Les obstructions tubaires distales sont aujourd’hui encore une cause fréquente d’infertilité. La prévalence estimée de l’infertilité tubaire est de l’ordre de 25 % dans les pays dits développés. Les principales causes d’altérations tubaires sont infectieuses (MST) et iatrogènes (postchirurgicales).
L’agent le plus souvent en cause dans de nombreux pays est Chlamydia trachomatis (CT). Son dépistage chez les femmes jeunes est une mesure préventive efficace. Le diagnostic des altérations tubaires repose essentiellement sur l’identification de certains antécédents, la sérologie de CT, l’hystérosalpingographie et l’échosonographie. L’endoscopie pelvienne est cependant la méthode de référence. Le traitement microchirurgical a été initié dans les années soixante-dix et est rapidement devenu le traitement de référence ; l’ensemble des principes de base de la chirurgie tubaire pour infertilité furent alors établis. Enfin, l’approche cœlioscopique a ouvert une alternative crédible, offrant des résultats comparable, mais une « agressivité » bien moindre. Diverses séries de traitement cœlioscopique des occlusions tubaires distales ont été publiées. Néanmoins, le nombre de cas est parfois limité, la sélection des cas opérés et la classification des lésions sont variables tout comme la méthode d’évaluation. C’est pourquoi nous avons décidé de publier une série continue de 434 cas pour réévaluer les principaux facteurs influençant les résultats et permettant de mieux identifier les cas où la chirurgie peut représenter une alternative possible à la FIV.
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Le point sur la stérilité tubaire distale en 2019
Aoû 07 2014 Rédaction-
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