Histology of proximal tubal occlusion

Patricia J. Sulak; Gerard S. Letterie; Charles C. Coddington; Clifford C. Hayslip; Joan E. Woodward; Thomas A. Klein

doi:10.1016/s0015-0282(16)59413-8

Infertility Tubal Factor

Histology of proximal tubal occlusion

Sulak PJ, Letterie GS, Coddington CC, Hayslip CC, Woodward JE, Klein TA

Published September 1987 Fertility and Sterility, 48(3), 437-440

DOI 10.1016/s0015-0282(16)59413-8 PMID 2957237

RRM Academy Synopsis

Proximal tubal blockage was documented on histology in 7 of 18 women

In a 1987 Walter Reed case series of women with proximal tubal obstruction, histology documented tubal blockage in only 7 out of 18 women. Surgeons removed the blocked tube segment for study under the microscope. Six women had tubal material of unknown cause that appeared to form a cast.

Key Findings

Histology documented tubal occlusion in 7 of the 18 women. The cause was fibrous obliteration in some women and salpingitis isthmica nodosum in others.
In 11 of the 18 women, histology could not show any tubal occlusion. Three had completely normal tubes, and 8 had open tubes with an abnormality such as fibrosis or inflammation.
In 6 of the 18 women, amorphous material in the tubal lumen appeared to form a cast. In 2 cases the staining pattern was diagnostic of calcification.
All 6 of these women also showed fibrosis or inflammation of the tube on histology. The tube was occluded in 3 of them and apparently open in the other 3.
The women were 22 to 34 years old (mean 27.4). Fourteen had secondary infertility and 4 had primary infertility. Infertility had lasted 4.2 years on average.

Interpretation

This retrospective case series comes from one U.S. Army medical center. The 18 tube segments studied all came from women whose blockage held up through repeated dye testing at surgery. Doctors did not see the amorphous material in tubes removed at hysterectomy from women with no history of pelvic inflammation or infertility. The pattern points to a link with pelvic disease. The authors note that how common these tubal casts are, and what they mean clinically, remains speculative. The findings support larger studies of this material as a possible, treatable cause of tubal blockage.

RRM Context

Restorative reproductive medicine looks for the cause of infertility in both partners. The authors went on to try a more direct way to relieve the apparent blockage. They applied more pressure at the opening of the tube into the uterus. They describe two patients in a separate article.

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

Abstract

From 1979 to 1985, 18 patients who were found to have proximal tubal obstruction by hysterosalpingography and laparoscopic chromopertubation underwent resection of the obstructed tubal segment and reimplantation or microanastomosis. Resected tubal segments were studied histologically, and in 11 of the 18 cases no tubal occlusion could be demonstrated. A variety of histologic abnormalities were noted, however, including six cases in which the tubal lumen contained an amorphous material of unknown etiology, often appearing to form a cast of the tube. Such "plugs," which the authors believe to be previously unreported, have no clearly established clinical significance at present. However, if they cause tubal occlusion, this would explain several previously published findings, and would also have implications for therapy.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.

12 min read

Topics

Infertility › Tubal Factor › Proximal Tubal Obstruction · Reproductive Surgery › Tubal Surgery › Tubal Anastomosis

Patricia J. Sulak, Gerard S. Letterie, Charles C. Coddington, Clifford C. Hayslip, Joan E. Woodward, Thomas A. Klein

Pat Sulak, Trish Sulak, P Sulak, G Letterie, Charlie Coddington, Chuck Coddington, C Coddington, C Hayslip, J Woodward, Tom Klein, T Klein

PMID 2957237 2957237 DOI 10.1016/s0015-0282(16)59413-8 10.1016/s0015-0282(16)59413-8 Sulak et al. 1987, Sulak 1987

Keywords

Adult, Fallopian Tube Diseases/pathology/surgery, Female, Humans, Hysterosalpingography, Infertility, Female/pathology/surgery, Laparoscopy

Histology of proximal tubal occlusion

Proximal tubal blockage was documented on histology in 7 of 18 women

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

By this author

Sexually transmitted diseases

Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization

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Proximal tubal disease: the place for tubal cannulation

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Pathophysiology and management of proximal tubal blockage

Keywords