Roberts, A. (2023). Fallopian tube recanalization for the management of infertility. CVIR Endovascular, 6(1), 13. https://doi.org/10.1186/s42155-023-00356-z
Roberts A. Fallopian tube recanalization for the management of infertility. CVIR Endovasc. 2023;6(1):13. doi:10.1186/s42155-023-00356-z
Roberts, Anne. "Fallopian tube recanalization for the management of infertility." CVIR Endovascular, vol. 6, no. 1, 2023, pp. 13.
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Tube recanalization reopens 70 to 100% of proximally blocked tubes
A 2023 review reports that recanalization reopened 70 to 100% of blocked tubes near the uterus. Reported pregnancy rates averaged about 3 out of 10 women. In the one prospective study, 41% of 61 women conceived within a year.
Key Findings
The review reports a technical success rate of 70–100% for transcervical fallopian tube recanalization (FTR).
Reported intrauterine pregnancy rates ranged from 20–60%, with an average of 30%.
In one prospective study of 61 women with tubal occlusion, followed for up to 1 year, 41% of the women had conceived.
Tubal patency at 6–12 months following FTR ranged from 40 to 72%.
Tubal perforation, infection and ectopic pregnancy were reported in 1–9%. Perforation occurred in approximately 2% and ectopic pregnancy in approximately 3%.
Interpretation
This narrative review examined reports on fallopian tube recanalization (FTR) for tubal infertility. Blockages far from the uterus were harder to reopen and had lower pregnancy rates than blockages near the uterus. The author recommends FTR as a first line therapy, citing an ASRM recommendation to try it before more invasive treatments. The authors note that follow-up data on pregnancy outcomes was incomplete in some of the reviewed reports. The findings support larger studies of this approach.
RRM Context
Selective salpingography looks inside a blocked tube and tries to open it. The blockage gets a diagnosis and a direct fix. A tubal cause makes the label unexplained infertility inapplicable. IVF goes around blocked tubes and leaves the blockage in place. Restorative reproductive medicine asks first why the tube is blocked.
Our editorial summary of this paper, not the article's abstract.
Abstract
Infertility is a world-wide problem, defined as failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. There are multiple causes for infertility involving both male and female factors. Fallopian tube occlusion is a common reason for female infertility. The initial attempts to treat proximal obstruction involved the use of a whalebone bougie positioned in the uterine cornua to dilate the proximal tube by Smith as early as 1849. Fluoroscopic fallopian tube recanalization for the treatment of infertility was first described in 1985. Since that time, there have been over 100 papers describing various methods for recanalization of occluded fallopian tubes. Fallopian tube recanalization is a minimally invasive procedure which is performed on an outpatient basis. It should be a first line therapy for patients with proximal occlusion of fallopian tubes.
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