Renaissance of surgical recanalization for proximal fallopian tubal occlusion:  falloposcopic tuboplasty as a promising therapeutic option in tubal infertility

Yudai Tanaka; Hiroto Tajima; Shino Sakuraba; Rise Shimokawa; Kazuhiko Kamei

doi:10.1016/j.jmig.2011.06.014

Reproductive Surgery Tubal Surgery

Renaissance of surgical recanalization for proximal fallopian tubal occlusion: falloposcopic tuboplasty as a promising therapeutic option in tubal infertility

Tanaka Y, Tajima H, Sakuraba S, Shimokawa R, Kamei K

Published August 30, 2011 Journal of Minimally Invasive Gynecology, 18(5), 651-659

DOI 10.1016/j.jmig.2011.06.014 PMID 21872171

RRM Academy Synopsis

Pregnancy followed falloposcopic tuboplasty in 91 of 304 women

A catheter procedure reopened blocked tubes in about 8 out of 10 women treated. This retrospective study reviewed records of 304 women with blocked tubes at one clinic in Japan. About 3 out of 10 of them became pregnant after the procedure.

Key Findings

Of 345 women with proximal tubal occlusion, 304 had falloposcopic tuboplasty. Recanalization succeeded in 248 women (81.6%).
Ninety-one of the 304 women (29.9%) became pregnant. Eighteen of the 91 (19.8%) miscarried, and four had an ectopic pregnancy located in the reopened tube.
Of the 91 pregnancies, 21 (23.1%) came in the month after the procedure, and 88% of pregnancies came within the first year.
Procedure-related complications occurred in 24 patients (7.9%), including catheter breakage (4.9%), falloposcope breakage (1.3%), tube perforation (1.3%) and one postsurgical infection (0.3%).
Pregnancy was more common with unilateral than bilateral occlusion (odds ratio 2.02, 95% CI 1.21–3.36). Mean age was 32.9 years in women who became pregnant and 35.3 in those who did not.

Interpretation

This retrospective cohort followed 304 women with blocked fallopian tubes treated with falloposcopic tuboplasty at one clinic in Japan. Recanalization succeeded in 81.6% of women, and 29.9% went on to become pregnant, most within the first year. The authors note that whether reopened tubes stay open over the long term remains unknown. The findings support larger studies of this restorative approach to tubal infertility.

RRM Context

Tubal blockage is one cause of infertility that a diagnostic evaluation can find. Restorative reproductive medicine aims to treat the cause, and this procedure aims to reopen the tube so conception can follow in an ordinary cycle. As of 2011 the authors report that the catheter system was supplied only to Japan, and a PubMed search found no articles on the procedure from the 2000s.

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

Abstract

Objective

To assess the clinical effectiveness of falloposcopic tuboplasty in tubal infertility.

Design

Retrospective cohort study (Canadian Task Force classification II-3).

Setting

Infertility clinic.

Patients

Three hundred forty-five infertile patients (≥2y) with a diagnosis of proximal tubal occlusion, either bilateral or unilateral, between January 2005 and January 2011.

Intervention

Falloposcopic tuboplasty.

Measurements and Main Results

Medical records for 345 patients with a diagnosis of proximal tubal occlusion were reviewed. Of the 345 patients, 304 underwent falloposcopic tuboplasty, with successful recanalization achieved in 248 patients (81.6%). Ninety-one of the 304 patients (29.9%) became pregnant. Of these, 18 patients (19.8%) miscarried, and 4 (4.4%) had ectopic pregnancies in the recanalized tube. At 1-, 3-, 6-, and 9-month follow-up, the cumulative probability of conception was 23.1%, 50.6%, 73.6%, and 82.4%, respectively. Related complications included postsurgical infection (0.3%), perforation of the fallopian tube (1.3%), and accidental breakage of the catheter (4.9%) or the falloposcope (1.3%).

Conclusions

Falloposcopic tuboplasty is safe and effective for treatment of tubal infertility. The pregnancy rate after falloposcopic tuboplasty is comparable to that after in vitro fertilization, which suggests that it can be an alternative to in vitro fertilization in women with tubal infertility.

Read the guide

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

Topics

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

Yudai Tanaka, Hiroto Tajima, Shino Sakuraba, Rise Shimokawa, Kazuhiko Kamei

Y Tanaka, H Tajima, S Sakuraba, R Shimokawa, K Kamei

PMID 21872171 21872171 DOI 10.1016/j.jmig.2011.06.014 10.1016/j.jmig.2011.06.014 Tanaka et al. 2011, Tanaka 2011

Renaissance of surgical recanalization for proximal fallopian tubal occlusion: falloposcopic tuboplasty as a promising therapeutic option in tubal infertility

Pregnancy followed falloposcopic tuboplasty in 91 of 304 women

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

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