Fallopian Tube Catheterization Research Articles

Impact of Endometriosis on the Therapeutic Effect of Hysteroscopic Fallopian Tube Catheterization Combined With Laparoscopy in Infertile Patients With Proximal Tubal Obstruction

To investigate the impact of endometriosis on the therapeutic effect of hysteroscopic fallopian tube catheterization combined with laparoscopy in infertile patients with proximal tubal obstruction. We conducted a retrospective analysis of patients who underwent hysteroscopic fallopian tube catheterization combined with laparoscopy for infertility caused by proximal fallopian tube obstruction between January 19, 2016 and March 20, 2020 at the Department of Reproductive Endocrinology, West China Second Hospital, Sichuan University. During the operation, hydrotubation was performed to verify whether there was proximal tubal obstruction. Then, the patients were categorized into an endometriosis group and a non-endometriosis group according to whether their proximal tubal obstruction was combined with endometriosis. The baseline data were balanced by propensity score matching and the rate of successful surgical unblocking of proximal tubal obstruction in infertile patients by hysteroscopic fallopian tube catheterization combined with laparoscopy was calculated. Treating cases lost to follow-up in both groups as non-pregnant cases according to the principle of intention-to-treat analysis, we followed up the pregnancy outcomes after surgery. The primary indicators included overall successful surgical unblocking rate, clinical pregnancy rate, and spontaneous pregnancy rate, while the secondary indicators included live birth rate, miscarriage rate, ectopic pregnancy rate, and the mean time to spontaneous pregnancy after surgery. The primary indicators included overall successful surgical unblocking rate, clinical pregnancy rate, and spontaneous conception rate, while the secondary indicators included live birth rate, miscarriage rate, ectopic pregnancy rate, and the mean time to spontaneous pregnancy after surgery. After propensity score matching, 113 cases were included in each of the two groups, with the overall successful surgical unblocking rate being 72.6%. The successful surgical unblocking rate of patients in the endometriosis group was higher than that of the non-endometriosis group, with the difference being statistically significant (78.8% vs. 66.4%, P<0.05). A total of 38 patients were lost after follow-up matching. Postoperative follow-up was performed to date and, through intention-to-treat analysis, the spontaneous conception rate was found to be higher in the endometriosis group than that in the non-endometriosis group (44.2% vs. 30.1%, P<0.05), while the mean time to spontaneous pregnancy after surgery was shorter in the endometriosis group than that in the non-endometriosis group (46 months vs. 53 months, P<0.05). There was no significant difference in clinical pregnancy rate, live birth rate, miscarriage rate, and ectopic pregnancy rate between the endometriosis group and the non-endometriosis group ( P>0.05). When infertility caused by proximal tubal obstruction is combined with endometriosis, performing hysteroscopic fallopian tube catheterization combined with laparoscopy contributes to the improvement of reproduction outcomes.

Fallopian tube catheterization in the treatment of proximal tubal obstruction: a systematic review and meta-analysis.

What is the chance of clinical pregnancy when fallopian tube catheterization is used for proximal tubal obstruction? The pooled clinical pregnancy rate of tubal catheterization after proximal tubal obstruction is 27% (95% CI 25-30%). Restoring fallopian tube patency by performing tubal catheterization has fallen out of favour since the increased availability of IVF. Our study is the first systematic review and meta-analysis to investigate reproductive outcomes following tubal catheterization for proximal tubal obstruction. We undertook a systematic review and meta-analysis of 27 observational studies consisting of 1720 patients undergoing tubal catheterization for proximal tubal obstruction, who attempted to conceive naturally after the procedure. Systematic literature searches were performed in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. A total of 2195 titles and abstracts were reviewed. Only studies that reported outcomes when tubal catheterization was performed with no other tubal surgery were included. Twenty-seven cohort studies matched the inclusion criteria for the meta-analysis. The meta-analysis showed a pooled clinical pregnancy rate of 27% (95% CI 25-30%) after the use of tubal catheterization for unilateral or bilateral proximal tubal obstruction (27 studies, 1556 patients). In women with bilateral obstruction (14 studies, 617 patients), the clinical pregnancy rate was 27% (95% CI 23-32%). Our meta-analysis demonstrated that the pooled cumulative clinical pregnancy rates were 22.3% (95% CI 17.8-27.8%) at 6 months, 25.8% (95% CI 21.1-31.5%) at 9 months, 26.4% (95% CI 23.0-30.2%) at 12 months, 26.0% (95% CI 22.8-29.7%) at 18 months, 27.0% (95% CI 24.0-30.5%) at 24 months, 27.9% (95% CI 24.9-31.3%) at 36 months and 28.5% (95% CI 25.5-31.8%) at 48 months. The pooled live birth rate (14 studies, 551 patients) was 22% (95% CI 18-26%). The pooled ectopic pregnancy rate (27 studies, 1556 patients) was 4% (95% CI 3-5%). The included studies scored satisfactorily on the Newcastle-Ottawa quality assessment scale. The pooled clinical pregnancy rate after tubal catheterization was found to be almost comparable to that after IVF. However, included studies were small, non-comparative series with significant clinical heterogeneity in population characteristics, follow-up and surgical equipment, technique and experience. These findings suggest fallopian tube catheterization as an alternative strategy to IVF in patients presenting with proximal tubal obstruction. Further research should focus on comparing different surgical techniques of fallopian tube catheterization with IVF and provide cumulative reproductive outcomes over long-term follow-up. No funding was required and the authors have no competing interests to declare. N/A.

