Experience of 1000 falloposcopic tuboplasty (FT) cases: FT is a novel, patient friendly and effective regimen for tubal factor infertility before ART

Abstract

OBJECTIVE: Tubal factor is a major cause of female infertility. The narrowest portion of the fallopian tube, extending from uterotubal ostium to ampullary-isthmic junction, is vulnerable and often causes infertility by occlusion (Oc) or stenosis (St). FT is the procedure of transcervical balloon tuboplasty combined with retrograde imaging of endotubal lining and can be performed outpatient bases. Although ART has been used for tubal factor as standard treatment, we apply FT as an initial treatment. The present study was conducted to evaluate whether outpatient FT is effective to recover tubal patency and achieve pregnancy from our experience of 1000 cases. DESIGN: Retrospective study at private setting infertility clinic. MATERIALS AND METHODS: One thousand patients with tubal Oc and/or St either unilaterally or bilaterally diagnosed by hysterosalpingography were treated by FT from January, 2002 through June, 2007. Indications for FT were tubal lesions without hydrosalpinges. Severe male factor patients were excluded. FT were performed under uterine cervical block. Eversion balloon catheter of 6 cm was used to recanalize affected oviducts. It was considered successful when more than 5 cm of the balloon advanced from tubal ostium. Patients were followed by conventional infertility treatments such as timed intercourse or IUI for at least 6 months. Success of FT procedures and subsequent pregnancy were analyzed. RESULTS: Nine hundred eighty eight out of 1000 patients (98.8%) were treated successfully with FT. Overall pregnancy rate after FT was 27.1% (268/988). Twenty four point seven percent of patients (170/688) with bilateral tubal lesions (Oc&Oc;169pt., Oc&St; 217pt and St&St; 302pt.) and 34.8% of patients with unilateral tubal lesion (Oc;141pt. and St;140pt.) achieved pregnancy. Pregnancy and condition of tubal linings were as follows; post inflammation image: 25.3% (57/225pt.), adhesions: 31.6% (113/357pt.) and other abnormalities: 19.0% (111/583pt.). Six ectopic pregnancies (2.2%) took place. The pregnancy took place in 4 months and 23 days on average after FT. The average duration of infertility of pregnant patients was 3 years and 9 months. CONCLUSIONS: FT could be performed out patient bases and achieved acceptable pregnancy rate (27.1%) with reasonable ectopic rate for tubal factor infertility. Moreover, FT is not only bringing natural pregnancies, but also patient friendly procedure. The present study has proven that outpatient FT could be the first option for tubal factor infertility patients before IVF.