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Mechanical Infertility

The incidence of mechanical factor infertility ranges from 7 to 18%, with the variability mostly associated with the geography and developmental status of the country in which the study was performed. Investigation can be done using a variety of procedures, and the objective of the survey below is to share information on diagnostic procedures used.

What is your primary method of evaluating tubal patency?
  • Hysterosalpingogram
  • Hysterosalpingo-contrast-sonography
  • Diagnostic laparoscopy with chromopertubation
  • None of the above

 

Do you routinely evaluate tubal patency in every case of infertility?
  • Always
  • Only in patients with risk factors for tubal obstruction
  • Only in cases where there is no clear indication for IVF
  • I do not evaluate tubal patency

 

What is your primary method of evaluating the uterine cavity?
  • Hysterosalpingogram
  • Sonohysterogram
  • Pelvic sonogram
  • Hysteroscopy
  • 3-D ultrasound
  • Other

 

Do you perform reproductive surgery for patients with tubal obstruction?
  • Yes
  • No

 

In the presence of a uterine septum (>50% of the uterine cavity length) do you perform hysteroscopic excision before starting treatment.
  • Yes, in all cases
  • Not before a failed IVF attempt
  • In patients over 37 y-o before starting any treatment
  • In patients over 40 y-o before starting any treatment
  • Only with a history of miscarriages
  • None of the above

 

What is your preferred treatment for women with a history of bilateral tubal ligation who desire more children?
  • IVF always
  • Tubal reanastomosis surgery
  • Depends on patient's request
  • None of the above

 

In the case of hydrosalpinx observed during an US examination, what would be your first treatment option?
  • Antibiotics
  • Salpingectomy
  • Salpingostomy
  • Proximal tubal catheterization/ligation
  • Aspiration of fluid from the tube
  • Continue with stimulation with no intervention for at least one cycle
  • None of the above

 

For which patients preparing for IVF do you perform a salpingectomy or any other procedure to block tubes?
  • All patients with hydrosalpinx visible on US examination before any IVF attempt
  • Only patients with failed IVF and visible hydrosalpinx - on the US examination
  • In all cases with failed IVF and blocked tubes even though they are not visible on the US
  • None of the above

 

How do you manage patients undergoing IVF with an endometrioma smaller than 5 cm in diameter?
  • No special procedure
  • Aspirate the endometrioma before starting IVF
  • Aspirate the endometrioma at the time of egg retrieval
  • Ignore the endometrioma in an attempt to avoid puncturing it
  • Pharmacological treatment only
  • None of the above

 

How do you manage patients going through IVF with an endometrioma larger than 5 cm?
  • No special procedure
  • Laparoscopic excision before starting IVF
  • Aspirate the endometrioma before stating IVF
  • Aspirate the endometrioma at the time of egg retrieval
  • Ignore the endometrioma in an attempt to avoid puncturing it
  • Pharmacological treatment only
  • None of the above

 

If you perform laparoscopic surgery for infertility patients, what percentage of the time is it robotic-assisted?
  • None
  • Less than 5%
  • More than 20%

 

In light of the possibility of using a surrogate mother, do you think it is worthwhile to put efforts into developing a method of uterine transplant?
  • Yes
  • No