Because of the large volume of elective sterilizations performed in this country during the past decade, the high rate of subsequent divorce and remarriage, and improved results of new sterilization reversal techniques, surgeons are receiving rapidly increasing numbers of requests for tuboplasty and vasovasostomy. During the past 10 years (1978-1987), a total of 44 corrective procedures were performed for patients with post-vasectomy azoospermias in this department. Herein, we analyze various factors influencing upon results of anastomosis, and compare results of macroscopic and microscopic anastomotic techniques. The results are as follows: 1. Reversal of vasectomy was requested due to change of mind is 25 patients (56.8%), remarriage in 10 patients (22.7%), death of children in 4 patients (9.1 %), psychologic problem in 4 patients (9.1%) and economic change in 1 patient (2.3%) 2. Results of total vasovasostomies revealed that viable sperms were present in 5 of patients (50%) in macrosurgery and in 22 of 24 patients (92%) in microsurgery. Pregnancy occurred in 2 of 10 patients (20%) in macrosurgery and in 16 of 24 patients (67%) in microsurgery. 3. The longer the interval of obstruction, the less anatomical and functional success rates were noted. 4. It is advised that total open loop technique is far more advanced technically with fool-proof measure. 5. Surgeons who perform the procedure regularly can obtain better results.
Azoospermia ; Child ; Divorce ; Humans ; Marriage ; Microsurgery ; Pregnancy ; Spermatozoa ; Sterilization ; Sterilization Reversal ; Vasectomy ; Vasovasostomy*

OBJECTIVETo investigate the changes and variation of serum antisperm antibodies (AsAb) from the men who received vasovasostomy 2 years after one of three methods of male sterilization, and evaluate the relationship between serum AsAb and pregnancy rate.

METHODSSperm reappearance, serum AsAb and pregnancy rate were investigated in 88 subjects who underwent reversal operation 2 years after one of three methods of male sterilization at 3, 6, 12 and 24 months post vasovasostomy.

RESULTSThere was no significant difference in positive rate of AsAb among groups of vasovasostomized men post one of three methods of sterilization, and between groups before and post vasovasostomy and between groups with and without sperm reappearance, respectively. The positive rate, intensity (percentage of motile sperm coated with beads) and type of serum AsAb had no influences on pregnancy. No significant difference was observed in positive rate of AsAb between pregnant group and non-pregnant group. The pregnancy rate of the group in which sperm concentration was more than 20 x 10(6)/ml was apparently higher than that of the group in which sperm concentration was less than 20 x 10(6)/ml.

CONCLUSIONThe serum AsAb and their positive rate can not be eliminated or decreased by vasovasostomy post male sterilization. The serum AsAb has no influence on pregnancy. There is a close relationship between sperm quality and pregnancy post vasovasostomy.

Autoantibodies ; blood ; Female ; Follow-Up Studies ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Prospective Studies ; Spermatozoa ; immunology ; Sterilization Reversal ; Vasovasostomy

This study was performed to review and evaluate a series of 1,118 patients who und-erwent microsurgical reanastomosis of previously sterilized fallopian tubes in the 134-month span encompassing January, 1980 to Febrary, 1991 at Seoul National University Hospital. Clinical characteristics of patients, pregnancy rates, and factors influencing the outcome of microsurgical tubal reversal were analyzed. Of 1,118 patients, 633(56.6%) had been sterilized by laparoscopic cautery. Loss of ch- ildren was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. The postoperative tubal length was 6 cm or more in 76.0%. Nine hundred and twenty-two(82.5%) patients were followed up for more than 5 years. Overall pregnancy rate after microsurgical tubal reanastomosis was 54.8%(505 /922) with delivery rate of 71.5%(418/585), and the estimated anatomical success rate was 88.2%(814/922). In 505 pregnant cases, mean age of patients was younger and postoperati- ve tubal length was longer with statistical significance compared with 417 nonpregnant cases. Pregnancy rate was significantly correlated with postoperative tubal length, but not with method and duration of sterilization or operative procedure. These data suggest that only the postoperative tubal length is a factor influencing si- gnificantly pregnancy rate after microsurgical reversal of tubal sterilization.
Cautery ; Fallopian Tubes ; Female ; Humans ; Pregnancy Rate ; Seoul ; Sterilization ; Sterilization Reversal ; Sterilization, Tubal* ; Surgical Procedures, Operative

