# Natural Conception After Tubal Reconstruction: A Rare Success Following Bilateral Fimbrioplasty for Post-pelvic Inflammatory Disease Occlusion

## TL;DR

A woman with infertility due to pelvic inflammatory disease successfully conceived naturally after a surgical procedure to repair her fallopian tubes.

## Contribution

This case demonstrates that tubal reconstructive surgery can lead to natural conception in selected patients with mild tubal damage.

## Key findings

- The patient achieved spontaneous conception 10 weeks after bilateral fimbrioplasty.
- Tubal reconstructive surgery remains a viable fertility option for patients with minimal tubal damage.
- Robotic fimbrioplasty restored tubal patency and enabled natural pregnancy.

## Abstract

Pelvic inflammatory disease (PID) remains a major cause of tubal factor infertility. Although in vitro fertilization (IVF) has largely replaced reconstructive surgery, selected patients with mild tubal damage may still achieve natural conception after surgical repair. This case highlights a spontaneous conception following bilateral fimbrioplasty in a patient with mild post-PID distal tubal occlusion.

A 33-year-old, gravida 4 para 2, woman presented with three years of secondary infertility. Hysterosalpingogram (HSG) showed mild bilateral hydrosalpinx and distal tubal occlusion, with normal ovarian reserve and hormonal evaluation. The patient underwent robotic fimbrioplasty on July 23, 2025. Operative findings included Fitz-Hugh-Curtis changes, bilateral filmy adhesions, and grade-I distal occlusion. Bilateral adhesiolysis and fimbrioplasty were performed with restoration of tubal patency on chromotubation. The postoperative course was uncomplicated. Ten weeks after surgery, the patient conceived spontaneously with a normal intrauterine pregnancy. Tubal reconstructive surgery remains a valuable fertility-preserving option for selected patients who decline or lack access to IVF. Success depends on careful patient selection, minimal tubal damage, and meticulous microsurgical technique.

Tubal reconstruction can offer selected women an affordable, fertility-preserving option, especially in low-resource settings where IVF is inaccessible.