546 Obstetrics and Gynecology Board Review •••
❍ What are the common histologic diagnoses in tubal occlusive disease?
(1) Obliterative luminal fibrosis.
(2) Salpingitis isthmica nodosa that is diverticulosis of the fallopian tube.
(3) Chronic inflammation.
(4) Intratubal endometriosis.
❍ Does assisted reproductive technology (ART) have the same outcomes compared with tubal reconstruction?
Yes. Advances in ART equal or exceed outcomes with tubal reconstruction.
❍ What are the poor prognostic factors for successful pregnancy in regard to tubal disease?
Tubal diameter >20 mm.
Absence of visible fimbriae.
Dense pelvic adhesions.
Ovarian adhesions.
Advanced age of male partner.
Duration of infertility problem.
❍ What is the treatment of endometriosis in the infertile patient?
Surgical removal/ablation of endometriomas/endometrial implants.
❍ Fecundability is highest up to how many months after the first surgery?
6 to 12 months.
❍ When there is documented ovulatory function, normal uterine cavity and patent tubes, as well as a normal
semen analysis, what are the most likely causes of occult infertility?
Abnormal gametes.
Abnormal implantation.
❍ What is the first-line treatment of unexplained infertility?
Ovulation induction and IUI; IUI alone demonstrates no significant improvement and Clomid alone demonstrates
no significant improvement. In cases refractory to Clomid and IUI, use gonadotropins and IUI.
❍ What is the most effective treatment of unexplained infertility?
IVF.
❍ What percentage of couples with unexplained infertility for <3 years duration will become pregnant with
3 years of expectant management?
60%.
❍ Is artificial/donor insemination first-line treatment of male factor infertility?
No! Artificial/donor insemination is now the treatment of last resort.