Fallopian Tube Recanalization (Cannulation)

Fallopian tube recanalization (tubal cannulation) is a brief procedure that opens a fallopian tube blocked near the uterus. A thin, flexible tube (catheter) passes through the cervix and the uterine cavity, then into the blocked tube. The clinician guides the catheter with live X-ray (fluoroscopy) or a narrow camera (hysteroscopy). A proximal blockage sits where the tube joins the uterus. It differs from a blockage at the far end of the tube. Many proximal blockages are plugs of mucus or loose debris. A true blockage can result from scarring. It can also result from salpingitis isthmica nodosa (SIN), a condition in which small nodules thicken the narrow part of the tube. SIN lowers the chance that the procedure will open the tube.¹ Many blockages seen on an HSG dye test are not true blockages. This procedure often clears them in one outpatient visit, without surgery.

The procedure uses selective salpingography, a dye X-ray of one tube at a time. The clinician guides the catheter to the opening of the blocked tube. Dye enters under pressure to show the location of the blockage. A thin guide wire or small catheter then passes through the blockage to open it. Measurement of the pressure inside the tube (intratubal pressure) before and after shows whether the tube is now open.¹ With a camera in the uterus, the clinician can see the tube opening directly. With X-ray guidance in an imaging suite, the procedure can take place without general anesthesia.

Proximal blockages account for a meaningful share of tubal-factor infertility. For this reason, the procedure matters as a restorative option. It avoids the risks of open surgery to rejoin the tube. It preserves the tube, so the couple can try to conceive naturally afterward. A tube can block again. After a healing period, a repeat HSG or a contrast ultrasound of the tubes (HyCoSy) confirms that the tube remains open. This check belongs before any conclusion that the tubes cause ongoing infertility.