OBJECTIVE: Many different methods have been undertaken to increase the success rate of tuboplasty. Ttubal reanastomosis, Nd-YAG laser, splint he development of a new generation of surgical lasers has offered a possibility for the practical use of the laser technique in microsurgical fields. In gynecology, the laser beam has been reported to be a precise instrument for successful tubal surgery with minimal bleeding and postoperative reaction. The authors studied the effect of the infrared laser beam in the area of tubal reanastomosis. METHODS: To compare tubal patency, pregnancy rate, and histologic difference in site of anastomosis, total 120 tubes of 60 rabbits were used for experimental tuboplasty. The study groups were divided according to the kinds of reanastomosis methods. Group I : 1 layer(right tube) and 2 layer(left tube) anastomosis without using splint, group II : 1 layer(right tube) and 2 layer(left tube) anastomosis with using splint, group III : reanastomosis using laser with splint(III-b) and without splint(III-a). RESULTS: 1. The infiltration of inflammatory cell were observed in all group by optical microscopic examination. Group II revealed more fibrotic change and inflammatory cell without significant statistical difference and there was no significant difference between left and right tubes in each group. 2. The tubes of group II were significantly more patent(75%) than that of group I(50%). Especially the patency of group III performed Nd-YAG laser with splint was the highest(90%). 3. The pregnancy rates in groups without splint were 40%(one layer without splint, group I-right tube), 60%(two layer without splint, group I-left tube), 30%(Nd-YAG laser without splint, group III-a), were significantly lower than that of group with splint, 60%(one layer with splint, Group II-right tube), 60%(two layer with splint, Group II-left tube), 80%(Nd-YAG laser with splint, Group III-b). Especially the group IIIb showed the hightest pregnancy rate(80%). CONCLUSIONS: From the above results, it is considered that the tubal reanastomosis using splint and Nd-YAG laser will improve the pregnancy rate and could be the procedure of choice in the future.
Fallopian Tubes* ; Female ; Gynecology ; Hemorrhage ; Lasers, Solid-State* ; Pregnancy Rate* ; Pregnancy* ; Rabbits ; Splints ; Sterilization Reversal ; Sutures*

OBJECTIVE: To investigate change in the activity of insulin-like growth factor binding protein-3 (IGFBP-3) protease and change in serum IGFBP-3 levels measurable by western ligand blot and immunoradiometric assay after hysterectomy, in patients with uterine myoma. METHODS: IGFBP-3 was analyzed by Western ligand blot (WLB) and immunoradiometric assay in sera obtained from patients (n=14) with uterine myoma undergoing hysterectomy, and IGFBP-3 protease activity were measured by protease assay using [125I] IGFBP-3 as substrate. Patients (n=13, control patients) undergoing tubal reanastomosis were served as controls. RESULTS: No significant differences in the preoperative and postoperative levels of serum IGFBP-3, and IGBPF-3 protease activity between patients with myoma and control patients were noted. In both group, serum IGFBP-3 level measured by WLB decreased significantly on 2nd day after operation and restored toward the preoperative level on 6th day after operation, while there was no significant change in postoperative serum IGFBP-3 levels measured by immunoradiometric assay. Serum IGFBP-3 protease activity increased significantly on 2nd day after operation and returned to the preoperative level on 6th day after operation in both group. CONCLUSION: Circulating IGFBP-3 levels measurable by immunoradiometric assay does not change postoperatively and an increase in IGFBP-3 protease activity on 2nd day after operation result in a decrease in circulating IGFBP-3 levels measurable by WLB.
Humans ; Hysterectomy* ; Immunoradiometric Assay ; Insulin-Like Growth Factor Binding Protein 3 ; Leiomyoma* ; Myoma ; Sterilization Reversal

OBJECTIVETo study the anti-fertility effect of maximum-dose Tongbi Composition and its reversibility in male rats.