Ultrasonography in Gynecology

Ultrasonography is the gold standard as a simple, safe, non-invasive, cost effective, reliable method in evaluation of gynecological diseases especially in infertility assessment and management. This unique new book “Ultrasonography in Gynecology” offers extensive coverage of technique of USG and comparison with other imaging technology and operative procedures. It highlights the importance of legal counseling and all benign and malignant gynecologic conditions with wonderful pictorial comparison of sonographic findings with actual pathologies. Intelligently selected topics in each section are comprehensive and cover all clinical aspects and different approaches in the ultrasonographic evaluation—including 3D ultrasonography, 3D sonohysterography, Doppler imaging, and pelvic floor imaging. The book is easy to read and the practical emphasis is reflected in the structure of the chapters. The fifth section of this book Ultrasonography in infertility is so detailed and that is why it is a must-read book for trainees, beginners, and also for practitioners in Infertility Gynecology and Radiology. “One Stop” fertility diagnosis and management is convenient and cost effective to patients. Every detail of sonologic assessment and management of an IVF cycle is written in the last fifteen chapters of this book. It explores the application of ultrasonography for determining ovarian reserves by 2D as well as 3D ultrasound, calculating ovarian volume using Virtual Organ Computer-aided Analysis (VOCAL) to obtain automated follicular measurement using a software program while monitoring follicular growth in oocyte retrieval and transabdominal as well as transvaginal embryo transfer. By describing ultrasound-guided fallopian tube catheterization, hysteroscopic myomectomy under ultrasound guidance, MRI-guided focused ultrasound, and percutaneous ultrasound-guided radiofrequency ablation, it emphasizes the therapeutic value of ultrasound in infertility. It introduces the concept of self-operated vaginal ultrasound as the future for monitoring follicular growth. There are certain chapters which are the highlight of this book like the chapter on Pelvic floor ultrasound which recommends the use of ultrasound as the method of choice for the assessment of pelvic organ prolapse most notably in the differential diagnosis of posterior compartment prolapse. The chapter is written in a very logical format where the functional assessments of the pelvic floor musculature, the imaging of anterior and posterior compartment, and diagnosis of their defects are made easy with the help of well-labeled high-resolution images to aid visual learning. The editorial team of two eminent editors Botros Rizk and Elizabeth Puscheck along with the world-renowned international contributors have combined their expertise and clinical experience to this outstanding book which is hugely referenced, comprehensive, and written step by step from the basic to most complicated case.

Fallopian tube catheterization.

Fallopian tube catheterization is used for treatment of infertility caused by proximal tubal occlusion, and has replaced surgical treatment for this condition. More recently, fallopian tube catheterization has been used for tubal sterilization. Interventional radiologists tested numerous methods for tubal occlusion using the rabbit as an animal model. As a result, a tubal device has recently been Food and Drug Administration approved for permanent sterilization using hysteroscopic guidance; it can also be placed fluoroscopically by fallopian tube catheterization as an "off-label" procedure. This is a 5-year continuation and update on a procedure that has been done by interventional radiologists for 25 years; history of the development of fallopian tube catheterization in women has been published in detail in this journal. Highlighted in this article will be description of the basic components needed for fallopian tube catheterization.

Fallopian tube catheterization.

