Subtle tubal abnormalities adversely affect gamete intrafallopian transfer outcome in women with endometriosis

OBJECTIVES: To evaluate prospectively the impact of subtle tubal disorders on GIFT pregnancy rates in women with pelvic endometriosis. DESIGN: A prospective comparison of pregnancy rates in different stages of endometriosis while controlling for the presence of tubal abnormalities. INTERVENTIONS: A total of 146 patients with endometriosis underwent 201 GIFT procedures. During laparoscopy special attention was brought to the fallopian tubes and any anatomical disorders were recorded. Tubal abnormalities included tubal sacculations, diverticulae, convolutions, phimosis, fimbrial agglutination, and peritubal adhesions. Best tube was considered in the final analysis. RESULTS: The presence of tubal abnormalities significantly lowered the pregnancy rates in all stages of endometriosis. When we controlled for age, semen characteristics, number of mature oocytes transferred, and tubal status, the extent of anatomical tubal disorders was the most important prognostic factor in determining pregnancy outcome. CONCLUSION: The extent of tubal abnormalities rather than the stage of endometriosis seems to be an important prognostic factor in determining GIFT pregnancy rates. Couples should be counseled accordingly and accurate prognostic parameters should be explained before enrollment in a GIFT program.