Selective Salpingography Research Articles

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

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

Diagnostic and therapeutic significance of selective salpingography in women with tubal blockage suspected by hysterosalpingography

Hysterosalpingography (HSG) is an essential way for the assessment of fallopian tubes. HSG sometimes may not determine whether tubal occlusion is due to tubal spasm or true anatomical blockage. In this study, we assess diagnostic and therapeutic effectiveness of selective salpingography (SSG) in infertile patients with tubal occlusion suspected by HSG.

Proximal tubal disease: the place for tubal cannulation

Tubal disease is the cause of subfertility in approximately 30% of women, and 10–25% of these are due to proximal tubal obstruction. False-positive diagnosis of proximal tubal obstruction can be as high as 50%. A decrease in expertise in tubal microsurgery has resulted largely from the use of IVF as the treatment option for most causes of infertility and more specifically for tubal factor infertility. Selective salpingography and tubal cannulation have a unique role in the management of tubal infertility and should be offered to selected candidates prior to IVF. Tubal cannulation can be used effectively to restore patency in a proportion of cases of proximal tubal obstruction thus avoiding the need for expensive assisted reproductive techniques. This review examines the evidence supporting the effectiveness of tubal cannulation and aims to enhance awareness of the procedure as an option for the management of female subfertility secondary to isolated proximal tubal obstruction.

Selective salpingography and fallopian tube recanalisation: Experience from a district general hospital

SummaryThe Royal College of Obstetricians and Gynaecologists has included selective salpingography and tubal catheterisation (SS-TC) in its evidence-based clinical guideline for the management of infertility in secondary care. In spite of being a cost-effective and minimally invasive treatment option for proximal tubal blockage, SS-TC has been slow to become adopted across the UK. We here describe our initial experience with setting up of tubal recanalisation service in a district general hospital (DGH) in the UK, along with our preliminary results. Tubal patency was achieved in 11 patients out of 14 who underwent SS-TC (78%). Four women achieved spontaneous pregnancy (success rate 28.57%) within 1 year of treatment. The procedure should become a universally accepted, taught and practiced approach in the diagnosis and treatment of the fallopian tube. Especially in infertility units located in a DGH it can be used selectively in the patients with good prognosis and other cases referred to tertiary center for more rapid in-vitro fertilisation (IVF).

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.

Hystérosalpingographie et cathétérisme sélectif des trompes

In 2003, the main indication of hysterosalpingography remains female infertility of tubal origin. Selective salpingography may be secondary to an hysterosalpingography that demonstrates a proximal tubal occlusion. Tubal catheterization can thus be undertaken in agreement with both the surgeon and the gynecologist. Hysterosalpingography brings decisive information for both the diagnosis, concerning the location and sometimes the cause of tubal obstruction, and the therapeutic management, since simple selective injection of contrast media may allow re-permeability of fallopian tubes. Tubal re-canalization is reserved to the failure of selective salpingography. Selective salpingography can be proposed as a first-line therapeutic procedure following hysterosalpingography, before more invasive methods (in vitro fertilization, tubal microsurgery).

The role of selective salpingography and tubal catheterization in the management of the infertile couple.

This review is intended to update the reader about recent developments in the field of selective salpingography and tubal catheterization, to offer an interpretation of the information presented and to suggest further research links. The measurement of tubal perfusion pressures at selective salpingography and tubal catheterization has offered a new dimension in the evaluation of the fallopian tube. A classification of infertile women based on tubal perfusion pressures is presented, and this is correlated with the possibility of spontaneous fertility, thus giving selective salpingography and tubal catheterization a prognostic profile in addition to diagnostic and therapeutic functions. Experience derived from the use of the technique in unselected infertile women (i.e. not with proximal tubal blockage) is presented. The use of selective tube catheterization for sterilization purposes joins the mainstream with the publication of the encouraging results of a multinational trial. The debate on the validity of the diagnosis of proximal tubal blockage is enriched by the suggestion that simply rotating the patient during hysterosalpingography will resolve most cases of the condition. The fertility gain by single-tube recanalization in women with unilateral proximal tubal blockage is given further support. The use of oil-based media for selective salpingography and tubal catheterization is discussed. A hypothesis on the pathophysiology of proximal tubal blockage is presented. The evidence clearly supports the use of selective salpingography and tubal catheterization for infertile women with proximal tubal blockage. The potential of the technique to play a wider role in the management of infertility is demonstrated by recent research.