METHODSThirty-six male SD rats were equally randomized into a control group and a medication group, the former given normal saline at 10 ml/(kg x d), while the latter treated with Tongbi Composition at 10 g/(kg x d), both for 60 days. Half the rats of each group were sacrificed randomly at the cessation of treatment, and the rest killed at 72 days after it. The relative testis weight, testis volume, sperm concentration and sperm motility were measured, and the pathological changes in the testicular tissue observed under the optical microscope.

RESULTSAfter 60 days of treatment, no statistically significant differences were found between the two groups in the relative testis weight, testis volume and sperm concentration (P > 0.05) , and the sperm motility of the medication group dropped to zero, but it was restored to normal at 72 days after drug withdrawal. Almost no lesions were observed in the testis tissue of the medication group.

CONCLUSIONThe short-term use of Tongbi Composition at the maximum clinical dose has an obvious anti-fertility effect, but it is reversible.

Animals ; Antispermatogenic Agents ; pharmacology ; Drugs, Chinese Herbal ; pharmacology ; Male ; Rats ; Rats, Sprague-Dawley ; Sperm Motility ; Sterilization Reversal ; Testis ; drug effects

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.
Female ; Fertility* ; Follow-Up Studies ; Hospitals, General ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Pain, Postoperative ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Sterilization ; Sterilization Reversal*

INTRODUCTIONWomen with previous tubal sterilisation seeking fertility are faced with treatment options of reconstructive tubal surgery or in vitro fertilisation (IVF) techniques. The aim was to assess the current viability of tubal anastomosis in a local clinical practice.

MATERIALS AND METHODSA retrospective cohort review of all sterilisation reversal cases from January 1998 to January 2008. The main outcome measures included fi rst pregnancy success and live birth after surgery. Subsequent live births, ectopic pregnancies, miscarriages, duration of surgery and hospitalisation within the study period were also reported. We included cases aged less than 40 years, without any known semen abnormalities, and performed by only one operator. Cases with only unilateral reversal were excluded.

RESULTSNineteen cases with previous Filshie clip ligation (9 laparoscopic/10 open) were reviewed. Cumulative pregnancy rates with surgery were 47.4% (<6 months), 57.9% (6 to 12 months), 68.4% (12 to 48 months) and 73.7% (>48 months). Pregnancy (77.8% vs 70.0%) and live birth rates (66.7% vs 60.0%) were similar between laparoscopy and open surgery. The mean interval to pregnancy was marginally lower via laparoscopy (11.3 vs 13.6 months). Hospitalisation stay was significantly halved (1.43 vs 3.00 days) but ectopic pregnancies were increased 3-fold (3 vs 1) with laparoscopy. Compared with IVF, the estimated average cost per delivery for laparoscopic reversal was reduced for laparoscopic reversal with no multiple pregnancies.

CONCLUSIONOur results favour surgical reversal after sterilisation for patients younger than 40 years old. It avoids hyperstimulation risks and the economic burdens associated with multiple pregnancies. Where expertise is available, laparoscopic reversal should be performed.

