Relocation of abnormal tubo-ovarian structure to treat unexplained infertility, an innovative procedure.

OBJECTIVE: This study examines the relation between the tubo-ovarian structure (TOS) and fertility and explores the possibility of treating unexplained infertility via relocation of abnormal TOS. METHODS: Anonymous retrospective study on the data from treating 372 women with unexplained infertility between 1999 and 2022. The data included clinical manifestation and treatment outcome of relocating abnormal TOS in these patients. All cases were designated as unexplained infertility (i.e., standard recommended infertility testing revealed no abnormality, and no other obvious cause of infertility). Ultrasound or hysterosalpingogram scans revealed abnormal TOS. Laparoscopy allowed visualizing the tubes and ovaries to identify pathologies. Closure ovarian fossa, complemented with uterine and/or ovarian suspension depending on the clinical need, were used to relocate abnormal TOS. RESULTS: Correcting abnormally located TOS was used to treat 372 cases of unexplained fertility with an average success rate of 64%. Pathology, increased patient's age, failed in vitro fertilization (IVF) attempts, and primary infertility increased the risk of no pregnancy. Country of origin and number of years trying prior to operation had no effect on treatment outcome. CONCLUSION: Normal TOS (fallopian tubes pointing down at pouch-of-Douglas) plays a key role in fertility, albeit frequently missed clinically and not typically investigated in patients with unexplained infertility. The procedures we developed to relocate abnormal TOS, including closure ovarian fossa as well as uterine and ovarian suspension, treat unexplained infertility with a high success rate. Applications of our procedures are particularly important in treating unexplained infertility in women over 40, with low anti-müllerian hormone or repeated IVF failure.