Selective salpingography and tubal catheterisation in the diagnosis and treatment of proximal tubal blockage

Proximal tubal blockage arises from several pathological processes and is often a sole cause of infertility. It can be diagnosed and treated by selective salpingography and tubal catheterisation. In this paper, deficiencies of current methods of tubal assessment are discussed, compared with the relative advantages of selective salpingography and tubal catheterisation. The latter are outpatient procedures that have been shown to achieve successful fallopian tube recanalisation and pregnancies in women with infertility, without any other intervention. Another advantage of these techniques is the measurement of tubal perfusion pressure, which has a potential place in management of infertility. Finally, directions of current research into this developing subject are outlined.

Diagnostic and therapeutic value of selective salpingography and tubal catheterization in an unselected infertile population

Objective To present diagnostic findings and fertility outcome after selective salpingography and tubal catheterization in an unselected infertile population. Design Cohort study. Setting Tertiary reproductive medicine unit. Patient(s) One hundred ten consecutive infertile women. No exclusion criteria were applied. Follow-up ranged from 16 to 54 months. Intervention(s) Selective salpingography and tubal catheterization under fluoroscopic guidance as the primary test for the assessment of the fallopian tubes. Main outcome measure(s) Incidence of tubal disease at selective salpingography, therapeutic effectiveness of tubal catheterization, and fertility outcome after the procedure. Result(s) Tubal disease was present in 31.4% of the tubes examined. Of tubes proximally blocked at selective salpingography, 52.1% were found to be normal after tubal catheterization. Proximal tubal blockage (bilateral or unilateral) was detected in 34.8% of women. This was reduced to 5.5% after tubal catheterization. Spontaneous conceptions occurred in 21.9% of the women. In total, 36.2% conceived without IVF or ICSI. Conclusion(s) Selective salpingography and tubal catheterization can be useful as a primary tubal assessment tool in the investigation of infertility. In cases of proximal tubal blockage, an effective see-and-treat approach can be adopted. More research into the possible therapeutic benefits of the procedure is justified.

The potential value of tubal perfusion pressures measured during selective salpingography in predicting fertility.

The value of tubal perfusion pressures assessed during selective salpingography and tubal catheterization in predicting fertility has not been investigated. A total of 325 infertile women underwent selective salpingography and tubal catheterization. Pregnancy information was collected in 256 (78.7%). The 50th (300 mmHg) and 90th (500 mmHg) centiles of the tubal perfusion pressure distribution in women with normal tubes on selective salpingography were used as thresholds. Women were divided into three tubal perfusion pressure groups: good (both tubes <300, or one tube <300 and the other 300-500 mmHg), mediocre (both tubes 300-500, or one tube <300 and the other >500 mmHg) and poor (both tubes >500, or one tube > 500 and the other 300-500 mmHg). The pregnancy rate in the good perfusion pressure group was significantly higher than that in the poor perfusion pressure group, both when all non-IVF/ICSI first conceptions (P = 0.001) as well as when spontaneous first conceptions only were considered (P = 0.010). The pregnancy rate in the mediocre group lay between the good and the poor groups, though none of the comparisons reached statistical significance. Selective salpingography can provide additional diagnostic information in comparison with other tubal assessment tests. Tubal perfusion pressures may be predictive of future fertility.

Modification of the coaxial technique for selective salpingography with measurement of tubal perfusion pressures

This article describes the use of the fallopotorque catheter system for transcervical selective salpingography and tubal catheterization under fluoroscopic guidance for the diagnosis and treatment of obstruction of the proximal Fallopian tube. The technique of tubal perfusion pressure assessment during the procedure, using the same catheter system, is also described. The relative advantages of this method of selective salpingography and tubal catheterization are then discussed in the background of previously described techniques.

Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage

Objective: The possibility of a conception following selective salpingography and tubal catheterization under fluoroscopic guidance is believed to decline sharply a few months following the procedure. However, this observation may be due to the relatively small number of patients and short follow up periods in previous studies. Our objective was to investigate the issue further.Design: Cohort StudyMaterials/Methods: Survival analysis of conceptions of 218 consecutive infertile women with proximal tubal blockage who underwent selective salpingography and tubal catheterization. No exclusion criteria were applied. Follow up ranged from 16 to 56 months.Results: 47.2% of spontaneous conceptions and 43.2% of all conceptions apart from those achieved by IVF or ICSI treatments, occurred after the first 12 months following selective salpingography and tubal catheterization. The decline in the possibility of pregnancy during the study period (conception hazard rate) was only minimal (Figure). Conclusions: In a population of infertile women with proximal tubal blockage, a significant proportion of conceptions occur after the first twelve months following selective salpingography and tubal catheterization. The presence of any causes of infertility in addition to proximal tubal blockage should not necessarily be regarded as an absolute contraindication to the procedure.Supported by: No support. Objective: The possibility of a conception following selective salpingography and tubal catheterization under fluoroscopic guidance is believed to decline sharply a few months following the procedure. However, this observation may be due to the relatively small number of patients and short follow up periods in previous studies. Our objective was to investigate the issue further. Design: Cohort Study Materials/Methods: Survival analysis of conceptions of 218 consecutive infertile women with proximal tubal blockage who underwent selective salpingography and tubal catheterization. No exclusion criteria were applied. Follow up ranged from 16 to 56 months. Results: 47.2% of spontaneous conceptions and 43.2% of all conceptions apart from those achieved by IVF or ICSI treatments, occurred after the first 12 months following selective salpingography and tubal catheterization. The decline in the possibility of pregnancy during the study period (conception hazard rate) was only minimal (Figure). Conclusions: In a population of infertile women with proximal tubal blockage, a significant proportion of conceptions occur after the first twelve months following selective salpingography and tubal catheterization. The presence of any causes of infertility in addition to proximal tubal blockage should not necessarily be regarded as an absolute contraindication to the procedure. Supported by: No support.

Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage.

The possibility of conception following selective salpingography and tubal catheterization is believed to decline sharply a few months after the procedure. This observation may be due to the relatively small number of patients and short follow-up of previous studies. Furthermore, couples with other causes of infertility apart from proximal tubal blockage have usually been excluded. Survival analysis of conceptions of 218 consecutive infertile women with proximal tubal blockage who underwent selective salpingography and tubal catheterization was performed. There were no exclusion criteria. Follow-up ranged from 16 to 56 months. A total of 47.2% of spontaneous conceptions and 43.2% of all conceptions, apart from those achieved by IVF or ICSI treatments, occurred after the first 12 months following selective salpingography and tubal catheterization. The decline in the possibility of pregnancy during the study period (conception hazard rate) was only minimal. In a population of infertile women with proximal tubal blockage, a significant proportion of conceptions occur after the first 12 months following selective salpingography and tubal catheterization. The presence of any additional causes of infertility in the couple should not be regarded as an absolute contraindication to the procedure.

The effect on pregnancy rates of tubal perfusion pressure reductions achieved by guide-wire tubal catheterization.

Selective salpingography enables us to measure the Fallopian tube perfusion pressure which, when high, can be effectively reduced with the use of transcervical guide-wire tubal catheterization. Whether fertility prognosis improves as a result is currently unknown. Our objective was to clarify the issue. Infertile women undergoing selective salpingography were classified into poor, mediocre and good tubal perfusion pressure groups, based on the distribution of tubal perfusion pressures in an unselected infertile population. Of 325 women, 150 (46.1%) were classified in the poor group and underwent guide-wire tubal catheterization. Complete pregnancy and tubal perfusion pressure data were available for 104 (69.4%) subjects. Following tubal catheterization, 29 women (group A) could be classified in the good, 25 (group B) in the mediocre, while 50 women (group C) remained in the poor tubal perfusion pressure group. Survival analysis showed that the pregnancy rate in group A was significantly higher than the rates in groups B and C (P = 0.036 and 0.005 respectively). Reductions of tubal perfusion pressures achieved with transcervical guide-wire tubal catheterization resulted in an improved fertility prognosis for women. Selective salpingography and tubal catheterization might have a wider role in the management of the infertile couple than currently believed.