Adult ; Age Factors ; Cohort Studies ; Female ; Fertilization in Vitro ; Humans ; Laparotomy ; adverse effects ; Microsurgery ; methods ; Pregnancy ; Pregnancy Rate ; Pregnancy, Ectopic ; etiology ; Retrospective Studies ; Sterilization Reversal ; adverse effects ; Sterilization, Tubal

Heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It is a rare obstetrical phenomenon with an incidence rate about 0.003%. The risk factors of heterotopic pregnancy are IUD, PID, endometriosis, tubal surgery, etc resulting in functional and anatomical injury to tubes. Recently, the wide use of ovulation induction and in vitro fertilization has increased the incidence rate. The clinical manifestation are low abdominal pain, adnexal mass, peritoneal irritation signs, vaginal bleeding, etc. Early detecion of heterotopic pregnancy is very difficult. However, recently, due to development of pelviscopy, ultrasonogram and other diagnostic procedures, the diagnostic rate has increased.Because of the high maternal morbidity and mortality resulted from intraabdominal bleeding after rupture of ectopic pregnacy, immediate termination of ectopic pregnancy is required usually by operative methods. We experienced a case of heterotopic pregnancy after tubal reanastomosis and report this case with a brief review of literatures.
Abdominal Pain ; Endometriosis ; Female ; Fertilization in Vitro ; Hemorrhage ; Incidence ; Mortality ; Ovulation Induction ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Risk Factors ; Rupture ; Sterilization Reversal* ; Ultrasonography ; Uterine Hemorrhage

From January, 1988 to December, 1994, 336 cases of tuboplastic surgery were performedfor the purpose of restoration of fertility at the Department of Obstetrics and Gynecology,Pusan National University Hospital. Of these 336 cases, 269 cases were followed-up for 36months postoperatively and reviewed for evaluation and comparison of pregnancy rate andfactors influencing pregnancy outcome according to the types of surgical procedure performed.Six types of surgical procedures were performed : salpingolysis, tubal reanastomosis, tubalimplantation, fimbrioplasty, neosalpingostomy, and combined procedure.The results for the 269 cases were as follows:1. The distribution of tuboplastic surgery was 38 cases(14.1%) for salpingolysis, 142(52.85) for tubal reanastomosis, 5(1.9%) for tubal implantation, 15(5.6%) for fimbrioplasty,45(16.7%) for neosalpingostomy, and 24(8.9%) for combined procedure.2. One hundred forty-eight(55.0%) of 269 patients who underwent tuboplastic surgeryconceived postoperatively. The pregnancy rate was 44.7%(17/38) for salpingolysis, 71.8%(102/142) for tubal reanastomosis, 20.0%(1/5) for tubal implantation, 26.7%(4/15) for fimbrioplasty,24.4%(11/45) for neosalpingostomy, and 54.2%(13/24) for combined procedure.3. The term pregnancy rate was 37.5%, the ectopic pregnancy rate was 5.6%, and thespontaneous abortion rate was 8.6% in patients who underwent tuboplastic surgery.4. Among one hundred forty-eight conceived cases, one hundred twenty-six pregnancies(85.1%) occurred during the first 21 months after surgery, and almost all pregnancies wereachieved before 24 months postoperatively. The mean interval from surgery to conception was11.1 months.5. On tubal reanastomosis, 1) Concerning the site of anastomosis, the pregnancy rate was higher in the isthmic-isth-mic(87.5%) than in other groups. 2) In patients whose postoperative tubal length was less than 3cm, pregnancy was notachieved. 3) Statistically significant differences were not found in the pregnancy rates followingmicro-and macro-surgery for tubal reanastomosis(p > 0.05). 4) There were no statistically significant differences between the pregnancy ratesfollowing unilateral and bilateral surgical procedures for tubal reanastomosis(p > 0.05). 5) The pregnancy rate was statistically higher in patients who underwent tubal ligationwith ring than with electrocautery(p < 0.05). 6) There were no statistically significant differences between the pregnancy ratesaccording to the duration of sterilization(p > 0.05).6. Distal tubal obstruction treated by neosalpingostomy resulted in pregnancy rates thatwere higher with mild disease than with moderate or severe disease(p < 0.05).
Abortion, Induced ; Fallopian Tube Diseases ; Female ; Fertility ; Fertilization ; Humans ; Infertility* ; Obstetrics ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Pregnancy, Ectopic ; Sterilization Reversal