The delicate fallopian tube is the anatomic pathway to human reproduction. Simple, inexpensive tools and techniques allow radiologists to access this structure for promoting, and preventing pregnancy. Results from centers worldwide have shown that catheter recanalization is possible in ~90% of women with proximal tubal occlusion using basic angiographic techniques familiar to all interventional radiologists. The American Society for Reproductive Medicine has recommended that patients in whom the hysterosalpingogram (HSG) demonstrates proximal tubal occlusion undergo fallopian tube catheterization with selective salpingography prior to more invasive and more costly infertility treatments. The pregnancy rate following fallopian tube recanalization is as high as 60% when the unblocked tubes are found to be normal and there is no history of tubal disease. In a population where the cause of infertility is less well-defined, tubal catheterization may not only help women conceive, but may also help to better define the underlying tubal abnormality. In the prevention of unwanted pregnancy, numerous materials and devices have been tested for blocking fallopian tubes. The ESSURE coil (Conceptus, Inc., Mountain View, CA) was FDA approved in 2002 for tubal sterilization by hysteroscopic placement. In some locales, radiologists are being asked to assist with this procedure or to place the coils fluoroscopically through fallopian tube catheterization.

Hystero-salpingography: An obituary or a new beginning.?

Hystero-salpingography: An obituary or a new beginning.?

Fluoroscopic guided fallopian tube recanalisation

Background: Fluoroscopic fallopian tube recanalisation is a procedure that relieves proximal fallopian tube obstruction with minimal trauma. Commercially available fallopian tube catheterization sets are costly and cumbersome to use. The modified technique used is easy, less traumatic and lessens the procedure and fluoroscopy time. Material and Methods: A headhunter catheter cut 40cm from its tip was introduced into the uterus under direct vision over a 0.035″ guide wire. A 50-cm headhunter 3F catheter was passed through tubal ostium. Microguide wire 0.018″ (Terumo) was passed into the fallopian tube. On successful recanalisation free peritoneal spill was seen in the peritoneum on injecting contrast through the microcatheter. Fluoroscopic guided fallopian tube recanalisation (FTR) was performed in 21 cases. Results: The procedure was successful with recanalisation of fallopian tubes in 15 cases. Pregnancy was seen in 3 cases (14.2%). Primary infertility was 71.4% and secondary infertility 28.6%. The mean time of the procedure was 21 minutes with a minimum of 10 minutes and maximum of 40 minutes. The fluoroscopy time was between 4 minutes to 20 minutes with a mean of 11 minutes. The patients who conceived had an average age of 28.2 years. Conclusion: The modified technique is simpler to perform with low cost, less trauma and procedure time with good results. This study highlights the need of using modified technique for ease of the procedure and reducing fluoroscopy time.

Efficacy ofFallopian tubecatheterization for treatment of infertility

Material and Methods: - Fluoroscopic transcervical fallopian tube catheterization was performed in two hundred and four patient with infertility in whom proximal tubal obstruction was documented by at least two hysterosalpingography procedures. Bilateral block in 147 and unilateral block was seen in 57 cases. All patients were submitted to selective salpingography, patients were followed up for six months at bimonthly interval. Results: - H.S.G revealed proximal tube obstruction in total of 264 tubes of these 258 tubes were successfully cannulated complete tubal patency was achieved in 249 cases. In 12 Cases recanalization was incomplete and hydrosalpinx was seen in 7 tubes. In six months follow up 72 out of 200 patients had pregnancy confirmed by material urine test for pregnancy and subsequent ultrasound examination. All pregnancies were intra uterine. Conclusion: - Fallopian tube catheterization is an effective procedure for infertility caused by proximal tubal obstruction.

Guided procedures using transvaginal sonography

AbstractTransvaginal sonography is indispensable for monitoring of follicular growth and is used for aspirating the follicular fluid for oocyte retrieval. Its use has improved the accuracy of embryo replacement into the uterus, or via the uterus, into the Fallopian tube and guidance of Fallopian-tube catheterization. Other ultrasonically guided procedures analyzed in this review article are aspiration of the ovarian cysts, drainage of cul-de-sac abscesses and selective reduction of multiple pregnancies. The advantages of ultrasonically guided transvaginal procedures are their performance under real-time imaging, relative simplicity, and low procedure-related complication rate. Most of these procedures can be performed in an office or emergency-room setting, but some require carefully monitored hospital protocols.

A review of selective salpingography and fallopian tube catheterization.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.

