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Infertility · Tubal Factor

Conception rates after fluoroscopy-guided fallopian tubal cannulation: an alternative to in vitro fertilization for patients with tubal occlusion

Wang JW, Rustia GM, Wood-Molo M, Tasse J, Tabriz D, Turba UC, Arslan B, Madassery S

Published October 8, 2020 Therapeutic Advances in Reproductive Health
DOI 10.1177/2633494120954248 PMID 33103116 PMC PMC7549323

RRM Academy Synopsis

Tubal recanalization left 94% of treated fallopian tubes open

In a 24-year single-center case series of 160 patients, X-ray-guided tubal recanalization left 319 of 341 treated tubes open, or 94%. Among 48 cases in the pregnancy analysis, 17 conceived afterward.

Key Findings

  • Technical success was 94% (319 of 341 tubes): 98% (181 of 184) with contrast injection alone, 90% (122 of 135) with selective catheterization, and 73% (16 of 22) with microcatheter/microwire.
  • Overall tubal conception was 35% (17 of 48). Nine of the 17 (53%) became viable pregnancies, and six of those reached the second trimester.
  • Conception was 21% (5 of 24) after contrast alone, 39% (7 of 18) after catheterization, and 67% (4 of 6) with microcatheter/microwire. Adjusted for other causes, intervention level showed no significant link.
  • Cases with unilateral obstruction conceived at 41% (9 of 22). Cases with bilateral obstruction conceived at 19% (3 of 16). Significance was not calculated for this difference.
  • One distal end perforation occurred. Two pregnancies in an abnormal location needed medical management, one after IUI and one after IVF. The authors report no serious adverse events.

Interpretation

Researchers reviewed charts from one center. The study had no comparison group. The pregnancy figures come from 48 cases, a subset of the 160 patients. Many had other causes of infertility too. Couples tried different ways of conceiving afterward, and the authors did not control for them. About 10 of the 17 conceptions followed IUI only. The authors followed pregnancies to about 20 weeks, when obstetric care began.

RRM Context

Restorative reproductive medicine looks for the cause of infertility. A blocked tube is a structural cause with a known location, and recanalization works on that spot. IVF bypasses the tubes and leaves the blockage in place. The authors call for head-to-head comparisons of recanalization methods.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

Previous studies show good technical success rates for fallopian tube recanalization. Scarce literature exists regarding advance techniques currently used by interventional radiologists during fallopian tube recanalization procedures. This study investigates the level of intervention and tubal patency and its association with technical success and associated pregnancy outcomes.

Methods

We retrospectively evaluated fallopian tube recanalization procedures performed at a single center in a 24-year period. A total of 160 couples undergoing a basic infertility evaluation were included. Hysterosalpingography with high pressure contrast injection followed by selective contrast, guidewire catheterization at the tubal ostium, and/or microcatheter/microwire recanalization were performed. Comparisons of the tubal fertilization rate by relevant characteristics were tested for statistical significance with t tests for continuous data or with Pearson chi-square tests for categorical data.

Results

Technical success rate was 94% (319 of 341 tubes). High pressure contrast injection alone (184 of 341, 54%), selective catheterization (40%), and microcatheter/microwire (6%) interventions yielded technical success rates of 98%, 90%, and 73%, respectively. The overall rate of conception was 35% (17 of 48).

Conclusion

Current techniques of fallopian tube recanalization offer a desirable and safe option with high technical success for patients seeking treatment for infertility due to proximal fallopian tube obstruction.

Topics

Related research

Infertility › Tubal Factor › Selective Salpingography · Reproductive Surgery › Tubal Surgery › Tubal Cannulation
PMID 33103116 33103116 DOI 10.1177/2633494120954248 10.1177/2633494120954248 Wang et al. 2020, Wang 2020

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