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Chapter-39 Reconstructive Surgeries Enhancing Fertility

BOOK TITLE: Principles and Practice of Assisted Reproductive Technology

Author
1. Shawki Osama
2. Shawki Yehia
3. Wahba Amr
ISBN
9789352705030
DOI
10.5005/jp/books/18020_40
Edition
2/e
Publishing Year
2019
Pages
14
Author Affiliations
1. Center for Infertility Advanced Endoscopic Surgery, Al Ebtesama Hospital, Heliopolis, Cairo, Egypt, Cairo University Hospital – Egypt, Cairo University; Ebtesama Center for Advanced Endoscopic Surgery; Hysteroscopy Academy for Research and Training (HART), Al Ebtesama Hospital, Heliopolis, Cairo, Egypt, School of Medicine, Cairo University; European Journal of Gynecologic Surgery; Giessen School of Endoscopy, Germany; International Society Gynecologic Endoscopy (ISGE); Ebtesama Center for Advanced Endoscopic Surgery and Hysteroscopy Academy for Research and Training (HART), AI Ebtesama Hospital, Heliopolis, Cairo, Egypt, IVF Specialist, Cairo University, Cairo, Egypt, Cairo University, Cairo, Egypt, Cairo, University, School of Medicine, Giessen School of Endoscopy, Germany; AI Ebtesama Hospital, Heliopolis, Cairo, Egypt
2. GMA, Egypt, Center of Excellence for Uterine Surgery, Cairo, Egypt
3. Cairo University, Cairo, Egypt
Chapter keywords
Reconstructive surgery, infertility, intra-abdominal surgery, peritoneal adhesion, abdominal hysterectomy, myomectomy, tubal infection, tubal sterilization, ectopic pregnancy

Abstract

This chapter will focus on the factors that contribute in the distortion of pelvic and uterine anatomy and will highlight the surgical procedures used to correct this distortion aiming to increase fertility. Intra-abdominal surgery is among the most important contributing factors for the development of peritoneal adhesions. The incidence of adhesions is higher after laparotomy rather than laparoscopy, with increasing number of laparotomies and midline incisions rather than suprapubic incisions. Abdominal hysterectomy and myomectomy (especially after a posterior uterine wall incision) have high associations with pelvic adhesions. Patency of the fallopian tube and normal function of its lining mucosa are mandatory for the transport of ovum, sperm and embryo. It is in the ampulla of the fallopian tube where fertilization takes place. Blockage of this conduit will impair fertility and may cause ectopic pregnancy. The most common causes for tubal damage or occlusion are tubal infection and tubal sterilization.

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