Hidden costs of infertility treatment in employee health benefits plans

Objectives: Many employers exclude infertility treatment from coverage under their health benefits plans. However, infertility treatment is often provided under other diagnoses or in association with therapy rendered for other disease processes. This study attempted to estimate those hidden costs and to determine what the impact would be of providing coverage for infertility treatment. Study Design: A 1-year retrospective analysis was carried out to isolate the hidden costs of infertility treatment from specific medical claims data gathered from a large representative employer with no infertility benefit provided. Data were analyzed in the context of the claims experience of a health plan covering approximately 28,000 employees. Infertility treatment was excluded under this plan. Medical claims for specific procedures and diagnoses in 1996 were analyzed by using Current Procedural Terminology codes in conjunction with International Classification of Diseases, Ninth Revision codes to estimate the hidden costs of infertility treatment. Forty-one Current Procedural Terminology codes and 68 International Classification of Diseases, Ninth Revision codes were used for the analysis. Clinical practice experience was used to set boundaries (conservative and moderate estimate) regarding the likelihood of a given treatment being associated with infertility. This was compared with 100% covered charges to generate claims per employee per month. Procedures covered operative, diagnostic, and laboratory services. These figures were used to compute a range of cost for infertility treatment per member per month. Results: Forty-one Current Procedural Terminology codes were identified that indicated possible infertility treatment. These covered the areas of laparoscopic and hysteroscopic surgery, lysis of adhesions, neosalpingostomy, cyst drainage, oocyte retrieval or embryo transfer, echography, and various hormonal analyses. Sixty-eight International Classification of Diseases, Ninth Revision codes indicated the possibility of infertility treatment. These included endocrine disorders, various uterine pathologic conditions, pelvic pain, endometriosis, pregnancy loss, irregular menses, and various ovulatory dysfunctions. The retrospective analysis found that 35 Current Procedural Terminology codes were involved in claims highly indicative of infertility services, such as 56353, hysteroscopic division of uterine septum, and 58345, transcervical fallopian tube catheterization. According to the 35 Current Procedural Terminology codes, $603,807.95 would have been paid if 100% of the charges had been covered; this would have resulted in a claim per employee per month of $1.12 by conservative estimate to $0.60 by moderate estimate. Computed cost figures per member per month showed the hidden costs of infertility to range between $0.27 and $0.50. Conclusion: On the basis of various cost studies, rate filings, and employee data, the cost of providing coverage for infertility treatment has previously been shown to vary between $0.20 and $2.00 per member per month. Through appropriate cost sharing, managed care, and algorithms, infertility coverage can be offered at a cost of $0.40 to $0.50 per member per month. This analysis indicates that at least some employers already pay this much even when infertility is specifically excluded under the plan. (Am J Obstet Gynecol 2000;182:891-5.)

Fallopian Tube Catheterization for Sterilization

Fallopian Tube Catheterization for Sterilization

Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction under simultaneous hysteroscopic and laparoscopic guidance

Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction under simultaneous hysteroscopic and laparoscopic guidance

Tubal obstruction after ligation reversal surgery: results of catheter recanalization.

To evaluate the role of transcervical fallopian tube catheterization in restoring tubal patency after ligation reversal surgery. Twenty-four women with tubal obstruction after ligation reversal surgery underwent selective salpingography and tubal recanalization. Patency was established in 26 (68%) of 38 anastomotic tubes without complication. In the 13 patients who were followed up and who could conceive only via a recanalized anastomotic tube, there were six (46%) pregnancies: two (15%) successful uterine pregnancies, two (15%) early spontaneous abortions, and two (15%) tubal pregnancies. The mean time from procedure to conception was 2 months. Patency of fallopian tubes not visualized at hysterosalpingography after ligation reversal surgery can be established 68% of the time with selective salpingography. In some patients, selective salpingography can be therapeutic. If subsequent conception occurs in these patients, it occurs shortly after the catheterization procedure.

Effects of fallopian tube catheterization on tubal health and function

Effects of fallopian tube catheterization on tubal health and function

Interventional radiology in the treatment of infertility: fallopian tube catheterization.

