Honoré, G. M., Holden, A. E., & Schenken, R. S. (1999). Pathophysiology and management of proximal tubal blockage. Fertility and Sterility, 71(5), 785-795. https://doi.org/10.1016/s0015-0282(99)00014-x
Honoré GM, Holden AE, Schenken RS. Pathophysiology and management of proximal tubal blockage. Fertil Steril. 1999;71(5):785-795. doi:10.1016/s0015-0282(99)00014-x
Honoré, Gerard M., et al. "Pathophysiology and management of proximal tubal blockage." Fertility and Sterility, vol. 71, no. 5, 1999, pp. 785-795.
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RRM Academy Synopsis
Pooled studies link microsurgery to more pregnancies in blocked tubes
A 1999 review pooled past studies and found ongoing pregnancy in about 5 out of 10 women after microsurgery and about 2 out of 10 after older surgery. All had tubes blocked near the uterus. Tube cannulation through the cervix matched microsurgery in some studies.
Ongoing pregnancy: Microsurgery, 47.4 in 100; Macrosurgery, 22.1 in 100. Source: Honoré GM et al., 1999, PMID 10231034.Study at a glance, pooled past studies of 175 women: Microsurgery had more ongoing pregnancies than older surgery. Source: Honoré GM et al., 1999, PMID 10231034.
Key Findings
Microsurgery (175 women): 103 total pregnancies (58.9%) and 83 ongoing pregnancies (47.4%). Macrosurgery (104 women): 38 total (36.5%) and 23 ongoing (22.1%).
Ongoing pregnancy after microsurgery versus macrosurgery: relative risk 2.2 (95% CI 1.5-3.2). Total pregnancy in the same pooled comparison: relative risk 1.8 (95% CI 1.3-2.5).
Radiographic cannulation group 2 (163 women) had 39.3% total pregnancies. Microsurgery versus group 2: relative risk 1.5 (95% CI 1.2-1.9) for total pregnancy.
Radiographic group 1 (319 women) had 12.2% total pregnancies. The authors judged these series probably contaminated by confounding variables.
Hysteroscopic cannulation (133 women) had 48.9% total pregnancies. Against microsurgery the relative risk was 1.3 (95% CI 0.9-1.6), a nonsignificant difference.
Interpretation
This review pooled past studies because no randomized trials existed. The review compared microsurgery, macrosurgery, and tube cannulation done by x-ray or by hysteroscopy. All of these treat blockage near the uterus. The authors note that few studies reported live births. The findings support larger, randomized studies of these treatments.
RRM Context
The review lists causes of this blockage: scarring from infection, endometriosis, mucus plugs and spasm. Restorative reproductive medicine starts by finding the cause. Repair works on the tube itself. IVF goes around the tube without resolving why it is blocked.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To review the physiology, pathology, and treatment of proximal tubal disease.
Data Identification
Relevant reports on the pathophysiology of proximal tubal disease were reviewed. All studies in English of microsurgery and macrosurgery, and of radiographic and hysteroscopic cannulation in women with proximal tubal blockage were identified through MEDLINE searches.
Study Selection
All studies of therapy for proximal blockage that included pregnancy rates were considered. Series of sterilization reversals, series of unilateral or combined procedures, and series in which the location of tubal blockage was not given were excluded from the data analyses.
Data Analysis
Raw data were assessed for homogeneity, then standardized and pooled. Total and ongoing pregnancy rates after microsurgery and macrosurgery, as well as radiographic and hysteroscopic transcervical cannulation, were compared by the chi2 test. Relative risks for total and ongoing pregnancies were calculated for all treatment methods.
Results
This meta-analysis suggests that, overall, microsurgical anastomosis results in higher total and ongoing pregnancy rates than macrosurgery or radiographic tubal cannulation. However, pregnancy rates in selected series of transcervical tubal cannulation are similar to those reported for microsurgery.
Conclusions
Ongoing intrauterine pregnancy rates near 50% can be achieved in patients with proximal blockage of the fallopian tube. Selective salpingography and transcervical cannulation under fluoroscopic guidance are effective at establishing patency in appropriately selected patients and are less invasive and costly than the surgical alternatives.
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