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The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

1
Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece
2
Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece
3
Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, Denmark Hill, 16-20, Windsor Walk, London SE5 8BB, UK
*
Author to whom correspondence should be addressed.
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J. Clin. Med. 2019, 8(4), 548; https://doi.org/10.3390/jcm8040548
Received: 21 March 2019 / Revised: 18 April 2019 / Accepted: 19 April 2019 / Published: 22 April 2019
(This article belongs to the Section Obstetrics & Gynecology)
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Abstract

The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients’ diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts. View Full-Text
Keywords: unexplained infertility; Recurrent Implantation Failure; laparoscopy; natural conception; endometriosis unexplained infertility; Recurrent Implantation Failure; laparoscopy; natural conception; endometriosis
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Pantou, A.; Simopoulou, M.; Sfakianoudis, K.; Giannelou, P.; Rapani, A.; Maziotis, E.; Grigoriadis, S.; Tsioulou, P.; Syrkos, S.; Souretis, K.; Koutsilieris, M.; Pantos, K. The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization. J. Clin. Med. 2019, 8, 548.

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