the present study three more patients are reported with pregnancy following fimbriectomy, and another four tuboperitoneal fistulas are morphologically investigated and their possible etiology is discussed. In spite of a failure rate of almost 2.6%, the concept about the reliability of fimbriectomy need not necessarily be condemned. This concept can be judged only if information is available both about the total number of fistulas subsequent to a certain technique and about the number of those fistulas which contributed to pregnancy.