Abstract
Objective: To evaluate the reproductive outcomes of infertile patients suffering from proximal tubal occlusion (PTO) following ultrasonography-guided hysteroscopic tubal catheterization (HTC). Materials and Methods: A retrospective cohort study of infertile patients who underwent ultrasonography-guided HTC in a tertiary hospital, between 2010 and 2016. All patients included were diagnosed with unilateral/bilateral PTO on hysterosalpingograpy (HSG). HTC was performed using a modified Novy cornual cannulation set which was inserted through a 5F working cannel during an office operative hysteroscopy, followed by fallopian tube irrigation with saline-air mixture under ultrasonographic imaging. Patients who did not conceive in the following 6-12 months were referred to IVF treatment. Results: Sixty-one patients were included. Tubal recanalization rate was achieved in 25/25 of unilaterally occluded tubes (100%), and in 63/72 of bilaterally occluded tubes (87.5%). Median duration of follow up after catheterization was 40.57 months. In a median of 3.5 months following the procedure, 16 (26.2%) patients conceived spontaneously (n=14) or following intrauterine insemination (n=2), 12 (19.6%) of them delivered . Twenty-two additional patients underwent IVF after a median of 11 months following HTC. Sixteen of them conceived following a median of two cycles, of whom 75% failed IVF treatment prior to HTC. Conclusion: Ultrasonography-guided HTC may form an acceptable treatment modality in cases of PTO. Further research is needed to investigate the role of HTC in cases of PTO and repeated implantation failure.
Highlights
Fallopian tube disease represents a common etiology for infertility
The reversibility of proximal tubal occlusion was shown to be attainable by various techniques of tubal recanalization performed under the guidance of fluoroscopy [2], ultrasonography [3], laparoscopy [4] or hysteroscopy [5]
Data was accessible for 61 of these patients, for whom proximal tubal occlusion was confirmed by hysteroscopy, using saline for tubal irrigation as previously described
Summary
Fallopian tube disease represents a common etiology for infertility. About 15% of cases can be attributed to proximal tubal occlusion [1], which may occur secondary to PID, previous pelvic surgery, endometriosis, and isthmic polyps. With the advent of IVF treatment, the use of tubal catheterization is quite diminished. This is well-reflected in the current literature, demonstrating scarce data on tubal catheterization, its applicability, and accompanied outcomes. In a recent study [7], the present authors presented an office procedure of hysteroscopic tubal catheterization under sonographic surveillance, which by itself allows the evaluation of both uterine cavity and tubal patency. In this study, they further report their experience with the procedure and its outcomes
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