Successful pregnancy after office microlaparoscopic correction of tubal herneation for a very rare congenital fimbrial-ovarian relationship, a case report *

At the moment of ovulation the follicular fluid and the cumulus oophorus are released from the follicular environment. How the cumulus oophorus is picked up by the fimbriae in the human is unknown. Studies in rabbits have suggested that ova could be ‘sucked’ into the oviduct, a theory that was further supported by the report of a negative pressure caused by tubal contractions 1, 2 and 3. This was refuted, however, by experiments in which oviducts were ligated at the base of the fimbriae and contractibility was blocked by propanol (4). In women, Edwards and Steptoe (1975) observed at laparoscopy that blood vessels in the fimbriae became engorged at ovulation to form a type of erectile tissue and that extensions from the fimbriae became arranged over the ovulating follicle. They suggested that ovum retrieval is controlled by muscular contractions 5, 6 and 7.The precise process of the entrapment of the oocyte by the fimbriae at the moment of its release has to the best of our knowledge never been observed in vivo in the human. Therefore laparoscopic manipulation is required to expose the full ovarian surface and the fimbriae, which are usually lying in the fossa ovarica in contact with the caudal pole of the ovary 8, 9 and 10.The process of ovum retrieval by the fimbriae in the human still remains elusive. Animal studies have suggested that ova can be ’sucked’ into the oviduct by negative pressure caused by muscular contractions of the tube, while laparoscopic observations in women have indicated a close relationship between fimbriae and the ovulating ovary 11 and 12.Here, a case is described in which a very rare congenital tubo-ovarian relationship had been observed and assessed during routine laparoscopy to discover the cause of delayed conception after previous spontaneous pregnancy. This very rare tubo-ovarian relationship had been observed directly using a newly advanced fiber optic 2 mm microlaparoscopic set, in an office procedure under augmented local anesthesia in stead of the conventional 10 mm laparoscopy.