SUMMARY

Microsurgical reconstruction of the
rabbit oviduct has shown to be an acceptable model for studying different
infertility problems.

First it has been shown that microsurgical
techniques for anastomosis of the oviduct do not interfere with normal
fertility and result in a normal pregnancy rate, ovulatory function,
transport function through the oviduct and implantation ratio with the
absence of major adhesions. When careful microsurgery is applied to oviduct
microsurgery for salpingostomy ad­junctive medical treatment is not able
to improve the results.

Training in gynecological microsurgery is
necessary before these tech­niques can be applied to human infertility.
As shown in our study at least one hundred oviduct-anastomoses must be
performed before the oviduct function returns to normal. When less
experience is present the ovulatory function and ovum transport function are
impaired, not only on the operated side, but in the early stages also on the
non-operated control side.

When searching for the ideal site of
oviduct-anastomosis, allowing a normal oviduct function after a
microsurgical anastomosis, no difference was found whether the anastomosis
was performed on the ampulla or on the isthmus.

In our aim to
investigate the function of the different segments of the oviduct, we
progressively shortened the isthmus, ampulla or ampullary-isthmic junction.


Shortening or removal of the isthmus did decrease its transport
function without abolishing it. Shortening the ampulla very quickly
decreased the oviduct's transport function which was totally lost when more
than 60% of the ampulla was removed. The ampullary-isthmic junction did not
seem to be indispensable in normal ovum transport.

Sterilization
methods were checked for their reversibility. The Falope ring method has the
highest reversibility potentials due to its high pregnancy rate, nidation
index and very low postoperative adhesion rate when com­pared with the
electrocoagulation sterilization method.

Denervation of the oviduct
did not significantly decrease its function and an adequate fixation
technique was applied. To investigate the problems related with hydrosalpinx
we have developed a method for inducing a hydrosalpinx and its mucosal
lesions were analyzed. Different methods for salpingostomy were compared. An
anastomosis type salpingostomy had the best chances for maintaining its
patency.

When the oviduct was totally destroyed in vitro fertilization
being the ultimate solution to restore fertility, we evaluated a method of
ovarian transplantation into the groin allowing ovum pick up of mature ova
without the need of repeated laparoscopy. Using a peritoneal sac around the
ovary we were able to allow a normal ovulatory function without interference
by periovarian adhesions.

The results of our study have clearly shown
that reconstructive microsur­gery of the rabbit oviduct offers many
models to investigate clinical infertility problems.

Sterilization at
the mid-isthmus with a mechanical method (e.g. Falo-pe - ring) is the best
choice when a function retaining reanastomosis is our goal.Microsurgery has shown not to interfere with normal oviduct
physiology and therefore is preferred in infertility
surgery.