Outpatient falloposcopic tuboplasty (FT) should be an initial regimen for tubal factor infertility due to tubal lumen lesions before in vitro fertilization (IVF)

Abstract

Objective: Tubal factor is a major cause of female infertility. The narrowest portion of the human fallopian tube, extending from the uterotubal ostium to the ampullary-isthmic junction is vulnerable to pathogenic organisms and often become stenotic or occlusive. However, this portion is difficult to treat and recently IVF has been the standard treatment option for its lesion. Falloposcopic tuboplasty is the procedure of transcervical balloon tuboplasty combined with retrograde observation of endotubal lining. This is usually performed under concomitant laparoscopic observation. The present study was conducted to determine whether outpatient FT without laparoscopy is effective to re-establish tubal patency and lead to pregnancy. Design: Forty treatment cycles (39 patients) with unilateral or bilateral tubal stenosis and/or occlusion confirmed by hysterosalpingogram were studied. FT on outpatient basis was performed from April through December 2001. Re-canalization of the affected tubes and pregnancy outcomes were analyzed. Materials/Methods: Indications for FT are the patients with tubal lesions without hydrosalpinges. Severe male factor patients who need ICSI were excluded. Outpatient FT treatments were performed under light sedation between menstrual cycle day 5 and 14. It was considered successful when more than 10 cm of the balloon advanced into the tubes. More than 5 cm was considered fair. Those patients were followed prospectively after FT for at least 3 months to see if pregnancy occurred by timed intercourse or IUI. Results: A total of 62 tubes (38 occluded and 24 stenosis) were treated by FT. Fifty six tubes (90.3%) were re-canalized successfully. Three tubes (4.8%) were fairly re-canalized and 3 tubes (4.8%) were unsuccessful. Eleven clinical pregnancies (27.5%) were achieved 3 months in average after FT treatment and two of them were ectopic pregnancies (18.2%). Pregnancy rate of the patients with tubes bilaterally affected was significantly higher compared to the patients with tubes unilaterally affected (39.1% versus 11.8%, p <0.05). Their average infertile periods were 5 years and 3 months. Conclusions: IVF is a present first choice for tubal factor infertility, but IVF is still stressful economically and physically. On the other hand, pregnancies achieved by using fallopian tubes are not only inexpensive, but also easy for the patients from all aspects. Outpatient FT obtained acceptable pregnancy rate (27.5%) for tubal infertility especially for the patients with bilateral tubal lesions (39.1%). The present study suggests that outpatient FT could be a first option of treatments for tubal factor infertility. Outpatient FT has potential medical as well as economical advantages over surgical treatments and over IVF. Supported by: None.