HomeRadioGraphicsVol. 18, No. 4 PreviousNext Interventional radiology in the treatment of infertility: fallopian tube catheterization.A S ThurmondA S ThurmondA S ThurmondPublished Online:Jul 1 1998https://doi.org/10.1148/radiographics.18.4.9672977MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1998 FiguresReferencesRelatedDetailsCited ByEndoscopic Microscopy X; and Optical Techniques in Pulmonary Medicine IIMelissa J.Suter, StephenLam, MatthewBrenner, Guillermo J.Tearney, Thomas D.Wang, Eric J.Seibel, C. DavidMelville, Richard S.Johnston, YuanzhengGong, KathyAgnew, SeineChiang, Elizabeth M.Swisher2015 | , Vol. 9304Physiologie, pathologie et thérapie de la reproduction chez l’humainH.Dechaud, J.-P.Rouanet, M.Viala Trentini, C.Dechanet2011Autofluorescence imaging can identify preinvasive or clinically occult lesions in fallopian tube epithelium: A promising step towards screening and early detectionJ.N.McAlpine, S.El Hallani, S.F.Lam, S.E.Kalloger, M.Luk, D.G.Huntsman, C.MacAulay, C.B.Gilks, D.M.Miller, P.M.Lane2011 | Gynecologic Oncology, Vol. 120, No. 3Hystérosalpingographie et cathétérisme sélectif des trompesM.De Graef, V.Juhan, Z.Kassem, R.Guillon, J.Villeval, A.Maubon, J.-P.Rouanet2006 | EMC - Radiologie et imagerie médicale - Génito-urinaire - Gynéco-obstétricale - Mammaire, Vol. 1, No. 1Hystérosalpingographie et cathétérisme sélectif des trompesM.De Graef, V.Juhan, Z.Kassem, R.Guillon, J.Villeval, A.Maubon, J.-P.Rouanet2005 | EMC - Radiologie, Vol. 2, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 18, No. 4 Metrics Altmetric Score PDF download

Ultrasound-guided fallopian tube cannulation using Albunex

Objective: To test the role of transcervical fallopian tube catheterization under ultrasound (US) guidance using an ultrasound contrast agent. Design: Catheterization was performed under US guidance in a patient with bilateral proximal tubal obstruction. Setting: This study is a case report. Patient(s): Proximal tubal obstruction had been diagnosed on previous roentgenogram hysterosalpingography. Intervention(s): Salpingography and tubal cannulation. Main Outcome Measure(s): Tubal patency was assessed using Albunex (Mallinckrodt Medical, St. Louis, MO) enhanced US. Result(s): Transvaginal catheterization was successful in achieving tubal patency. Conclusion(s): This catheterization technique should be investigated for possible use in the treatment of proximally obstructed tubes.

Tubal Sterilization by Means of Selective Catheterization: Comparison of a Hydrogel and a Collagen Glue

To test, in an animal model, two potentially suitable materials for nonsurgical selective tubal sterilization. A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed in four rabbit fallopian tubes, and a proprietary collagen glue was placed into three rabbit fallopian tubes by means of transvaginal fluoroscopic fallopian tube catheterization. As controls, 11 tubes were catheterized without sterilization material injection. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Histologic analysis was performed. The short-term contraception rate was 100% in the hydrogel group, 33% in the collagen glue group, and 0% in the control group (P < .001 hydrogel group, P not significant in collagen group). Inflammation was minimal in the three groups (P not significant). The collagen glue had an insufficient contraceptive effect and should be abandoned. The hydrogel used proved effective and biocompatible, and long-term studies of this compound are warranted.

Radiological evaluation of infertility

With unwanted infertility on the rise, the radiologist is becoming increasingly involved both in the diagnosis and treatment of these patients. Assessment of the six most common factors causing infertility should be performed during the initial clinical evaluation. These six factors include the cervical factor, endometrial-uterine factor, tubal factor, ovarian factor, peritoneal factor, and male factor. Each of these groups will be discussed in detail with special attention to optimal methods of diagnosis. Hysterosalpingography and ultrasound play the major roles in evaluation; however, there is an important emerging role for newer techniques such as MRI and selective fallopian tube catheterization.

Selective tubal sterilization in rabbits: experience with a hydrogel combined with a sclerosing agent.

To test a method of nonsurgical sterilization. A hydrogel that forms an in situ plug by phase inversion of a polymer solution was placed into fallopian tubes of eight rabbits by means of transvaginal rabbits by means of transvaginal fluoroscopic fallopian tube catheterization. The rabbits were bred, and the presence of embryos was confirmed with palpation and at autopsy. Seven of the eight rabbits became pregnant. Six of these rabbits contained embryos in the control uterus but not in the uterus on the side of the hydrogel injection. The seventh rabbit had embryos in both uteri, but the hydrogel had been expelled. All seven tubes that contained hydrogel showed evidence of acute and chronic salpingitis and a foreign-body reaction. The tube from which hydrogel had been expelled and the eight control tubes were not inflamed. Transcervical catheter methods of tubal occlusion and sterilization are promising, but a non-reactive material is needed.