The learning curve of selective salpingography and tubal catheterization

Objective: To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure. Design: Retrospective case note analysis. Setting: IVF center of an academic teaching hospital . Patients: Three hundred sixty-six patients with infertility seen over 3.5 years. Intervention(s): Fluoroscopically guided selective salpingography and tubal catheterization. Main Outcome Measure(s): Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures. Result(s): During the study period, The median dose of radiation decreased by 62.6%–71.9%, and the median screening time declined by 61.5%–78.5%. Reductions per 10 procedures were 2.5%–4.2% and 2.7%–5%, respectively. Conclusion(s): Significant reductions in radiation doses and screening times start early in a clinical team’s practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators.

Long term safety of fluoroscopically guided selective salpingography and tubal catheterization.

The irradiation of the ovaries of reproductive age women during fluoroscopically guided selective salpingography and tubal catheterization has raised concern about the safety of the procedure. In addition to the risk of cancer induction, which exists with the irradiation of all tissues, with the gonads, the induction of hereditary disorders is possible. The objective of this study was to estimate these risks and present them in a clinically meaningful way. Retrospective analysis was undertaken of 366 consecutive cases of selective salpingography and tubal catheterization performed at the Birmingham Women's Hospital, UK. The radiation doses of different types of procedure were compared with the background annual radiation dose. The risks of cancer and genetic disorders induction were calculated using conversion coefficients published by the International Commission on Radiological Protection. The radiation dose women were exposed to during selective salpingography and tubal catheterization under fluoroscopic guidance was a fraction of the background annual radiation dose. The excess lifetime risks of cancer and hereditary disorders were in the order of four to 13 and two to six per million procedures respectively. The long term risks of selective salpingography and tubal catheterization under fluoroscopic guidance are low.

Survival analysis of conception rates after selective salpingography and tubal catheterization.

Objective: Selective salpingography and tubal catheterization under fluoroscopic guidance (SS/TC) are trancervical methods effective, in cases of proximal tubal obstruction (PTO), in achieving tubal re-canalization and restoring fertility. The likelihood of conception as a function of time after SS/TC has not been reported and was the objective of this study.

Use of Ethylene Vinyl Alcohol Copolymer for Tubal Sterilization by Selective Catheterization in Rabbits

To assess the efficacy of ethylene vinyl alcohol copolymer (Uryx) in nonsurgically occluding the fallopian tube and achieving tubal sterilization in the rabbit model. Ten mature virgin female New England rabbits underwent transvaginal selective bilateral fallopian tube cannulation with use of a coaxial catheter system under general anesthesia. Selective salpingography was performed bilaterally to assess patency of the fallopian tubes. Ethylene vinyl alcohol copolymer was injected unilaterally through a microcatheter to completely fill the middle portion of the tube. Three to seven days after injection, each animal was bred. Conception was determined by ultrasonography (US) 7-19 days after effective breeding. If pregnant, the rabbit was killed. Otherwise, it was permitted to rebreed until pregnancy was achieved. Histologic specimens of the fallopian tubes were prepared and analyzed. Patency of the fallopian tubes was demonstrated bilaterally in all animals by the free spillage of contrast material into the peritoneum. The delivery of ethylene vinyl alcohol copolymer into the fallopian tubes was successful in all animals but one, in which most of the plug almost immediately extruded into the uterus. Pregnancy was detected by US in the untreated fallopian tube in the nine rabbits that were receptive to breeding. No pregnancies were detected in the injected side. Histologic analysis demonstrated variable degrees of occlusion, fibrosis, and inflammation, with the majority of specimens demonstrating mild to moderate inflammation and moderate to marked fibrosis. Ethylene vinyl alcohol copolymer can reliably be placed nonsurgically via the transvaginal approach into the fallopian tubes with use of a coaxial catheter system. Ethylene vinyl alcohol copolymer appears to result in less fibrosis than previously investigated agents and demonstrates a 100% early sterilization rate in the rabbit model.

Interventional radiology in female infertility: technique and role.

The purpose of this paper is to describe the modifications in the radiologic approach to female infertility. The role of hysterosalpingography (HSG) has evolved from being the only source of information about the uterus to a more minor role, after ultrasound, that essentially deals with the morphology of the fallopian tubes. But if its diagnostic yield in the uterus is challenged by ultrasound and hysterosonography, it retains a major impact in the work-up of female infertility. Hysterosalpingography brings decisive diagnostic information concerning the state of the tubes and peritoneum. The interventional procedures of selective salpingography and tubal recanalization have a definite therapeutic effect and allow numerous pregnancies that would otherwise have required in vitro fertilization or tubal microsurgery.

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.